Prediabetes

Diagnosis  

When to begin screening: Diabetes screening for adults typically begins at age 35 but should commence earlier if you’re overweight with added diabetes risk factors. Additionally, individuals with a history of gestational diabetes should undergo screening at least once every three years.

Types of blood tests for prediabetes: 

• Glycated hemoglobin (A1C) test: The glycated hemoglobin (A1C) test assesses your average blood sugar levels over a 2–3 month period. The interpretation of the results is as follows: an A1C level below 5.7% is considered normal, while a range of 5.7% to 6.4% indicates prediabetes, and an A1C measurement of 6.5% or higher on two separate tests signifies diabetes. It’s important to note that certain conditions, such as pregnancy or the presence of unusual forms of hemoglobin, can potentially affect the accuracy of the A1C test. 
• Fasting blood sugar test: The fasting blood sugar test, performed following an overnight fast of at least 8 hours, provides results in either mg/dL or mmol/L units. Interpretation of the results is as follows: blood sugar levels below 100 mg/dL (5.6 mmol/L) are considered normal, readings falling between 100 to 125 mg/dL (5.6 to 6.9 mmol/L) indicate prediabetes, and a measurement of 126 mg/dL (7.0 mmol/L) or higher on two separate tests signifies diabetes. 
• Oral glucose tolerance test: The oral glucose tolerance test, less commonly employed except during pregnancy, involves an overnight fast followed by the consumption of a sugary solution. Over the course of two hours, blood sugar levels are periodically monitored. Interpretation of the results is as follows: blood sugar levels less than 140 mg/dL (7.8 mmol/L) are considered normal, levels ranging from 140 to 199 mg/dL (7.8 to 11.0 mmol/L) indicate prediabetes, and a reading of 200 mg/dL (11.1 mmol/L) or higher after the two–hour period suggests diabetes.

Monitoring for prediabetes: If you have prediabetes, get your blood sugar levels checked at least once a year. 

Prediabetes testing for children: Children are also at risk of diabetes due to increasing rates of childhood obesity. It is advisable to conduct testing for overweight or obese children who possess additional risk factors such as a family history of diabetes, specific racial backgrounds, low birth weight, or exposure to gestational diabetes during pregnancy. The blood sugar ranges for normal, prediabetes, and diabetes are consistent for both children and adults. For children with prediabetes, annual testing is recommended, or more frequent assessments if they undergo weight fluctuations or exhibit symptoms like heightened thirst, increased urination, fatigue, or blurred vision. 

Treatment  

To prevent prediabetes from progressing to type 2 diabetes, consider these steps: 

• Eat a balanced diet rich in fruits, vegetables, nuts, whole grains, and olive oil. Choose low–fat, high–fiber foods to maintain a healthy weight. 
• Get physically active with at least 150 minutes of moderate or 75 minutes of vigorous exercise per week, or a mix of both, to help control weight and improve insulin function. 
• Aim to shed excess weight; even losing 5–7% of body weight can lower diabetes risk. 
• Quit smoking, as it can improve insulin sensitivity and blood sugar levels. 
• If necessary, your healthcare provider may prescribe medications like metformin, along with managing cholesterol and blood pressure. 

For children with prediabetes: 

• Encourage weight loss, reduce refined carbs and fats, control portion sizes, limit eating out, and prioritize daily physical activity.
• Medication is typically not recommended for children unless lifestyle changes aren’t effective, with metformin being the usual choice if needed.