Prediabetes, the precursor stage of diabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. Prediabetes is highly prevalent in older age groups and obese individuals. Insulin resistance, impaired incretin action, and insulin hypersecretion are central to the pathophysiology of prediabetes. Risks of major complications in persons with prediabetes, including diabetes, cardiovascular disease, kidney disease, and death, and the prevalence of the risk vary depending on the prediabetes definition used. (1) (3)

In the current practice, five different definitions of prediabetes are used in current practice, which is based on different cut points of HbA1C, fasting glucose, and 2-h glucose. However, the use of different cut points presents a major challenge due to a lack of guidance on when one definition should be preferred over another.

Significance of Screening Strategies for Prediabetes, Diabetes, and Associated Complications

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The most commonly used definition is issued by the American Diabetes Association. According to the ADA guidelines, the diagnostic criteria for prediabetes is an elevated fasting plasma glucose level (100 mg/dL-125 mg/ dL), a glycated hemoglobin HbA1c) value of 5.7% to 6.4%, or an elevated plasma glucose level after an oral glucose tolerance test (140-199 mg/dL). (2)

Additionally, the American Diabetes Association recommends that diabetes testing starts at age 45 years for all adults who are overweight (body mass index [BMI] ≥ 25 kg/m2) and have any of the following additional risk factors:

Physical inactivity
Hypertension or history of cardiovascular disease
Low levels of high-density lipoprotein cholesterol and high triglycerides
First-degree relative with diabetes
History of previously elevated blood glucose level or HbA1c measurement
Women with polycystic ovarian syndrome
History of gestational diabetes or giving birth to a baby weighing more than 4.082 kg (9 lb)
Member of an ethnic or minority racial group (2) (3)

In comparison to diabetes, where treatment can prevent some of its devastating complications but does not usually restore normal blood glucose levels, prediabetes represents a window of opportunity for reverting to a normoglycemic level. Only by achieving a normal glucose state can complications of prediabetes and diabetes be prevented. However, this time window is often lost due to unhealthy lifestyle practices, such as sedentary life, consumption of high fat or high carbohydrate diet, etc.

It is a well-known fact that the incidence of diabetes is directly proportional to weight loss in risk-stratified individuals. Several clinical studies have shown that intensive lifestyle intervention produced long-term beneficial changes in diet, physical activity, and clinical and biochemical parameters and reduced diabetes risk. In most of these clinical studies, the interventional goals were to reduce body weight, reduce intake of dietary and saturated fat, and increase physical activity and dietary fiber intake.

Hence, lifestyle modification is a viable option to prevent developing diabetes within 10 years after the initial diagnosis of prediabetes, according to the National Institute of Digestive and Kidney Diseases. All patients with prediabetes should complete the following goals:

7% weight loss if BMI exceeds 25 kg/m2
150 min or more of moderate- to vigorous-intensity aerobic activity per week
Lifestyle modification training, such as dietary changes, changes in the habit of prolonged sitting during work hours, improper sleeping patterns, etc (3)

The identification and treatment of prediabetes is a crucial measure to ensure affordable healthcare, prevention of preventable diseases, and saving of lives. Economic considerations are important for health care groups because the cost to care for individuals with diabetes far exceeds the cost to care for patients with prediabetes or normal glucose levels.

Therefore, screening and risk-stratifying individuals as prediabetic can help in developing strategies to prevent prediabetes from progressing to diabetes. (1) (3)

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