While approximately 319 million people are affected by prediabetes globally, the vast majority are not aware that they have the condition.

Awareness is however vital because through medication and lifestyle changes, you can reverse prediabetes and prevent complications.

What is prediabetes?

Prediabetes occurs when your blood sugar is higher than normal but does not meet the criteria to fulfil the diagnosis of Type 2 diabetes, explains Dr Chris Greyling an endocrinologist at Mediclinic Durbanville.

There are various tests used to diagnose both conditions. These are:

  • A haemoglobin A1C (HbA1C) test – a blood test that measures your average blood sugar (glucose) level over the past three months. If this is more than or equal to 6,5% that is diabetes. If it is more than or equal to 5,7% and less than 6.5%, prediabetes is diagnosed.
  • A fasting plasma glucose (a fasting blood sugar test) that gives a result equal to or more than 7mmol/L indicates diabetes. “It’s normal for this to be less than 5.6 mmol/L,” Dr Greyling says. “If it’s between this level and 6.9, that is prediabetes.”
  • An oral glucose tolerance test or a random blood sugar test that yields a result more than or equal to 11,1mmol/L indicates diabetes, 7.8 to 11mmol/L indicates prediabetes.

“Before people develop Type 2 diabetes, almost all of them have prediabetes,” explains Dr Greyling. Prediabetes is driven by the obesity pandemic, he adds, referring statistics that show that 30% of South Africans are obese, while 23% are overweight. What’s more 6,2% of the world’s population is pre-diabetic, he says.

The danger of undiagnosed prediabetes

“Despite the fact that prediabetes is a massive problem, four out of five people with prediabetes are completely unaware of it,” Dr Greyling says. This lack of awareness leads to limited levels of diagnosis because prediabetes is asymptomatic.

This is particularly worrying as there is evidence to show that prediabetes can cause subclinical organ damage – macrovascular complications (affecting any of the body’s large blood vessels) that are not severe enough to present easily observable symptoms – as well as neuropathies (peripheral nerve damage) and nephropathy (any disease of the kidneys). “Even at a low level, glucose is toxic for your tissues,” says Dr Greyling.

If you are diagnosed with prediabetes, it’s important to look out for diabetes symptoms which suggest development of overt diabetes including:

  • blurry vision
  • frequent urination
  • fatigue
  • increased thirst and hunger

Reversing prediabetes

When it comes to managing – and potentially reversing – prediabetes, a multidisciplinary treatment approach is recommended – much the same as in the case of diabetes itself. Dr Greyling points to a trial called the Diabetes Prevention Program Outcomes Study (DPPOS), an extension of the Diabetes Prevention Program (DPP) conducted in the United States of America over 15 years.

It found that if patients with prediabetes are given the medication Metformin or Glucophage and make lifestyle changes and lose a modest amount of weight, there’s a 58% chance that they will avoid becoming diabetic. “They put a lot of emphasis on the lifestyle changes, mainly through diet and exercise,” he explains.

“In Type 1 diabetes, you treat the patient with insulin, but with Type 2 diabetes and prediabetes, your lifestyle changes are the most pertinent,” says Dr Greyling. “If you are prediabetic and you lose 10% of your bodyweight, it prevents you from developing diabetes.”

Lifestyle changes that can help you to reverse prediabetes, include:

  • eating healthily – for example learn to count carbs, eat a balanced diet which includes lots of vegetables and fruits
  • cutting out sugar
  • drinking a lot of water – 2 litres per day
  • exercising 30 minutes at least three times a week
  • maintaining a healthy weight – aim for a body mass index (BMI) of less than 30, ideally 25
  • Stopping smoking and decreasing your alcohol intake

“One of the big driving forces of diabetes is insulin resistance,” explains Dr Greyling, “and Metformin works well because it sensitises your body to insulin and delays gastric emptying, so it makes you feel fuller for longer.” To limit side effects of the medication which include diarrhoea and bloating, one needs to start slowly with a low dose and then build up to a higher one if needed.

Boosting prediabetes awareness

Dr Greyling stresses the importance of boosting prediabetes awareness. “We are not testing for it, we are focusing on diabetes – yet prediabetes is the precursor to this,” he says. “Once the damage has been done, to organs or limbs, for example, there’s not a lot we can do to prevent the disease from getting worse.

“Yet you can reverse prediabetes and prevent complications. It entails picking up prediabetes and managing it properly. Doing an HbA1C test should be part of your routine annual check-up with your general practitioner.  In this way we can prevent diabetes, an often-devastating disease.”