Prediabetes

What is prediabetes?

Prediabetes is a metabolic condition characterized by a moderate elevation in fasting blood glucose levels, without reaching the diagnostic thresholds for type 2 diabetes. It serves as a genuine warning sign indicating that the body is beginning to develop insulin resistance, a hormone produced by the pancreas that regulates sugar levels. This resistance means that cells respond less effectively to insulin, leading to an accumulation of blood sugar.

According to the World Health Organization, prediabetes cases are on the rise globally, making it a major public health issue. In France, the French Federation of Diabetics emphasizes the importance of rapid screening for individuals with prediabetes to prevent progression to type 2 diabetes and its associated complications. This situation requires careful attention to change behavior and reduce the likelihood of developing full-blown diabetes.

What does a high fasting blood glucose level mean?

An elevated blood sugar indicates that the blood sugar level is higher than normal after a fasting period of at least eight hours. In a healthy individual, fasting blood sugar typically ranges between 0.70 g/L and 1.10 g/L. A level between 1.10 g/L and 1.25 g/L is considered a marker of prediabetes. This excessive increase in blood sugar reflects a glucose intolerance, often due to insulin resistance.

An elevated blood glucose level is therefore an important indicator of a glycemic disorder requiring medical attention to prevent progression to type 2 diabetes.

What is the blood sugar level for prediabetes?

The blood glucose level that indicates a prediabetes diagnosis ranges from 1.10 g/L to 1.25 g/L (or 6.1 to 6.9 mmol/L) during a fasting blood glucose test. This threshold is critical as it precedes the diagnosis of type 2 diabetes, which is confirmed when fasting blood glucose reaches or exceeds 1.26 g/L on two consecutive tests. Detecting blood glucose within this range should prompt the patient to consult their doctor for screening and appropriate management. Indeed, even a moderately elevated blood sugar level can progressively damage blood vessels and nerves, increasing the likelihood of long-term complications.

What are the causes of prediabetes?

Prediabetes primarily results from a combination of genetic and environmental factors leading to insulin resistance. Among the most common causes are:

• Overweight: The excess of adipose tissue, especially at the abdominal level (increased waist circumference), contributes to insulin resistance.
• Sedentary lifestyle: Lack of physical activity reduces the metabolism’s ability to use insulin effectively.
• Unbalanced diet: Excessive consumption of meals high in carbohydrates and saturated fats can disrupt carbohydrate metabolism.
• Genetic predispositions: A family history of diabetes increases the likelihood of developing prediabetes.
• Advanced age: Prevalence increases with age, particularly after 45 years.
• Metabolic factors: High blood pressure and elevated cholesterol levels are often associated with prediabetes.
• Effects of Covid-19: Studies suggest that infection with Covid-19 could influence carbohydrate metabolism.

These exposures contribute to the impairment of pancreatic beta-cell function, which are responsible for insulin production, and to a decrease in metabolic sensitivity.

What are the symptoms and signs of prediabetes?

Prediabetes is often asymptomatic, making its early screening challenging. However, certain signs may alert the patient:

• Persistent fatigue: An unexplained feeling of tiredness may result from the cellular inability to use carbohydrates to produce energy.
• Increased thirst: High blood sugar levels can lead to dehydration, resulting in excessive thirst.
• Frequent urination: Excess sugar is eliminated by the kidneys, increasing the need to urinate.
• Vision trouble: Fluctuations in blood sugar levels can affect vision.
• Slow healing: Poor circulation and high blood sugar levels can delay the healing of wounds.

What are the consequences of glucose intolerance?

Carbohydrate intolerance is an inability of the body to effectively manage ingested sugar, leading to elevated blood glucose levels after meals. Without intervention, it can result in several complications:

• Progression to type 2 diabetes: Glucose intolerance is a major factor in the development of diabetes.
• Cardiovascular complications: High blood sugar levels can damage blood vessels, increasing the risk of high blood pressure, atherosclerosis, heart attacks, and strokes.
• Neuropathies: Nerve damage may occur, causing a loss of sensation or tingling in the extremities.
• Kidney issues: The kidneys can be damaged by consistently high blood sugar levels.
• Retinopathy: Excess sugar can affect the blood vessels of the retina, leading to visual disturbances.

Recognizing carbohydrate intolerance as a warning sign requiring immediate management is therefore one of the first steps in an appropriate care pathway.

Is prediabetes reversible?

Yes, prediabetes is reversible, especially when detected early. Studies have shown that lifestyle modifications can normalize blood sugar levels and restore insulin sensitivity. The following preventive measures are essential:

• Adopt a balanced diet: Reduce caloric intake, limit high-carbohydrate meals with a high glycemic index, and prioritize fiber-rich foods.
• Increase physical expenditure: Engage in regular activity, such as brisk walking for at least half an hour a day, to improve glucose utilization by the muscles.
• Weight loss: Reduces insulin resistance.
• Medical monitoring: Conduct regular blood glucose checks to track progress.

According to the World Health Organization, accumulating at least 150 minutes per week of moderate activity is recommended to improve metabolic health.

Are there treatments for prediabetes?

The main treatment for prediabetes involves lifestyle modifications, but in certain cases, the physician may consider additional interventions:

• Appropriate diet: Work with a dietitian to develop a balanced dietary plan rich in fiber and low in quick sugars.
• Improvement of Sedentary Lifestyle: Incorporate aerobic and resistance exercises to enhance insulin sensitivity.
• Medications: Although less common, certain pharmacological treatments may be prescribed to improve blood glucose levels, such as metformin, especially in individuals with a high probability of progression towards diabetes.
• Therapeutic education: Participate in educational programs to understand the condition and learn how to manage it effectively.
• Medical monitoring: Regular check-ups allow for treatment adjustments based on the evolution of blood sugar levels.

In France, the Fédération Française des Diabétiques offers resources and training to help patients with prediabetes adopt a healthy lifestyle. Working closely with a professional to personalize prediabetes treatment is also recommended.

What is the diet for a pre-diabetic?

The diet for a prediabetic patient aims to regulate blood sugar levels and enhance metabolic sensitivity. The key principles are:

• Favor low glycemic index foods: They release carbohydrates gradually, preventing blood sugar spikes.
• Increase fiber intake: Fruits, vegetables, legumes, and whole grains promote satiety and stabilize blood sugar levels.
• Limit added sugars: Reduce the consumption of sugary drinks, candies, and pastries.
• Choose lean proteins: White meats, fish, tofu, and legumes contribute to a balanced diet.
• Reducing saturated fats: Limit full-fat dairy products and red meats to improve lipid profile.
• Divide meals: Eat in moderate portions and distribute intake throughout the day to prevent glycemic fluctuations.

What is the link between prediabetes and weight loss?

Weight loss is closely associated with the improvement of prediabetes, especially in overweight or obese patients. Losing even 5 to 10% of total body mass can:

• Improve insulin sensitivity: Reducing excess weight decreases insulin resistance at the cellular level.
• Lower blood sugar: Better utilization of sugar by the metabolism normalizes blood sugar level.
• Reduce cardiovascular risk: Weight loss promotes a decrease in blood pressure and cholesterol levels.
• Preventing type 2 diabetes: Reducing stress on the pancreas delays the depletion of insulin-producing units.

Exercises such as brisk walking for at least half an hour per day significantly contribute to weight loss and the improvement of insulin sensitivity.