Practical Matters: Number of prediabetics rising in the U.S.

Diabetes doesn’t pounce on a person out of the blue. Before the diagnosis, a person may linger on the fringes of the condition — blood sugar high but not yet over that line that is clearly diabetes — for years. The U.S. Centers for Disease Control and Prevention released figures in January showing that the number of American adults with prediabetes had jumped from 57 million in 2008 to 79 million in 2010. During the same period, the number with full-on diabetes grew from 23.6 million to 26 million, the vast majority of which are Type 2 cases.

These numbers are somewhat inflated by the use of a new test, hemoglobin A1c, that can detect cases of prediabetes or diabetes that older tests might have missed. Still, experts have no doubt that prediabetes really is on the rise. “Many people have it and don’t know it,” says Dr. Kevin Kaiserman, a pediatric endocrinologist in private practice and president of the American Diabetes Assn, Los Angeles.

Just like people with Type 2 diabetes, those with prediabetes have high blood sugar levels because their body has become less responsive to insulin, the hormone that keeps blood sugar levels in check, or doesn’t produce enough of it. But having prediabetes is not necessarily a guarantee that a person will get Type 2 diabetes. Improved nutrition and increased physical activity can help stave off the condition.

“Lifestyle changes can absolutely reverse the course,” Kaiserman says.


Without such changes, most people with prediabetes will develop Type 2 diabetes within 10 years, according to the National Institute of Diabetes and Digestive and Kidney Diseases. And that is serious. Compared with people with normal blood sugar levels, those with diabetes are 50% more likely to have cardiovascular disease, and two out of three people with diabetes die of heart attack or stroke, according to the American Diabetes Assn.

One of the major problems with diagnosing and treating prediabetes is that it is virtually silent. While full-blown diabetes brings symptoms such as heightened thirst, frequent urination, blurry vision and fatigue, people don’t know if they’re prediabetic until they get tested.

But prediabetes doesn’t strike at random. People who don’t get much exercise are definitely at risk. And extra weight really puts a person on the fast track toward diabetes. According to a 2010 report by UnitedHealth Group, a health benefits and services company, gaining 11 to 16 pounds for someone of average weight doubles the risk of developing prediabetes, and adding 17 to 24 pounds triples the risk.

These risk factors put a sizable portion of the nation in jeopardy: The UnitedHealth Group report estimated that more than half of all overweight adults in the United States are either prediabetic or diabetic. But they also present a clear path to prevention. The best remedy for prediabetes is not medication, says Dr. Andrew Drexler, director of the Gonda (Goldschmied) Diabetes Center at UCLA’s David Geffen School of Medicine — it’s weight loss and exercise. Prediabetics, unlike diabetics, don’t have to focus so much on their intake of sugar, he adds: “Counting calories is more important than the composition of the diet.”


This lifestyle approach was vindicated by the landmark Diabetes Prevention Program study, which followed more than 3,000 people who were overweight and prediabetic. Researchers randomly separated the subjects into three groups: One-third took the diabetes drug metformin, one-third received a placebo and the other one-third received intense support to help them get more exercise and lose weight. The results of the three-year study, reported in 2002, were impressive: People receiving intense counseling and support on diet and exercise reduced their risk of developing diabetes by 58%; those on metformin reduced their risk by 31%.

It doesn’t necessarily take intensive exercise and a completely overhauled diet to improve health. A closer look at the results showed that getting 30 minutes a day of moderate physical activity and a reduction of body weight by 5% to 10% can produce results.

Kaiserman recommends increasing consumption of fruits and vegetables, reducing portion sizes, exercising daily and spending less time in front of a TV.

Want to know if you’re at risk? Check out the diabetes risk test at the American Diabetes Assn. website,


To learn more about prediabetes and Type 2 diabetes, visit the National Diabetes Education Program website at