Prediabetes: unravelling the mysteries of this condition and how to stay on the path to wellness

Prevention is better than cure, the old saying goes – and never has it been truer than when it comes to recognising the signs of a condition that can severely impact your life.

Identifying prediabetes is essential to stop it from progressing into full-blown diabetes. Dr Elana du Plessis, an endocrinologist at Mediclinic Panorama, helps us understand what prediabetes is and explains how to halt its march.

What is prediabetes?

Firstly, it’s important to understand the role of insulin, Dr du Plessis says. Its key role is to facilitate glucose entry into the cells of the body to be used for energy or stored for when the body needs it. Insulin also plays a role in protein and fat metabolism and promotes cell growth.

In the early stages of insulin resistance, muscle, fat, and the liver struggle to respond to insulin and the pancreas compensates by working harder and producing more insulin and glucose levels remain normal.

“During the prediabetic stage, the compensation from the pancreas fails and glucose levels become higher than normal, but you don’t meet the criteria for diagnosis of Type 2 diabetes. Prediabetes refers to impaired fasting glucose or impaired glucose intolerance.”

If it is left unchecked, blood glucose levels continue to rise, and you meet the criteria for Type 2 diabetes.

“If poorly controlled, diabetes progresses and complications can occur, such as renal failure, stroke and heart attack,” Dr du Plessis says.

Classic signs you’ve moved from prediabetes to Type 2 diabetes include increased thirst, frequent need to urinate, increased hunger, fatigue, blurred vision, numbness of the hands and feet, and sores that are slow to heal.

Symptoms of prediabetes

Dr du Plessis says warning signs include:

• Acanthosis nigricans which is a dark velvety discolouration seen in skin folds, especially behind the neck, armpit and beneath the breasts
• Skin tags which are small painless growths of the skin, also typically found in the face, neck, armpit and beast folds
• Visceral adiposity, which refers to increased fat around the belly
• Reproductive abnormalities like polycystic ovary syndrome
• Non-alcoholic fatty liver, which is an umbrella term for a range of liver conditions in people who don’t drink a lot of alcohol
• Metabolic syndrome conditions, such as hypertension, dyslipidaemia which is the imbalance of lipids such as cholesterol and triglycerides, and abdominal obesity based on waist circumference

How does one diagnose pre-diabetes?

“The gold standard for diagnosing diabetes is with the use of an oral glucose tolerance test, whereby fasting blood glucose is drawn,” Dr du Plessis explains. “Individuals are given a standardised 75g glucose load to drink and blood glucose levels are repeated after two hours.”

To have your fasting blood glucose drawn, you must not eat or drink for eight to 10 hours before the test.

A diagnosis of overt diabetes is made if your fasting blood glucose is 7 millimoles per litre or more, or if your blood glucose is 11.1 millimoles per litre or more after the glucose load. Impaired fasting glucose is defined as a glucose level between 6 to 6.9 millimoles per litre and impaired glucose tolerance if glucose levels are between 7.8 to 11 millimoles per litre. Either of these abnormalities is defined as prediabetes.

“People with prediabetes should be screened for other cardiovascular risk factors, such as high blood pressure and elevated cholesterol,” Dr du Plessis says.

What you can do to prevent or delay the onset of Type 2 diabetes

Lifestyle changes should be made, Dr du Plessis says. Prediabetics should achieve and maintain a weight loss of 5%; reduce energy from saturated fat by 10% and increase their fibre intake.

It’s recommended prediabetics see a registered dietitian to come up with a comprehensive, sustainable eating plan to lose weight and ensure maximum health benefits going forward. Getting regular exercise – at least 150 minutes a week – is also recommended.

Monitoring prediabetes

You should be monitored by your doctor every six to 12 months, Dr du Plessis says. “If there is no improvement or there’s been a deterioration in your blood glucose levels, medication can be considered.”

Metformin should be considered in high-risk individuals including those who are under the age of 60, have a history of gestational diabetes, those who have a body mass index of over 35, those with elevated blood glucose levels and people with a metabolic syndrome.

Semaglutide is an anti-diabetic drug that is also used for weight reduction and may help delay or prevent the onset of Type 2 diabetes in overweight or obese individuals with prediabetes, Dr du Plessis says.