Is prediabetes a disease?

What it means to have prediabetes and what should be done about it?

What is Prediabetes?

In 1997, the Expert Committee on Diagnosis and Classification of Diabetes Mellitus recognized a group of individuals whose glucose levels did not meet the criteria for diabetes, but were higher than normal.  Prior to that, a category called “impaired glucose tolerance,”(IGT), was already recognized, and defined as individuals whose plasma glucose levels 2 hours after an oral glucose tolerance test were between 140-199 mg/dl.  Unfortunately, most providers don't utilize a glucose tolerance test, so identification of IGT was (and still is) rare.  These individuals were thought to have increased risk for the development of diabetes.  The term “prediabetes” was also thrown about, and defined as individuals with normal plasma glucose levels, but whose genetic makeup was such that they were destined to develop diabetes.  In 1997 the new definition of prediabetes became individuals whose fasting plasma glucose levels were between 100-125 mg/dl and/or their plasma glucose levels were between 140-199 mg/dl, 2 hours after an oral glucose tolerance test.  It was not until 2010 that HbA1c between 5.7- 6.4% was added to the definition of prediabetes.  Studies had shown that individuals with HbA1c in that range had a high likelihood (25-50%) of developing diabetes within the next 5 years.

What we know is this:

1. Prediabetes is reversible; diabetes is (mostly) not.

2. Physiological changes associated with diabetes start in prediabetes, affecting cardiovascular health, kidney function, the way we digest food, and our vision. 

3. Diabetes is a progressive disease, and although our genetic make-up can greatly affect the development of this disease, our lifestyle can significantly delay/prevent the onset of diabetes (and the complications that can accompany it).

4. Prediabetes (and even diabetes) often times have subtle or no symptoms.  This can be frustrating, since we associate "disease" with having accompanying symptoms.  But recall that disease is simply a condition that impairs normal functioning within the body.

5. Lab tests, which are used to diagnose diabetes and prediabetes, are not always accurate.  We recommend looking at not only the HgA1C and fasting glucose to determine how well your body is metabolizing sugar, but evaluate the presence of insulin resistance and risk factors that increase the chance of developing diabetes.  Risk factors include obesity, high "bad" cholesterol (LDL and triglycerides), low "good" cholesterol (HDL), high blood pressure, family history of diabetes, inactive lifestyle, and poor nutrition choices (e.g. fast food, packaged/processed foods, low vegetable intake, high soda/juice/milk intake).

So is prediabetes a disease?