Prediabetes is rising in the US - but it is reversible

Early diagnosis is key to keeping prediabetes from turning into diabetes.
Maia Mulko
Blood sugar measurement stock image.
Blood sugar measurement stock image.


According to the Centers for Disease Control's National Diabetes Statistics Report, about 88 million American adults had prediabetes in 2018.  

In 2019, the Centers for Disease Control and Prevention (CDC) reported that roughly 96 million American adults had the condition. It is also becoming more common in children from 12 to 19 years old, at least in the U.S. 

Prediabetes means that a person's blood sugar levels are higher than normal but not high enough to fit in the diabetes diagnosis. However, prediabetes is actually often a precursor of diabetes. If left untreated, prediabetes can evolve into diabetes. 

Prediabetes is rising in the US - but it is reversible
Regular measurements are important to keep blood sugar stable.

The process may take years, and it is reversible in most cases, but patients must take measures to stop it. According to the CDC, 80 percent of people with prediabetes don't know they have it, as prediabetes is mostly asymptomatic. 

Here's all you need to know about this silent, potentially serious condition and how to reverse it.

What is prediabetes?

Prediabetes is a condition in which there are higher-than-normal levels of glucose in a person's bloodstream. 

Glucose is a simple sugar that works as a source of energy for the body. We obtain it from what we eat and drink and from the breakdown of glycogen, a form of glucose that's stored in muscle cells and liver cells.

When people have prediabetes, their bodies don't use as much glucose as they should, primarily because they become resistant to insulin, a hormone produced in the pancreas that enables glucose to enter the cells as ready-to-use energy. This way, glucose stays in the bloodstream.

At first, this may not cause any symptoms, but as prediabetes turns into type 2 diabetes, it can damage the body in several ways. And if blood sugar levels remain high for a long time, or if they rise uncontrollably, they can lead to life-threatening conditions, such as heart disease or kidney disease.

How is prediabetes diagnosed?

Prediabetes doesn't usually cause any symptoms by itself; when people have symptoms, it's usually because it's evolved into type 2 diabetes. This is why it is hard to diagnose prediabetes unless you regularly check your blood sugar levels. This is especially important for people who meet the following risk factors for prediabetes and type 2 diabetes:

  • Aged over 45 years old

  • Family history of type 2 diabetes

  • Being overweight or obese

  • Having a sedentary lifestyle

  • Eating a lot of sugar and simple carbs

Prediabetes can be confirmed through several blood tests.

  • A1C test. This test reveals a person's average blood sugar levels over the past 2 or 3 months by measuring the amount of glucose attached to their hemoglobin. An A1C below 5.7 percent is normal, between 5.7 and 6.4 percent indicates prediabetes, and 6.5 percent or higher signifies diabetes.

  • Fasting blood sugar test. This test measures the patient's blood sugar levels after an overnight fast, using a blood sample taken from the individual 8 or 12 hours after they last ate. Results below 99 mg/dL are normal, 100 to 125 mg/dL is a sign of prediabetes, and 126 mg/dL or higher indicates diabetes.

  • Glucose tolerance test. This test measures a person's ability to absorb glucose by taking blood samples before and after they drink a glucose-based liquid. Two hours after drinking the liquid, healthy people would have a blood sugar level of 140 mg/dL or lower, but people with prediabetes would have a blood sugar level of 140 to 199 mg/dL. Higher than 200 mg/dL indicates diabetes.

Why is prediabetes on the rise in the U.S.?

One of the strongest explanations for the rise of prediabetes in the U.S. is related to the ongoing issue of overweight and obesity in the country's population. 

According to Harvard's School of Public Health, 69 percent of American adults are overweight or obese, and 36 percent are obese. That is roughly two out of three and one out of three people, respectively. 

Being overweight or obese is a risk factor for prediabetes and type 2 diabetes. In fact, the country with the highest rates of type 2 diabetes is also the country with the highest rates of overweight and obesity: Nauru.

Prediabetes is rising in the US - but it is reversible
Participants of a walk against Diabetes.

In this small island of the Southern Pacific Ocean, roughly 97 percent of men are overweight, 71 percent of men and women are obese, and 40 percent are diagnosed with type 2 diabetes. This is related to the fact that Nauru's land is covered with strip-mined phosphate deposits and other non-arable soil, so it must import all food - most of which is cheap, processed food with little nutritional value.

In the United States, experts link prediabetes to the "obesity epidemic" that's been present in the country since the 1970s

Medical doctors Tobin Abraham and Caroline Fox wrote in an article for the American Diabetes Association (ADA) that prediabetes rates "should be addressed in the broader context of the current obesity and diabetes epidemics," reminding us that, based on the cited studies, the prevalence of prediabetes was found to be highest among overweight and obese individuals.

How to reverse prediabetes

According to the CDC, people with prediabetes are at a high risk of developing type 2 diabetes within five years. This can be prevented if people —especially those with risk factors— take tests to get a diagnosis and start treatment for prediabetes as soon as they know they have it.

Prediabetes reversal is based on lifestyle and dietary changes, such as exercising at least three times per week and eating a plant-based, low-carb, and low-sugar diet. 

Prediabetes is rising in the US - but it is reversible
Nutritionist giving consultation to patient.

The main goal is to lose weight in a healthy way. A study by the CDC's Diabetes Prevention Program (DPP) shows that, for overweight people, losing about five percent to seven percent of their weight can cut their type 2 diabetes risk by 58 percent. 

If nothing else works, doctors can prescribe medication, such as metformin, the third most commonly prescribed medication in the United States and the front-line drug used for diabetes treatment, as it reduces glucose production and increases insulin sensitivity in body tissues, along with other benefits.

However, there are no drugs specifically for prediabetes approved by the Food and Drug Administration (FDA). 

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