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Pre-diabetes - what is it and how do you test for it ?

Uncategorized Jun 17, 2019

What is Pre-diabetes?

Pre-diabetes, also referred to as insulin resistance, and type 2 diabetes is on the rise. Prediabetes, also known as borderline diabetes, is a metabolic condition and is characterised by blood glucose levels, which are higher than normal, but not high enough for a patient to be diagnosed as having type 2 diabetes. 

In the UK, around 7 million people are thought to have prediabetes, and between 2003 and 2011, the prevalence of pre-diabetes in England alone more than tripled, with an alarming 35.3% of the adult population, or 1 in every 3 people having prediabetes.

Pre-diabetes is closely associated with obesity, and if undiagnosed or untreated, prediabetes can develop into type 2 diabetes.

 

What are the risk factors for prediabetes?

You should be tested for prediabetes if you:

  • Are overweight or obese
  • Have a close relative (parent or sibling) who currently has or has had diabetes
  • Have high blood pressurelow HDL cholesterolor high triglyceride levels
  • Have given birth to a baby who weighed over 9 pounds
  • Are over the age of 40

 

While pre-diabetes can affect anyone, some groups are genetically at an increased risk. These include:

  • Afro-Caribbean
  • South Asian
  • Native American

 

How can you test for pre-diabetes?

Pre-diabetes is usually be diagnosed by a doctor using either an HbA1c, or a fasting plasma glucose (FPG) test. And, an OGTT test may also be performed, in some cases.

 

  • HbA1c Test

This test is also known as the haemoglobin A1c or glycated haemoglobin test, and along with the fasting plasma glucose test, the HbA1c test is one of the main ways in which type 2 diabetes is diagnosed. 

 

The World Health Organisation (WHO) suggests the below diagnostic guidelines for diabetes:

  • HbA1c below 42 mmol/mol (6.0%):Non-diabetic
  • HbA1c between 42 and 47 mmol/mol (6.0–6.4%):Impaired glucose regulation  (IGR) or pre-diabetes
  • HbA1c of 48 mmol/mol (6.5%) or over: type 2 diabetes

 

If your HbA1c test returns a reading of 6.0–6.4%, that indicates pre-diabetes. Your doctor should work with you to suggest appropriate lifestyle changes (nutrition, exercise etc.) that may reduce your risk of developing type 2 diabetes.

 

  • Fasting Plasma Glucose Test (FPG)

The FPG test is used to diagnose diabetes, and it works by measuring blood glucose levels in an individual after they have fasted for a certain amount of time (usually at least for 8 hours).

Any individuals who are at an increased risk of pre-diabetes, such as those who are extremely overweight/obese, with a family history of type 2 diabetes, or South Asian or African-Caribbean individuals, should be offered the FPG test.

Individuals who have a blood glucose level greater than or equal to 7.0 mmol/L (126 mg/dl) will be retested and, if the results are consistent, diagnosed with diabetes.

 

If the results are less than 7.0 mmol/L (126 mg/dl) but greater than 6.1 mmol/L (110 mg/dl) the individual will be diagnosed as having impaired fasting glucose, or pre-diabetes.

 

 

  • Glucose Tolerance Test (OGTT)

The OGTT tests the individual's plasma glucose level after consuming a glucose-rich drink that contains 75 grams of glucose.  An OGTT may be carried out in individuals that present with symptoms of diabetes, but have not tested for diabetic levels in the test for HbA1c or the FGT test.

Individuals who have impaired glucose tolerance (IGT) or pre-diabetes will have a plasma glucose level of less than 11.0 mmol/L (200 mg/dl) but equal to or greater than 7.8 mmol/L (140 mg/dl). And individuals who have a plasma glucose level over or equal to 11.0 mmol/l (200 mg/dl) after two hours will be asked to have a fasting plasma glucose test to determine diagnosis of type 2 diabetes.

 

 

 

 

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