Prediabetes (tūraru mate huka) is when the amount of glucose (sugar) in your blood is higher than normal but doesn’t meet the criteria for diabetes yet. This means you are at much higher risk of getting type 2 diabetes and heart disease.
Key points about prediabetes
- Prediabetes affects about 20% of New Zealanders.
- Symptoms of prediabetes can include extreme thirst, urinating (peeing) more often and feeling tired. However, not everyone with prediabetes has symptoms.
- People who are overweight or obese, have a family history of type 2 diabetes or with Māori, Pacific or Indo-Asian ethnicity are at greater risk of developing prediabetes.
- Finding out whether you have prediabetes can be an opportunity to make changes and stop it progressing to type 2 diabetes and increasing your risk of heart disease – prevention is better than cure.
- The best things you can do to prevent prediabetes or delay it progressing to diabetes are to maintain a healthy body weight, make healthy food and drink choices and have regular physical activity.
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What is prediabetes?
Prediabetes occurs when the amount of glucose (sugar) in your blood is higher than normal but doesn’t meet the criteria for diabetes yet. Insulin is the hormone that usually controls your blood glucose, keeping it in the healthy range. Sometimes people stop making enough insulin, or it does not work well enough, to control their blood glucose levels. This is called prediabetes.
People with prediabetes are at increased risk of developing type 2 diabetes and heart disease. However, if you follow a healthy lifestyle at this stage, you have a chance to delay or prevent type 2 diabetes developing.
What are the causes of prediabetes?
People who are overweight or who have obesity are at higher risk of developing prediabetes. This is due to excess energy (from food and drinks) being stored as fat around your body’s organs and tissues. Over time, these fatty deposits can damage key organs, such as your pancreas, causing it to stop producing enough insulin, and other body cells, causing them to be less sensitive to insulin. This leads to your blood glucose rising, causing prediabetes.
What are the symptoms of prediabetes?
Not everyone with prediabetes has symptoms. Early signs of prediabetes can include:
- extreme thirst
- needing to urinate (pee) often
- dry skin
- feeling hungry
- blurred vision
- feeling drowsy
- wounds being slow to heal.
If you have noticed some or all of these symptoms, visit your doctor for a blood glucose check.
How is prediabetes diagnosed?
Prediabetes is diagnosed if any of the following criteria is met:
- An HbA1c result of 41–49 mmol/mol – HbA1c is a test that measures your average blood glucose over the previous 8–12 weeks and gives an indication of your longer-term blood glucose control. Read more about HbA1c testing.
- A fasting blood sugar of 6.1–6.9 mmol/L – your blood glucose is tested while you are fasting.
- A 2-hour glucose on 75g glucose tolerance test that shows 7.8–11 mmol/L – this test measures your blood glucose 2 hours after you have had a 75g sugar drink.
Who should be tested for prediabetes?
You may not notice any obvious symptoms of prediabetes, but if you are in any of the high-risk groups below, it’s important to talk to your doctor or nurse about a screening test.
If you are over 25 years of age and:
- have obesity (BMI of 30 or more, or 27 or more if you are Indo-Asian)
- there is a family history of early age onset of type 2 diabetes in more than one first degree relative (parent, brother or sister)
- are a woman who has had gestational diabetes
- have cardiovascular disease (conditions affecting your heart and blood vessels)
- are on long-term steroid or antipsychotic treatment.
If you are a child or young adult with obesity (BMI of 30 or more, or 27 or more if you are Indo-Asian) and:
- there is a family history of early onset type 2 diabetes
- you are of Māori, Pacific or Indo-Asian ethnicity (Indian, including Fijian Indian, Sri Lankan, Afghan people, Bangladeshi, Nepalese, Pakistani, Tibetan).
It is a good idea for other adults to also be tested as you become due for a cardiovascular (heart health) risk assessment at age 35, 45 or 55.
How is prediabetes treated?
People with prediabetes are also at increased risk of developing diabetes complications, so it needs to be treated. Read more about complications of diabetes.
Prediabetes is treated mainly by changing your lifestyle where needed. This could delay you developing diabetes by 3–4 years or even prevent you developing it. Healthy lifestyles are made up of healthy eating, active living, a healthy body weight and being smoke free.
Other treatment of prediabetes can also include:
- Diabetes medicine – if lifestyle changes don’t lead to your blood glucose levels reducing enough, your doctor may consider also prescribing metformin.
- Treatment of other cardiovascular risk factors such as hypertension (high blood pressure) and high lipids or high cholesterol.
If you have prediabetes, it is also important to have an HbA1c test every year to check whether you have progressed to type 2 diabetes.
- There is no special diabetes diet. Like everyone, you can follow Michael Pollan's advice to “Eat food. Not too much. Mostly plants”.
- Healthy eating is not about sticking to strict diets or depriving yourself of the foods you love.
- Instead, eat a wide range of different foods, mostly plant-based and less processed, that help you feel great, have more energy, improve your outlook and achieve or maintain a healthy weight.
- Find out more healthy eating basics and advice from the New Zealand Society for the Study of Diabetes on healthy eating.
- Regular physical activity, sitting less and moving more can help you have a healthy body weight, feel more positive and lower your risk of diabetes, heart disease and some cancers.
- Physical activity also helps your body to use insulin properly.
- Try not to sit down for longer than 30 minutes at a time.
- Aim to be active for at least 30 minutes every day, increasing to 60 minutes daily if you want to reduce your body weight.
- Include some resistance exercise at least twice a week.
- Doing some physical activity is still better than doing none.
- Make sure you wear comfortable, supportive and well-fitting shoes as you are at greater risk of foot problems if you have prediabetes or diabetes.
- If you find it hard to start or maintain an exercise routine, talk to your doctor as you may be able to get a green prescription to access support.
- Find out more about physical activity.
A healthy body weight
- If you have overweight or obesity, losing 5–10% of your initial body weight can significantly improve your blood glucose, blood pressure and cholesterol.
- Making good choices about what you eat and drink, and being physically active, are important to achieve and keep a healthy body weight.
- For every 1 kilogram of weight you lose, your risk of diabetes could reduce by 16%.
Be smoke free
If you are a smoker, quitting smoking is also important.
If you drink alcohol, try to reduce your intake as it contains a lot of calories and can make weight management more difficult. Drinking may also increase your risk of developing Type 2 diabetes.
How is prediabetes prevented?
The best things you can do to prevent prediabetes are:
- maintaining a healthy body weight
- making healthy food and drink choices
- doing regular physical activity.
What support is available with prediabetes?
Diabetes support groups Diabetes self-management support (6–8 hours over 1 day or for 3–4 consecutive weeks) is available in some areas. Ask your GP or practice nurse about what’s available in your area.
The following links provide further information about prediabetes. Be aware that websites from other countries may have information that differs from New Zealand recommendations.
- Prediabetes Ministry of Health, NZ & New Zealand Society for the Study of Diabetes, 2020
- Prediabetes – risk factor management Ministry of Health, NZ, 2016
- HbA1c testing Health Navigator NZ
|Julie Carter works as a liaison dietitian for the Auckland District Health Board. She has an interest in public health nutrition.|