Ticking clock


One in 3 adults in the United States—approximately 84 million—has prediabetes (a blood glucose level that is higher than normal, but not high enough for a diagnosis of diabetes with a fasting blood glucose of 100–125 mg/dL). Of those, 90% don’t know they have it, and without lifestyle changes to improve their health, 15%-30% will develop type 2 diabetes mellitus within 5 years.1

Don’t let the “pre” be deceiving—prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as diabetes. Prediabetes puts individuals at increased risk of developing type 2 diabetes, heart disease and stroke. Lisa Thorp, RN, CDE, Great Plains QIN Quality Improvement Specialist, states, “Primary care providers are sometimes hesitant to ‘label’ a patient as ‘pre-diabetic’ or ‘diabetic’ because it becomes part of their permanent medical chart. However, mis-labeling them with diagnoses of glucose intolerance, impaired fasting glucose or borderline diabetes is doing them a grave disservice. This is the critical juncture at which action should be taken to implement the lifestyle changes that can stop prediabetes in its tracks.”

A normal fasting blood sugar should be less than 100 mg/dl. Prediabetes is diagnosed when the fasting blood glucose is in the 100-125 mg/dl range. When fasting glucose starts to climb above 100, this is a red flag that the body is starting to have trouble maintaining a normal blood glucose range. At this point, lifestyle needs to be assessed to see if there are any changes that can be made to help manage blood glucose.

Lifestyle changes are key in preventing prediabetes progression to diabetes. Thorp continues, “Studies have shown that lifestyle changes can be as successful as taking meds and can have overall positive benefits on health, especially in changing the trajectory of their risk for progressing to Type 2 diabetes.”

Minot ND DSME GraduatesThorp recently completed a six-week diabetes self-management class in Minot, ND, and her students were actively and enthusiastically engaged. They immediately recognized the value of self-management classes and stressed the importance for clinicians to refer their prediabetic patients to this type of education. Student Angie Heinze stated, “As a prediabetic and nurse, I found the classes very educational, informative and fun. The information was presented in a way everyone could understand with examples, demonstrations and resources.”

Another student commented that it was helpful to see meal comparisons that show you can eat the foods you like by making healthier choices, such as choosing grilled chicken over fried chicken. Students agreed it was beneficial to hear the discussion and feedback from others and what they are doing to manage their diabetes.

One student stated: “I initially did not want to come to the class, but my daughter told me I had to go. I learned a lot and I would actually like to attend the class a second time. I would tell everyone to find a class like this to attend.”

The American Association of Clinical Endocrinologists (AACE) emphasizes the primary goal of prediabetes management is to normalize glucose levels and prevent or delay progression to diabetes. The preferred treatment approach for prediabetes is intensive lifestyle management including medical nutrition therapy for weight loss, appropriate physical activity, avoidance of tobacco products, adequate quantity and quality of sleep, limited alcohol consumption, and stress reduction.2 Below are the AACE’s recommendations for screening for prediabetes.

Screening for Prediabetes
AACE recommends that individuals who meet any of the clinical risk criteria noted below should be screened for prediabetes or type 2 diabetes (T2D).

  • Age ≥45 years without other risk factors
  • CVD or family history of T2D
  • Overweight or obese
  • Sedentary lifestyle
  • Member of an at-risk racial or ethnic group:
    • Asian
    • African American
    • Hispanic
    • Native American (Alaska Natives and American Indians)
    • Pacific Islander
  • High-density lipoprotein cholesterol (HDL-C) <35 mg/dL (0.90 mmol/L) and/or a triglyceride level >250 mg/dL (2.82 mmol/L)
  • Impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and/or metabolic syndrome
  • Polycystic ovary syndrome (PCOS), acanthosis nigricans, or nonalcoholic fatty liver disease (NAFLD)
  • Hypertension (blood pressure >140/90 mm Hg or on antihypertensive therapy)
  • History of gestational diabetes or delivery of a baby weighing more than 4 kg (9 lb)
  • Antipsychotic therapy for schizophrenia and/or severe bipolar disease
  • Chronic glucocorticoid exposure
  • Sleep disorders in the presence of glucose intolerance (A1C >5.7%, IGT, or IFG on previous testing), including obstructive sleep apnea (OSA), chronic sleep deprivation, and night-shift occupation

Take the Test to Find Out If You May Be Prediabetic
Visit http://www.DoIHavePrediabetes.org and take the short online risk test now
1. Centers for Disease Control and Prevention. Prediabetes. http://www.cdc.gov/diabetes/pubs/statsreport14/prediabetes-infographic.pdf.
2. Garber AJ, Handelsman Y, Einhorn D, Bergman DA, Bloomgarden ZT, Fonseca V, et al. Diagnosis and management of prediabetes in the continuum of hyperglycemia: when do the risks of diabetes begin? A consensus statement from the American College of Endocrinology and the American Association of Clinical Endocrinologists. Endocr Pract. 2008;14:933-46.

In the event of normal results, repeat testing at least every 3 years. Clinicians may consider annual screening for patients with 2 or more risk factors.2