Pre-Diabetes: a Call to Action October 5, 2012
Topics: Diabetes

Home > Articles > 

By Julie Paff, RD, LD, CDE

Whether you call it pre-diabetes, impaired glucose tolerance, metabolic syndrome, or syndrome X, the facts are clear. One in three Americans likely have pre-diabetes. Looking closely at the name, pre- diabetes, you literally get the definition, 'before' diabetes. Diabetes takes up to ten years to develop, and physicians can identify early changes through physical examination and lab work that identify a person is 'on the path' to develop diabetes in the future.

The ability for doctors to intervene early and prevent or delay the development of diabetes was BIG news in 2006 with the Diabetes Prevention Trials. We know that 40-50 percent of all persons with pre- diabetes will develop type 2 diabetes within 10 years. After 2006, physicians had evidence-based tools to delay or prevent diabetes with lifestyle changes (weight loss, increased physical activity, and healthy diet changes). Health professionals could offer hope to decrease the future risk of diabetes-related health complications like heart attacks, strokes, kidney disease, neuropathy and vision loss in two ways:

  • Better blood glucose control after early diagnosis of diabetes.
  • Ability to delay or prevent diabetes in persons at risk for diagnosis with early lifestyle intervention.

What is the Difference between Diabetes and Pre-diabetes?

The same changes that lead up to diabetes are present in pre-diabetes. It truly comes down to a matter of degree. Blood glucose levels are more abnormal in diabetes, but abnormal blood glucose are commonly found in pre-diabetes to a lesser degree. Even if the blood glucose is normal, almost every person with pre-diabetes makes a lot more insulin (up to ten times more insulin) to keep the blood glucose levels in that normal range. Leptin (a hormone secreted by fat cells while we sleep) is believed to act in the blood to 'slow down' the body's insulin in its job to move glucose from the blood to muscle or fat cells. The result--your body needs to make more and more insulin to keep blood glucose levels normal. After years of producing excessive amounts of insulin, the pancreas eventually struggles to keep up with increased demand caused by leptin. This process is called insulin resistance and explains the underlying connection between body fat, especially abdominal fat, and diabetes or pre-diabetes.

After 8 to 10 years of increased insulin production, the pancreas beta cells start to fail. By the time diabetes is diagnosed, a person may have lost up to 50 percent of his/her potential to make insulin. Wouldn't it really be powerful to make changes BEFORE so much pancreas function is lost?

Both pre-diabetes and diabetes share a cluster of health challenges. Persons with pre-diabetes typically also have:

  • High blood pressure or hypertension
  • High LDL cholesterol-the bad cholesterol
  • Low HDL cholesterol-the good cholesterol
  • Increased weight (overweight or obese), often with a recent undesired weight gain.

Some people are at higher risk for developing pre-diabetes or diabetes, including:

  • Older adults
  • Persons with a family history of diabetes
  • Persons who are physically inactive
  • Persons of specific ethnicity-African American, Hispanic American, Asian American, Native American
  • Women diagnosed with gestational diabetes or with a history of delivering a baby over 9 pounds in weight.

What is the Risk with Pre-Diabetes REALLY?

We know that persons with diabetes are at two-to-four times the risk for heart attack and stroke, as well as significantly increased risk for kidney disease, vision loss, and nerve damage. All these problems are related to abnormally high blood glucose levels. Elevated glucose in the blood actually changes the structure of blood vessels by attaching to protein structures. This process, called glycosylation, increases the risk for changes that lead to all these health problems.

Clearly, as my blood glucose levels slightly exceed normal values, the potential risk for complications (resulting from higher blood glucose levels) also slightly increase. In fact, not everyone with pre- diabetes will go on to develop diabetes, but all persons with pre-diabetes are at higher risk for heart disease and kidney disease. Evidence is emerging that risks are also increased for nerve and vision problems in persons with metabolic syndrome. The very same lifestyle changes that lower health risk in persons with diabetes (diet, exercise, weight and medications) can lower the risk for these life-altering health challenges in pre-diabetes.

Let's look at the facts about health complications with pre-diabetes:

  • Persons with pre-diabetes are at up to 50% greater risk for heart disease as the general population.
  • Persons with pre-diabetes were 50% more likely to die after a cardiovascular event than the general population; in fact because more people have pre-diabetes, the number of premature and deaths with CVD and pre-diabetes is higher than diabetes-related CVD deaths.
  • While only 10 percent of persons with normal glucose tolerance had early chronic kidney disease, 18 percent of persons with pre-diabetes had early kidney disease, about half the incidence found in persons with a diabetes diagnosis.
  • Up to one in four persons diagnosed with pre-diabetes are believed to have peripheral neuropathy (nerve damage) In fact, 25 percent to 62 percent of all persons with idiopathic neuropathy have pre-diabetes.
  • 8-12 percent of persons with pre-diabetes already have retinopathy (eye changes)
  • 33 percent to 65 percent of persons with impaired glucose tolerance go on to develop diabetes within six years, compared to under 5 percent of persons with normal blood glucose levels.

What Can I Do to Reduce My Personal Risk?

Did you know that only 7 percent of people meeting diagnostic criteria for pre-diabetes are aware that they have pre-diabetes? Awareness is the most important first step. The lack of awareness may be related to less fewer doctor visits in many cases. If you have a family history, struggle with weight or blood pressure/cholesterol abnormalities….the first step is to talk to your doctor.

Did you know that once diagnosed, only about half the people with pre-diabetes implemented lifestyle changes to lower their health risks, as recommended by their doctor? If you know you have pre- diabetes, it is important to take action right away. The following lifestyle changes are proven to lower future health risk:

  • Move to a healthier weight if you are overweight or obese. Ten to twenty pounds weight loss greatly reduces your future risk for diabetes and heart disease.
  • Get moving! Less than 20 percent of American adults meet the Physical Activity Guidelines. Only 35 percent of Americans exercise regularly and one third of all American adults do not exercise at all.
  • Lower your Calorie and fat intake! By increasing more nutrient dense foods (like vegetables and whole grains) we can increase nutrient intake and lower calorie intake. Limit fats, alcohol and refined sugar to lower the calorie cost of your food choices.

A diagnosis of pre-diabetes is a wake-up call and an opportunity, but you need to take the challenge for lifestyle changes if you want to see a benefit in future decades. The facts are clear! The benefits of early intervention are proven, but the decision to take action is a personal commitment. You must invest in your future health if you have pre-diabetes.

About the Author

Julie Paff is a Registered Dietitian and a Certified Diabetes Educator at Seton Diabetes Education Center. She has 30 years experience and regularly offers diabetes prevention and pre- diabetes intervention education to persons with impaired glucose tolerance or at risk of developing diabetes.

If you need more information on diabetes prevention or pre-diabetes management, check out these offerings:

ABC's of Diabetes Prevention on October 24, 2012 is a free seminar outlining the facts about reducing your risk of developing diabetes. While the seminar is free, space is limited, so advanced registration is required. You can enroll online at or by calling (512)324-1891 press #2

Living Well with Pre-Diabetes is an evidence-based lifestyle management program designed to improve health in persons already diagnosed with pre-diabetes, metabolic syndrome, or impaired glucose tolerance. While a physician referral is recommended, you can enroll in this low-cost series of 2 classes by calling (512)324-1891, extension 2.

Walk Texas Challenge! Is an opportunity for persons with diabetes or pre-diabetes to increase their physical activity. Seton Diabetes Education Center will be sponsoring a team starting October 17. To enroll in the 10-week challenge, you must register for the enrollment session, either online at or by calling (512)324-1891 extension 2.

Watch us on YouTube