Prediabetes

Diagnosis

The American Diabetes Association recommends that most adults start screening for diabetes at age 35. Screening may begin earlier than age 35 for people who are overweight and have additional risk factors for prediabetes or type 2 diabetes.

People who have had gestational diabetes are at higher risk and are usually advised to have their blood sugar levels checked at least once every three years.

Several blood tests are used to diagnose prediabetes.

Glycated hemoglobin (A1C) test

This test reflects the average blood sugar level over the previous two to three months.

Blood sugar ranges are generally interpreted as follows:

• Below 5.7% is considered normal

• Between 5.7% and 6.4% is diagnosed as prediabetes

• 6.5% or higher on two separate tests indicates diabetes

Certain conditions, such as pregnancy or uncommon hemoglobin disorders, can affect the accuracy of the A1C test.

Fasting blood sugar test

This test requires a blood sample after not eating for at least eight hours or overnight.

Blood sugar levels are measured in milligrams per deciliter or millimoles per liter. Typical results include:

• Less than 100 mg/dL (5.6 mmol/L) is normal

• 100 to 125 mg/dL (5.6 to 6.9 mmol/L) is diagnosed as prediabetes

• 126 mg/dL (7.0 mmol/L) or higher on two separate tests indicates diabetes

Oral glucose tolerance test

This test is used less often, except during pregnancy. After fasting overnight, the person drinks a sugary liquid, and blood sugar levels are tested at intervals over the next two hours.

General interpretation includes:

• Less than 140 mg/dL (7.8 mmol/L) is normal

• 140 to 199 mg/dL (7.8 to 11.0 mmol/L) suggests prediabetes

• 200 mg/dL (11.1 mmol/L) or higher after two hours indicates diabetes

People diagnosed with prediabetes are usually advised to have their blood sugar levels checked at least once a year.

Children and prediabetes testing

Type 2 diabetes is becoming increasingly common in children and adolescents, largely due to rising obesity rates. The American Diabetes Association recommends prediabetes testing for children who are overweight or obese and who have one or more additional risk factors, including:

• A family history of type 2 diabetes

• Belonging to a race or ethnicity associated with increased risk

• Low birth weight

• Being born to a mother who had gestational diabetes

The same blood sugar ranges used for adults apply to children. Children with prediabetes should be tested yearly for type 2 diabetes, or more often if they gain weight or develop symptoms such as increased thirst, frequent urination, fatigue, or blurred vision.

Treatment

Healthy lifestyle changes can help bring blood sugar levels back to normal or prevent them from rising to levels linked with type 2 diabetes.

To reduce the risk of progression, key strategies include:

• Eating healthy foods
  A diet rich in fruits, vegetables, nuts, whole grains, and healthy fats such as olive oil is linked to a lower risk of prediabetes. Choosing foods low in calories and fat and high in fiber supports better blood sugar control.

• Being more active
  Regular physical activity helps with weight control and improves how the body uses insulin. The goal is at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous activity each week, or a combination of both.

• Losing excess weight
  Losing about 5% to 7% of body weight can significantly reduce the risk of developing type 2 diabetes. Long-term success depends on sustainable eating and exercise habits.

• Stopping smoking
  Quitting smoking can improve insulin sensitivity and help stabilize blood sugar levels.

• Taking medications if needed
  For people at high risk, healthcare providers may prescribe metformin. Medications to manage cholesterol or high blood pressure may also be recommended when necessary.

Children and prediabetes treatment

Children with prediabetes are generally advised to follow the same lifestyle changes recommended for adults. These may include:

• Achieving and maintaining a healthy weight

• Eating fewer refined carbohydrates and fats while increasing fiber intake

• Reducing portion sizes

• Eating out less often

• Engaging in at least one hour of physical activity each day

Medication is not commonly recommended for children with prediabetes unless lifestyle changes fail to improve blood sugar levels. When medication is necessary, metformin is usually the preferred option.