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Prediabetes Overview

Prediabetes is a condition in which your blood sugar (glucose) is above normal but not high enough for a diagnosis of diabetes. It often, but not always, leads to type 2 diabetes, by far the most common form of diabetes. In fact, people with type 2 diabetes nearly always have prediabetes first. That's why it's so important to detect and treat prediabetes early.

Diabetes is serious. If you develop this disease, it will be with you the rest of your life. However, people with prediabetes can reduce their risk of developing diabetes. They may even be able to bring their blood sugar back to normal by making healthy lifestyle changes, including exercising, eating right and losing any excess pounds.

About insulin and glucose
In prediabetes (also called impaired glucose tolerance or impaired fasting glucose) and type 2 diabetes, the body's ability to use the hormone insulin to process glucose is impaired. Insulin is made in the pancreas, a glandular organ in the abdomen. Glucose is the main fuel used by our cells and organs.

Glucose is a simple sugar, meaning it cannot be broken down into other sugars. We obtain glucose by eating foods that contain carbohydrates, such as breads and cereals, vegetables, fruits and sugary sweets. Glucose is also made in our bodies through the breakdown (metabolism) of protein and fats.

When you eat a food, it is digested and broken down into glucose before it is absorbed into your bloodstream. As glucose levels rise in the blood, your pancreas begins producing insulin. This hormone helps move glucose from your bloodstream into your cells.

If your body has trouble processing glucose, the glucose builds up in your bloodstream. Excess glucose (hyperglycemia) can damage your heart, nerves, kidneys, skin, eyes and other organs. It can cause sexual difficulties, impaired thinking, dental problems, foot problems and other complications.

Many people with prediabetes also have a related condition called insulin resistance. This occurs when your body's cells have difficulty using insulin to transport glucose. As with prediabetes, this condition causes high blood glucose, which eventually may lead to development of type 2 diabetes.

One in three American adults has some degree of insulin resistance, according to the American Association of Clinical Endocrinologists. Though the majority of these individuals do not develop diabetes, they are at increased risk for heart attack, stroke and other problems.

A growing problem
The number of people with prediabetes and diabetes has been soaring in the United States, in other developed nations and even in developing regions such as Latin America, India, China and Africa. The main reason for this is the increased rate of obesity, which is caused by poor eating habits and lack of physical activity.

In the United States, at least 41 million people ages 40 to 74 have prediabetes, according the American Diabetes Association. But prediabetes is also a problem of the young. Two million Americans ages 12 to 19 ‑- seven percent of that age group ‑- are prediabetic, federal researchers estimated in 2005. Among overweight adolescents, the rate of prediabetes is 18 percent.

There has also been a steady increase in the number of people diagnosed with type 2 diabetes, which is almost always preceded by prediabetes. According to the U.S. Centers for Disease Control and Prevention (CDC), the number of new cases of diagnosed diabetes jumped by 47 percent between 1997 and 2002. Alarmed, scientists have begun to research how to identify earlier the people at risk for diabetes.

There is no known way to prevent type 1 diabetes, an immune disorder in which the pancreas stops making insulin and obesity is not a factor. However, with early identification of prediabetes, it may be possible to delay or even prevent type 2 diabetes. A diagnosis of prediabetes has emerged as a new predictor of type 2 diabetes.

In the past, mildly elevated levels of blood glucose were often ignored. Today, glucose levels slightly above the normal range are a warning sign for an individual to take prompt action to prevent type 2 diabetes.

Detection and action
It is important to watch out for and treat prediabetes, especially if you have a family history of diabetes.

Your doctor can diagnose prediabetes with standard blood tests such as a fasting plasma glucose (FPG) test or an oral glucose tolerance test (OGTT). These tests measure the level of glucose in the blood. If the level of blood sugar is found to be within an elevated range, prediabetes is diagnosed. The range, in milligrams per deciliter (mg/dL) of blood, is 100 to 125 mg/dL for a fasting plasma glucose test and 140 to 199 mg/dL for an oral glucose tolerance test.

Research conducted by the U.S. Department of Health and Human Services indicates that individuals with newly diagnosed prediabetes will likely develop type 2 diabetes within 10 years unless they make healthy lifestyle changes.

In addition, women diagnosed with prediabetes are at a high risk of developing gestational diabetes during pregnancy. If not controlled, this condition can complicate pregnancy and harm the mother or baby or both. It does not continue after the baby is born, although women who have had gestational diabetes are at higher risk of developing type 2 diabetes later.

Prediabetic individuals also often have other risk factors that increase their risk of developing type 2 diabetes. These factors include high blood pressure (hypertension) and unhealthy levels of cholesterol and other blood fats such as triglycerides. So it's important to be screened by a doctor for these conditions.

Treatment of prediabetes is likely to focus on a doctor-recommended weight-loss plan, improvements in diet and a doctor-approved exercise plan. Quitting smoking and limiting alcohol will also help. If there are problems with blood pressure or cholesterol, these need to be addressed as well.

Preventing the onset of type 2 diabetes is not the only benefit of early prediabetes treatment. Research has shown that medical complications linked to diabetes may actually start in the prediabetes stage. The heart, blood vessels, kidneys and eyes may be damaged during the prediabetes condition. Treatment and prevention in the prediabetic stage may slow down the damage of vital organs and body systems.

Whichever term is used, prediabetes can be thought of as a wake-up call. If you have, suspect you have or are at risk of this condition, be assured that lifestyle changes can help control it and prevent complications. Such changes can greatly improve your overall health and reduce your risk of heart disease, stroke, liver disease, obesity, sexual problems, osteoporosis and other disorders.

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