Prediabetes: what it means and what you can do

Being told you have prediabetes can feel confusing. You do not have diabetes, but your doctor is concerned. The best way to think of it is as an early warning. Your body is starting to struggle to keep sugar in the normal range, and this is the stage where changes make the biggest difference.

What counts as prediabetes?

Prediabetes is diagnosed when any one of these is in the in-between range:

• HbA1c of 5.7% to 6.4%
• Fasting plasma sugar of 100 to 125 mg/dL (impaired fasting glucose)
• Two-hour value in the glucose tolerance test of 140 to 199 mg/dL (impaired glucose tolerance)

Above these ranges is diabetes. For how each test works, read normal blood sugar levels and what your HbA1c result means. On some Indian reports you may see a fasting cut-off of 110 mg/dL instead, which is the value the World Health Organization prefers.

How common is it in India?

Very common. The national ICMR-INDIAB survey, which tested more than one lakh adults across India, found prediabetes in about 15% of adults and diabetes in about 11%. In some states there were more people with prediabetes than with diabetes, which means a large wave of new diabetes may still be coming.

Why does prediabetes happen?

Two problems usually combine. The body’s cells stop responding well to insulin (insulin resistance), and the pancreas cannot make enough extra insulin to make up for it. Common drivers in India include:

• extra fat around the waist, even at a “normal” BMI. Read waist size and health risk and BMI cut-offs for Indians.
• low physical activity and long hours of sitting
• diets heavy in refined grains, sugar and fried snacks
• poor sleep and stress
• a family history of diabetes
• a past history of gestational diabetes or PCOS

Will I definitely get diabetes?

No. Prediabetes raises the risk, but it is not a fixed path. Some people stay in the prediabetes range for years, and some return to normal. The risk is higher if both fasting and after-glucose values are raised, if your HbA1c is near 6.4%, or if you have several risk factors.

Prediabetes also matters beyond diabetes. It often comes with high blood pressure, abnormal cholesterol and fatty liver, which together raise the risk of heart disease.

What has been shown to help?

Two large trials changed how doctors treat prediabetes:

• The Diabetes Prevention Program in the US found that a structured lifestyle programme, aiming for about 7% weight loss and 150 minutes a week of activity such as brisk walking, cut the chance of developing diabetes by more than half over about three years.
• The Indian Diabetes Prevention Programme found that lifestyle changes also worked in Indian adults with impaired glucose tolerance, many of whom were not very overweight.

In practice, the steps that help most are:

• Move more. Aim for regular brisk walking or other activity most days, and add strength exercises a couple of times a week. Break up long sitting with short walks.
• Improve the plate. Fill half the plate with vegetables, add a source of protein such as dal, eggs, paneer, fish or chicken, and cut back on refined rice, maida, sweets and sugary drinks.
• Lose a modest amount of weight if you are overweight. Even 5% to 7% of body weight helps.
• Sleep well and manage stress.
• Stop smoking, which raises diabetes and heart risk.

Will I need medicines?

Many people do well with lifestyle changes alone. In some situations your doctor may discuss metformin, which also lowered the risk of diabetes in both trials, though less than lifestyle change did in the US study. It is more often considered in younger adults, people with obesity, or women with past gestational diabetes. If you have obesity, your doctor may also talk about weight-loss medicines. These are decisions to make with your doctor, not on your own.

How often should I be tested?

Most guidelines suggest checking your sugar or HbA1c at least once a year if you have prediabetes. Your doctor may also check blood pressure, cholesterol and liver tests.

Can prediabetes be reversed?

Often, yes. Many people bring their numbers back into the normal range with weight loss and activity. This is the best time to act, before diabetes develops. If you already have type 2 diabetes, read can diabetes be reversed.

What should I ask my doctor?

• Which test showed prediabetes, and should it be repeated?
• What is my personal risk of developing diabetes?
• How much weight loss and activity would help me most?
• Should I also be checked for blood pressure, cholesterol and fatty liver?

If you would like a personal plan, book a consultation.