What Is Pre-diabetes?
Pre-diabetes is a condition in which a person’s blood glucose levels are higher than normal but not yet high enough for a diagnosis of diabetes. It encompasses both impaired fasting glucose (IFG) and impaired glucose tolerance. It is a condition for which there’s a high likelihood of progressing on to type 2 diabetes unless something is done about it. People with prediabetes may already be experiencing the adverse effects of elevated blood glucose, and they are at increased risk for cardiovascular disease.

How Is Pre-diabetes Diagnosed?
Diagnosis of pre-diabetes requires a blood test, either a fasting plasma glucose (FPG) test after an 8-hour fast or a 2-hour oral glucose tolerance test (OGTT) after a standard challenge of 75 g of glucose. At present, either one of those will suffice. It is still not clear whether eventually both tests will be required. There is ongoing discussion about that, but, given the convenience and ease with which it is possible to do an FPG test, more doctors are going to depend on this test to establish a diagnosis of IFG, a type of prediabetes. According to the current ADA (American Diabetes Association) and NIDDK (National Institute of Diabetes and Digestive and Kidney Disease) recommendations, it’s not necessary to follow up with an OGTT if the fasting test is positive. If IFG is present, a program of modest weight loss and increased physical activity should be started without having to measure postprandial glucose. These recommendations are being further reviewed.

Who Should Be Screened For Pre-Diabetes?
The ADA and NIDDK have established criteria that appear to be useful in identifying people at greater risk for having unrecognized prediabetes. Certainly, screening should be considered if there is a family history of diabetes and for individuals who are overweight and more than 45 years of age. Screening may also be warranted for individuals who have, separate from those first 3 factors, abnormalities in blood lipids or hypertension.

What Percentage Of Patients With Will Go On To Develop Type 2 Diabetes?
In a Diabetes Prevention Program (DPP), more than 3000 men and women with elevated postprandial plasma glucose levels were randomly assigned to placebo, metformin, or a behavioral intervention group.2 Without treatment, the rate of progression among these people, who, on average, were middle aged and quite overweight, with a body mass index of about 34 kg/m2, was roughly 10% per year. With the behavioral intervention, there was a reduction of 58% in progression to diabetes. The intervention was directed toward getting individuals to lose about 8 to 10 pounds and being a bit more active, mainly by walking briskly 150 minutes per week or more.