Prediabetes: The Wakeup Call That Can Save Your Life

It may take years to diagnose type 2 diabetes. Yet the signs are often there beforehand in a condition known as prediabetes.

Prediabetes. It doesn’t sound like a real diagnosis. So why pay attention to a disease you don’t have yet?

“What it comes down to is this: Prediabetes means that if you do nothing, you’re at high risk of developing type 2 diabetes,” says Jane Jeffrie Seley, DNP, CDE, a diabetes nurse practitioner and certified diabetes educator in the division of endocrinology, diabetes and metabolism at NewYork-Presbyterian/Weill Cornell Medical Center. “Prediabetes equals high risk. Explain it that way and people start to pay attention.”

Prediabetes means your blood sugar levels are higher than normal but not yet in the diabetes range. When left unchecked, 15 to 30 percent of the estimated 86 million Americans with prediabetes will go on to develop full-blown type 2 diabetes within five years, according to a 2014 report from the Centers for Disease Control and Prevention (CDC).

Type 2 diabetes is characterized by insulin resistance — when your body doesn’t use insulin properly — which leads to problems processing blood sugar and potentially a host of serious medical illnesses, including heart disease and stroke. More than 76,000 adults die of complications from type 1 and type 2 diabetes every year, according to the CDC. Many of these complications can be prevented or reduced through earlier diagnosis and treatment. One in three U.S. adults will have type 2 diabetes by 2050, the CDC estimates.

How Did We Get Here?

“The epidemic of prediabetes is following the epidemic of obesity,” says Dr. Louis Aronne, director of the Comprehensive Weight Control Center at NewYork-Presbyterian and the Sanford I. Weill Professor of Metabolic Research at Weill Cornell Medicine. “It’s pretty clear that an increase in body weight raises the risk of developing type 2 diabetes. As body weight in the general population has increased, the rate of diabetes has followed in kind.”

Experts believe a combination of genetics (family history), ethnic background, and lifestyle habits (dietary excesses and lack of exercise) is to blame.

“If you have a close relative with prediabetes or diabetes [meaning a parent, sibling, or child], your risk of developing the condition increases,” says Seley.

Certain ethnic groups, including Asian-Americans, African-Americans, Latino Americans and Native Americans, are also at higher risk. Other risk factors include being overweight, advancing age and having high blood pressure, according to the American Diabetes Association.

Diet and exercise can be just as important when it comes to preventing prediabetes and type 2 diabetes. Type 1 diabetes cannot be prevented. It is an autoimmune disease that typically occurs at a younger age where there is no insulin produced. Individuals have to take insulin for life. Type 1 accounts for 5 percent of all diabetes cases.

“When I first started in my career in the late 1970s, I never saw type 2 diabetes in a child,” says Seley. “Now, I see prediabetes and type 2 in kids as young as 3 years old! Children and adults are watching more TV, spending more time on their computers and playing video games. They’re sitting more and moving less.”


“The epidemic of prediabetes is following the epidemic of obesity.”

— Dr. Louis Aronne


One reason for the correlation between weight gain and diabetes is that fat cells cause resistance to the hormone insulin, which regulates blood sugar. With prediabetes as well as with type 2, the body gradually becomes more and more resistant to insulin, and without insulin working well, blood sugar rises.

In each case for both type 1 and type 2 diabetes, if blood sugar isn’t brought back to normal, either by dietary changes, exercise and medication to improve blood sugar, blood vessels throughout the body can be damaged. This may lead to complications such as blindness, kidney failure, and neuropathy (nerve damage), as well as heart attacks and strokes.

Small Changes, Huge Health Benefits

The good news: Once you know you have prediabetes, you can manage it — and that can help prevent you from developing diabetes and other health problems.

A CDC study known as the National Diabetes Prevention Program found that people who took part in a healthy eating and exercise program and lost 5 to 7 percent of their total body weight (10 to 14 pounds for someone who weighs 200 pounds) were able to reduce their risk of diabetes by 58 percent.

The results were even more dramatic for people more than 60 years old: A 5 percent weight loss lowered older adults’ risk of type 2 diabetes by 71 percent.

“Whatever you weigh to start with, if you lose 5 to 7 percent of your total, you get enormous health benefits,” says Dr. Aronne. “That’s because as your fat cells shrink, an alteration in the production of key hormones improves insulin resistance, inflammation, blood pressure and many other metabolic disorders associated with obesity.”

What’s surprising is that you may have to make fewer changes than you think to get your blood sugar back on track.

“You don’t have to eat special food,” says Seley. “It’s more about smaller portion sizes and adding short bursts of activity to your day.” The people in the National Diabetes Prevention Program exercised for 150 minutes a week — less than 22 minutes of moving a day. “Take a 15-minute walk in the morning and one in the evening and you’re there. Or take the stairs instead of using the elevator or get off the bus or train one stop sooner. All of these strategies add up.”

In addition to moving more and getting your blood sugar checked regularly, if you’ve been told you have prediabetes, it may also make sense to get some support. “Insurance is getting much better about paying for individual prediabetes counseling and group programs,” says Seley.

If you don’t have time to see someone in person, the CDC website offers links to online diet and weight loss programs, as well as in-person approved weight loss programs across the country. Take this quiz to see if you’re at risk for prediabetes, and keep these smart eating tips in mind as suggested by NewYork-Presbyterian/Weill Cornell Medical Center experts.

Helpful Nutrition Tips

Write down exactly what you eat for three days. “Keeping a food diary may help you become more mindful of what and how much you’re actually consuming,” says Georgia Giannopoulos, R.D.-A.P., registered dietitian and manager of NYPBeHealthy, NewYork-Presbyterian’s health and well-being program. “If you decide to see an expert, bringing your food diary may help jump-start the creation of your personalized nutrition plan.” Many diet and fitness apps make it easy to track your food, calories, and exercise, adds Seley.

Downsize your plates. “Using a smaller plate may help you control the amount of food you eat without even realizing it,” says Giannopoulos. “Try swapping a dinner plate with a salad plate. Food portions may look larger than they actually are, which may help you eat less.” Another tip: Divide snacks into small servings ahead of time so you’re less tempted to grab handfuls from a large bag.

Fill up on fiber. “It’s smart to switch from white bread, white rice and fruit juice for more high-fiber foods such as whole-grain bread, brown rice, and whole fruit, which reduces your rise in blood sugar after eating,” says Seley.

Save carbs for later. “Our studies have shown that if you have carbohydrates at the end of a meal instead of at the beginning, there isn’t as big an impact on blood sugar,” says Dr. Aronne. “Start with veggies and lean protein first, so your blood sugar rises more gradually.”

What if the scale still isn’t budging?

“There are also prescription medications and treatments that can help with both weight and blood sugar,” says Dr. Aronne. “Right now, those medications are approved for diabetes only, but we are trying to get them approved for prediabetes and weight loss, as well.”

The bottom line: There’s no reason to set hard-to-reach diet and exercise goals.

“When it comes to prediabetes, small lifestyle changes really make a difference,” says Seley. “You can change your future to a healthy one.”