Identifying prediabetes early can help you head off diabetes and other long-term health problems.
Many women are living with an unseen health risk — prediabetes, a condition where blood sugar is elevated, but not high enough to meet the threshold for diabetes.
"Although prediabetes affects one in every three adults, nine out every 10 people with prediabetes don't know that they have it," says Dr. Osama Hamdy, an associate professor of medicine at Harvard Medical School and director of the obesity clinical program at the Joslin Diabetes Center.
While prediabetes doesn't produce symptoms, the condition may silently wreak havoc on your health. People who have prediabetes have almost the same cardiovascular risks as people with type 2 diabetes, says Dr. Hamdy. An analysis published July 18, 2020, in The BMJ found that prediabetes raised the risk of developing cardiovascular disease by 15% and of death from any cause by 13% over a median follow-up period of about 10 years.
The risk of early death was even higher in people with prediabetes who already had plaque buildup in their arteries. These people had a 36% increased risk of dying within a median follow-up period of just three years. The elevated blood sugar seen in prediabetes may also damage the blood vessels in the back of your eye (a condition called retinopathy), which can lead to blindness.
A high risk of diabetes
If it's not treated, prediabetes often progresses to full-blown diabetes, a condition in which your body's cells are not able to properly absorb glucose (sugar) from the blood. The resulting rise in blood sugar levels can lead to even more health problems. In addition to heart attacks, strokes, and blindness, people with diabetes are also more prone to kidney problems and infections.
"Around 15% to 30% of people with prediabetes develop diabetes within five years," says Dr. Hamdy.
Identifying your risk
So, how do you know if you're at risk for prediabetes and should be screened? Anyone with any of the factors below should get tested, says Dr. Hamdy:
- a body weight categorized as overweight or obese
- a family history of type 2 diabetes among first-degree relatives, such as a parent or sibling
- a significant history of irregular, infrequent periods, sometimes associated with a condition called polycystic ovarian syndrome
- signs of insulin resistance on your skin, including dark patches in your armpits or the creases in your neck (which signals a condition called acanthosis nigricans) or numerous clusters of skin tags
- gestational diabetes during pregnancy
- delivery of a baby weighing more than 9 pounds.
Testing for prediabetes typically takes two forms. Postmenopausal women, who are at particularly high risk for both prediabetes and diabetes, should ask their doctor to measure their hemoglobin A1c. This test measures the amount of sugar on molecules inside your blood cells, and can give your doctor an idea about your blood sugar levels over the prior three months.
"If the A1c measures 5.7% to 6.4%, it indicates prediabetes," says Dr. Hamdy. Other indications of prediabetes are a fasting blood sugar level of 100 to 125 milligrams per deciliter (mg/dL) or a reading of 140 to 199 mg/dL two hours after you drink a beverage that contains 75 grams of glucose (a process called a glucose tolerance test).
Diabetes is not inevitable
If you do have prediabetes, developing diabetes is not a foregone conclusion. You can prevent it. The best way to do so is by adopting a healthier lifestyle.
The National Diabetes Prevention Program showed that people with prediabetes who adopted intensive lifestyle changes reduced their likelihood of developing diabetes over the next three years by 58%, Dr. Hamdy notes. The most effective approach, he says, is a weight management program that combines nutrition counseling, at least 150 minutes of exercise per week, and a variety of cognitive behavioral modifications, such as learning stress-reduction strategies and adopting healthier eating habits that you can sustain over the long term.
You don't need to lose a lot of weight to make a difference in your diabetes risk. High-risk adults who lost just 5% to 7% of their starting body weight — that's approximately 8 to 11 pounds for a 160-pound woman — lowered their risk of diabetes by 58%.
Image: © Chinnapong/Getty Images
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