What is prediabetes

Celebrated every year on November 14th, World Diabetes Day brings global attention to the growing concerns of diabetes and its impact on millions of lives. This day serves as a crucial reminder of the importance of awareness, early detection, and prevention.

One key aspect that often goes unnoticed is prediabetes—a condition where blood sugar levels are higher than normal but not yet high enough to be classified as diabetes. 

Prediabetes is a condition marked by raised blood glucose levels that are below the cut-off point for a diabetes diagnosis but are linked to an increased risk of developing diabetes.

Individuals with prediabetes are at a significantly increased risk of developing diabetes, with as many as 50% progressing to the condition within five years. Additionally, people with prediabetes are more likely to develop eye problems, nerve damage, kidney disease, heart issues, and may even face an increased risk of dying early.

Difference between prediabetes and diabetes

The main difference between prediabetes and diabetes can be seen in the difference in ranges of results for blood glucose parameters like fasting blood glucose and glycated haemoglobin.

Another difference is that in prediabetes, patients may typically not show symptoms (that is why it can go undetected for a long time) whereas diabetes has symptoms such as increased thirst and hunger, frequent urination, fatigue, slow-healing sores, unintended weight loss, among others.

Statistics

In 2021, 5.8% (298 million) of adults worldwide aged 20–79 were estimated to have impaired fasting glucose (suggestive of prediabetes), a figure expected to increase to 6.5% (414 million) by 2045. In Africa, the prevalence of impaired fasting glucose in 2021 was 4.2%, projected to increase to 4.8% by 2045.

Risk factors

Factors that increase the risk of prediabetes include non-modifiable ones such as family history, age, race or ethnicity, polycystic ovary syndrome (PCOS), as well as other modifiable risk factors such as diet, physical inactivity, being overweight, having an increased waist size, and tobacco smoking.

Prediabetes – how and why it happens

The exact cause of prediabetes is not fully known; however, genetics and family history are significant contributors. One thing that is clear however is that individuals with prediabetes no longer process glucose properly (a process known as insulin resistance).

It is also clear that certain lifestyle factors can lead to the development of prediabetes.

Insulin resistance: insulin is a hormone made by the pancreas that helps cells absorb glucose from the blood. In people with prediabetes, the cells become less responsive to insulin (insulin resistance).

As the body's cells become resistant to insulin, the pancreas produces more insulin to help glucose enter the cells. However, over time, the pancreas may struggle to meet this increased demand, causing blood sugar levels to rise, consequently leading to prediabetes.

Genetics: If a parent or sibling has diabetes, one’s chances of developing prediabetes are higher. Certain genetic traits and ethnic-specific genetic variations (e.g., South Asian, African, Hispanic populations), among others have been associated with increased risk of insulin resistance.

Lifestyle: lifestyle factors (such as physical inactivity, poor diet and smoking diet) can increase the risk of insulin resistance, leading to prediabetes and eventually diabetes.

• Physical inactivity-Not being physically active can make it harder for the body to handle sugar and use insulin properly. Also, sitting too much increases the risk of the body not responding well to insulin, thus predisposing people to prediabetes. Regular exercise helps make the body more responsive to insulin and lowers blood sugar levels. Recent studies show that physical activity greatly improves how the body uses insulin.
• Poor Diet: Diets that are high in refined carbohydrates (e.g., sugary drinks, refined cereal foods such as white bread, white rice and pastries etc) and low in fibre (typically characterized by low intake of fruit and vegetables) can lead to spikes in blood sugar levels. This can lead to insulin resistance over time, especially if combined with other poor dietary patterns like overeating or consuming excessive ultra-processed foods.
• Smoking tobacco: this contributes to the development of prediabetes by increasing insulin resistance (due to the composition of nicotine and other chemicals in the cigarette) promoting inflammation, altering fat distribution, disrupting blood sugar regulation, and increasing the risk of obesity. These factors collectively raise the likelihood of developing prediabetes and type 2 diabetes.

Why you should know about prediabetes

The recently released Ghana Steps Report has indicated that, majority (70.3%) of adults aged 18-69 years, have never had their blood glucose levels checked. This indicates that there is a high likelihood of undiagnosed diabetes and prediabetes, which can lead to severe health complications if left untreated.

Undiagnosed and untreated diabetes can result in complications such as heart disease, kidney failure, and neuropathy, leading to increased healthcare costs for both individuals and the healthcare system.

To address this, public awareness campaigns, accessible screening programs, healthcare provider training, supportive policies, partnerships with NGOs, and follow-up care are essential to improve early detection and management of diabetes.

On a personal level, we encourage all to take advantage of the free diabetes screening programs being organized by various organisations this month to ensure that you are not part of the majority who do not know their blood sugar status.

Consulting a registered dietitian is an essential aspect of management of blood glucose. Stay tuned for our article next week to learn more.

Written by Dr. Laurene Boateng (PhD, RD) and Ophelia Yaa Adwo Asare (MSc, RD)

Laurene Boateng (PhD, RD) is a Registered Dietitian and Senior Lecturer in the Department of Dietetics, University of Ghana. She is the founder and editor-in-chief of www.fullproofnutrition.com , a website committed to providing reliable, evidence-based, and practical healthy eating advice.

Ophelia Yaa Adwo Asare (MSc, RD) is a Registered Dietitian and contributing writer for www.fullproofnutrition.com

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References

Mary R. Rooney, Michael Fang, Katherine Ogurtsova, Bige Ozkan, Justin B. Echouffo-Tcheugui, Edward J. Boyko, Dianna J. Magliano, Elizabeth Selvin. (2023). Global Prevalence of Prediabetes. Diabetes Care 1, 46(7), 1388–1394. https://doi.org/10.2337/dc22-2376

Ghana Steps Report. (2023) https://www.afro.who.int/sites/default/files/2024-11/GHANA%20STEPS%20REPORT%202023.pdf