Prediabetes
Prediabetes is a state of blood sugar higher than normal but not yet in the diabetic range. Without intervention, up to 37% of people with prediabetes develop type 2 diabetes within four years -- but intensive lifestyle change can cut that risk by more than half.
Symptoms
Most people have no symptoms. Fatigue, increased thirst, or blurred vision may occur at higher glucose levels. Darkened patches of skin in armpits or neck (acanthosis nigricans) are a skin marker sometimes associated with insulin resistance.
Causes and risk
Insulin resistance is the underlying mechanism. Risk factors mirror those for type 2 diabetes: overweight or obesity, sedentary lifestyle, family history of diabetes, gestational diabetes, PCOS, high blood pressure, high triglycerides, and age over 35.
How it is evaluated
Prediabetes is diagnosed by fasting glucose 100 -- 125 mg/dL, two-hour glucose after oral glucose challenge of 140 -- 199 mg/dL, or A1C 5.7 -- 6.4%. We also check fasting insulin and lipids to gauge overall metabolic risk.
Treatment
The Diabetes Prevention Program showed a 5 -- 7% weight reduction plus 150 minutes of moderate activity per week reduces diabetes risk by 58%. We build a practical nutrition and exercise plan, address barriers, and reassess in three to six months. Metformin is an option for high-risk individuals who cannot sustain lifestyle changes.