What is prediabetes and what can I do about it? | Expert Opinion

“I know my blood sugar has been running a little high, but why does my chart now say I have prediabetes?”

We hear this comment quite often in primary care. In the past, clinicians may have mentioned elevated blood sugar. But a named diagnosis was uncommon until diabetes eventually made its grand debut when the glucose level surpassed 125 mg/dl.

So why the emphasis on a prediabetes diagnosis now?

Prediabetes is defined as a fasting blood sugar between 100 and 125, or a glycated hemoglobin (HbA1c) between 5.7% and 6.4% (a test that shows your average blood sugar over the last three months).

Prediabetes is associated with increased mortality and increased heart disease risk. It is also extremely common, affecting one in three adults in the U.S. and 720 million people worldwide.

By making prediabetes a distinct diagnosis category, doctors can focus more attention on this important public health problem before it develops into diabetes.

But here is the real carrot — early treatment can significantly reduce the risk of getting diabetes and does not necessarily involve medication. The mainstay of treatment for prediabetes is lifestyle modification, including cutting calories and increasing exercise to achieve weight loss.

Studies have shown that you are more likely to succeed with these lifestyle changes if coaching support and self-monitoring of your blood sugar are part of your plan.

Medication does have a role in prediabetes, too, and is especially helpful among two groups of people:

The medicine proven most effective in these situations is metformin, a commonly prescribed drug.

A drawback is that discontinuing medication may cause blood sugar to return to the higher pretreatment levels. Lifestyle modification is the preferred approach, because the improvement is long-lasting.

If you have not already done so, make sure to request screening for prediabetes at your next routine checkup. The U.S. Preventive Services Task Force (USPSTF) recommends screening every three years for adults between 35 and 70 years old who are overweight (BMI>25).

People previously diagnosed with prediabetes should get annual screenings to track whether they’ve progressed to diabetes, the USPSTF recommends.

If preventive medicine is to remain a pillar of health care, we must continue to pay heed to potential blind spots and consider how we might bring them into better view. A diagnosis of prediabetes can do just that. It is more than a label — it is an opportunity.

Ella Eisinger is a second-year medical student at Perelman School of Medicine. Jeffrey Millstein is an internist and regional medical director for Penn Primary Care.