Dr. Jacqueline Gerhart: If You Have Prediabetes, Will You Get Diabetes?

UW Health Family Medicine physician Dr. Jacqueline GerhartMadison, Wisconsin - UW Health Family Medicine physician Jacqueline Gerhart writes a column that appears Tuesdays on madison.com and in the Wisconsin State Journal. Columns are re-published here with permission.


Dear Dr. Gerhart: I was just told I have prediabetes. What are the chances I'm going to get full-blown diabetes?


Dear Reader: I'm sorry to hear you have prediabetes, also known as impaired fasting glucose or impaired glucose tolerance. It is diagnosed in patients with elevated blood sugars that are not yet high enough to be considered diabetes.


There are a few ways to test for diabetes.

  • Fasting blood sugar: This can be done either by a traditional blood draw or by a finger prick. If the value is from 100 to 125 mg/dL (milligrams per deciliter), you are considered to have impaired fasting glucose. If it is greater than 126 mg/dL on two different occasions, you are diagnosed with diabetes.
  • Two-hour oral glucose tolerance test: This test is done less frequently because you have to drink a sugary drink, then wait two hours before your blood is drawn. On this test, if your blood sugar is 140 to 199 mg/dL, you have impaired glucose tolerance. Greater than 200 mg/dL means diabetes.
  • Hemoglobin A1C: This test is often used for both the diagnosis and the ongoing management of diabetes. If your value is 5.7 to 6.4 percent, you have prediabetes. Greater than 6.5 percent is diabetes.

Having prediabetes does place you at a high risk of developing diabetes. For example, people with hemoglobin A1C values of 5.5 to 6.0 have a 9 to 25 percent chance of developing diabetes in five years. Those with values from 6.0 to 6.4 have a 25 to 50 percent chance, and they are 20 times more likely to develop diabetes than those with a normal hemoglobin A1C.


Prediabetes is associated with cardiovascular disease, obesity, high cholesterol and high blood pressure. Therefore, if you are overweight and have elevated cholesterol, elevated blood pressure or heart disease, you should be screened for diabetes. If you are not overweight and do not have other diabetic risk factors (no diabetes in your family, etc.), then you can wait until age 45 to be screened.


So now that you are diagnosed with prediabetes, what should you do? The American Diabetic Association has the following recommendations:


First, consider weight loss. A general goal is gradual loss of 7 percent of your body weight - with no more than 1 to 2 pounds per week. Also, try to increase your physical activity to 150 minutes per week of moderate activity (such as brisk walking).


Medication also can be considered. Usually, patients start with a medication called metformin that has minimal risk in causing too-low blood sugars (hypoglycemia). In addition, see your doctor at least yearly for monitoring of your blood pressure, cholesterol and, of course, blood sugar.


I applaud you for finding out early, while your blood sugars are only slightly elevated. More early diagnosis and treatment in our country will help lower the overall diabetes rates, which are spiraling out of control.


The Centers for Disease Control reported that from 1980 to 2010, the number of Americans with diabetes has tripled. They estimate that by 2050, one in three adults will have diabetes.


In Wisconsin in 2010, 7.1 percent of the population had diabetes, and another 6.2 percent had been diagnosed with prediabetes. And over the past three years, the prevalence of diabetes has increased by 13 percent - meaning an estimated 8 percent of Wisconsinites will have diabetes in 2013.


For more information on your personal risk of developing diabetes, contact your primary care provider.


This column provides general health information and is not specific advice intended for any particular individual(s). It is not a professional medical opinion or a diagnosis. Always consult your personal health care provider about your concerns. No ongoing relationship of any sort (including but not limited to any form of professional relationship) is implied or offered by Dr. Gerhart to people submitting questions.

Date Published: 01/29/2013

News tag(s):  jacqueline l gerhart

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