Q: My patient's primary care provider told him he has prediabetes. Is this the same as borderline diabetes? How do I explain this to my patient?

Prediabetes is a condition that occurs before the development of diabetes; blood glucose levels will be higher than normal, but not high enough to diagnose diabetes. Borderline diabetes is an inaccurate term that was used in years past when a patient had elevated blood glucose, above normal, but not in the "diabetes range" for diagnosis or in the lower range of diabetes. Another term that was used during this time was "a touch of sugar." Although some primary care providers still use these terms, they are not accurate or meaningful.

The American Diabetes Association (2014) describes prediabetes as a fasting blood glucose from 100 to 125 mg/dL. Another way to diagnose prediabetes is the glucose tolerance test. An oral glucose tolerance test measures the blood glucose level at fasting and again 2 hours after ingestion of a glucose drink. If the fasting blood glucose is between 100 and 125 mg/dL, impaired fasting glucose is diagnosed. If the glucose level is only high after the drink (140-199 mg/dL), impaired glucose tolerance is diagnosed. In addition, the A1c blood test can be used to diagnose prediabetes (5.7%-6.4%). The value of the A1c test is that there is no need to fast, which allows for easy screening.

There are currently 79 million people in the United States with prediabetes. About 30% of those with prediabetes will progress to Type 2 diabetes within a decade. Research shows that there is a 58% decrease in risk of developing Type 2 diabetes by implementing lifestyle changes.

The most important thing to talk about with your patient is that prediabetes progresses to Type 2 diabetes and that now is the time to make changes to prevent or delay the onset of the disease. Encourage your patient to increase their activity level. Daily exercise will decrease insulin resistance, which is a primary factor in the body's ability to utilize glucose. Exercise will also help the patient lose or maintain body weight, which impacts insulin resistance as well. Even a modest weight loss of 5% to 7% of body weight will have an impact on glucose metabolism. The current recommendation is for 150 minutes of moderate exercise (i.e., brisk walking) per week.

From the nutritional aspect, encourage your patient to increase vegetables and fiber intake and to decrease processed foods as this will also help your patient with weight control. In addition, helping your patient understand which foods have carbohydrates and how to read a nutrition label will go a long way in improving nutritional status. Limiting carbohydrate intake will help the patient manage blood glucose levels because carbohydrates turn into sugar in the blood stream and must be managed by the insulin from the pancreas.

Hypercholesteremia and hypertension are also frequently found in people with prediabetes. The lifestyle changes discussed above have a positive impact on these areas as well. You can get a lot of "bang for your buck" by choosing lifestyle change to impact your health!

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