Prediabetes: How to Stop Progression and Protect Your Health

What is Prediabetes and Why is it Dangerous?

Prediabetes is a condition in which blood glucose levels are higher than normal, but do not yet reach the values characteristic of type 2 diabetes mellitus. This is an important warning signal, because without timely intervention, prediabetes often progresses to full-blown type 2 diabetes [5]. The danger of prediabetes lies not only in the high risk of developing diabetes, but also in the fact that it is already associated with an increased risk of cardiovascular diseases, such as heart attack and stroke [4].

Studies show that atherosclerosis, the process of artery narrowing, can begin as early as childhood, and hypercholesterolemia (high cholesterol levels) is a key risk factor for coronary artery disease [4]. Prediabetes often coexists with other metabolic disorders, such as dyslipidemia (lipid metabolism disorder), hypertension (high blood pressure), and hepatic steatosis (fatty liver disease), which also increase overall health risks [2, 5, 6]. There is an increase in the prevalence of type 2 diabetes, dyslipidemia, and hepatic steatosis, which underscores the relevance of preventive measures [5].

Key Risk Factors and Early Diagnosis

Detecting prediabetes at an early stage is critical to preventing its progression. There are a number of risk factors that may indicate an increased likelihood of developing this condition:

• Overweight or obesity: Especially abdominal obesity.
• Family history: Presence of type 2 diabetes in close relatives.
• Sedentary lifestyle.
• Age: Risk increases with age.
• History of gestational diabetes or giving birth to a large baby.
• Polycystic ovary syndrome.
• Certain chronic conditions: For example, inflammatory bowel disease (IBD); although the direct link with prediabetes is not always obvious, patients with IBD may not receive full preventive services, making them more vulnerable to comorbidities [3, 8].

For the early diagnosis of prediabetes and associated metabolic disorders, regular screening is recommended, including:

• Determining fasting blood glucose levels.
• Measuring glycated hemoglobin (HbA1C), which reflects average glucose levels over the past 2-3 months [2].
• Lipid profile (cholesterol, triglycerides, LDL, HDL) to assess the risk of dyslipidemia [2, 4].
• Blood pressure measurement [6].

Early detection of these indicators allows for the timely initiation of preventive measures and the slowing or halting of the development of serious complications [4].

Lifestyle: The Foundation of Prevention

Lifestyle modification is the cornerstone in the prevention of prediabetes and its progression. Even small, consistent changes can yield significant benefits:

• Healthy eating: A balanced diet with a restriction of simple carbohydrates, saturated fats, and processed foods. Increasing the consumption of vegetables, fruits, whole grains, and lean proteins. Portion control is important.
• Regular physical activity: At least 150 minutes of moderate aerobic exercise per week (e.g., brisk walking) and 2-3 strength training sessions are recommended. Physical activity improves cell sensitivity to insulin and promotes weight loss.
• Weight loss: Even moderate weight loss (5-7% of initial body weight) can significantly reduce the risk of developing type 2 diabetes. For people who are overweight or obese (BMI ≥27 kg/m2), weight loss is one of the main goals [1].
• Smoking cessation and moderate alcohol consumption: These factors also affect metabolic health and increase the risk of complications.

These measures not only help control glucose levels, but also improve overall health, reducing the risks of cardiovascular disease and other comorbid conditions.

Medication Support: When is it Necessary?

In some cases, especially for individuals with prediabetes and overweight or obesity (BMI ≥27 kg/m2), lifestyle changes can be supplemented with drug therapy for more effective prevention of type 2 diabetes [1]. Obesity pharmacotherapy can be used to maintain achieved weight loss and prevent weight regain [1].

According to recommendations, to delay or prevent the development of type 2 diabetes in individuals with prediabetes who are overweight or obese, the following medications may be prescribed in combination with behavioral and lifestyle modifications:

• Liraglutide (3.0 mg daily) [1].
• Orlistat (120 mg three times daily) [1].

These medications help reduce weight and improve metabolic parameters, thereby reducing the risk of prediabetes progression. It is important to emphasize that drug treatment should always be prescribed by a doctor and used as an adjunct to a healthy lifestyle, rather than a replacement for it [1].

Comprehensive Approach and Management of Comorbidities

Effective prediabetes prevention requires a comprehensive approach that includes not only glucose control, but also active management of comorbid conditions.

• Dyslipidemia: Controlling cholesterol and triglyceride levels is crucial, as dyslipidemia is a significant risk factor for cardiovascular diseases, which frequently accompany prediabetes and diabetes [2, 4]. In some cases, for the primary prevention of atherothrombotic events, antiplatelet therapy, such as acetylsalicylic acid, may be considered as prescribed by a physician [7].
• Hypertension: High blood pressure is common in people with diabetes and prediabetes. Adequate control of it is a priority to reduce the risk of cardiovascular complications [6]. Regular blood pressure monitoring and, if necessary, drug treatment should be part of the prevention plan [6].
• Other conditions: It is also important to pay attention to other comorbid conditions, such as thyroid disorders [2] and hepatic steatosis [5], which can affect metabolism and overall health.

Patients are advised to undergo regular medical check-ups and maintain close interaction with a general practitioner and other specialists (e.g., endocrinologist, cardiologist). This is especially relevant for patients with chronic diseases such as IBD, who often require coordinated management of preventive measures, including timely vaccination to prevent infections [3, 8].

Sources

• [1] Pharmacotherapy for obesity management. https://pubmed.ncbi.nlm.nih.gov/41378657/
• [2] Evaluation of Diabetes Mellitus, Hyperlipidemia, and Thyroid Disease Comorbidities in Palmoplantar Pustulosis. https://pubmed.ncbi.nlm.nih.gov/41942412/
• [3] ACG Clinical Guideline: Preventive Care in Inflammatory Bowel Disease. https://pubmed.ncbi.nlm.nih.gov/28071656/
• [4] Cholesterol screening and statin use in children: a literature review. https://pubmed.ncbi.nlm.nih.gov/29858795/
• [5] Prevalence trends of type 2 diabetes treatment, dyslipidemia and hepatic steatosis in Northeast Germany. https://pubmed.ncbi.nlm.nih.gov/39611572/
• [6] Hypertension Treatment and Control in Canadians With Diabetes. https://pubmed.ncbi.nlm.nih.gov/40447187/
• [7] Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology 2023 Focused Update of the Guidelines for the Use of Antiplatelet Therapy. https://pubmed.ncbi.nlm.nih.gov/38104631/
• [8] Preventative Care in the Patient with Inflammatory Bowel Disease: What Is New? https://pubmed.ncbi.nlm.nih.gov/27061291/

Disclaimer: The information presented in this article is for reference purposes only and is not intended for self-diagnosis or self-treatment. Always consult a qualified medical professional for an accurate diagnosis and an individualized treatment plan.