Pre-Diabetes: Causes, Prevalence, and Prevention Strategies

Introduction to Pre-Diabetes

The term pre-diabetes applies to persons highly susceptible to contracting type 2 diabetes mellitus. Those diagnosed as pre-diabetic have sustained, higher-than-normal blood glucose levels; however, these levels are not sufficiently high to be characterized as diabetes. Pre-diabetics suffer from either IGT (impaired glucose tolerance), IFG (impaired fasting glucose), or both. IGT denotes a condition in which an individual's glucose tolerance levels, measured two hours after glucose consumption, lie between 140 and 199 milligrams per deciliter. IFG refers to a condition in which fasting blood glucose levels — measured after consuming nothing throughout the night — lie between 100 and 125 milligrams per deciliter (Thomaskutty & Dwivedi, 2011).

After pre-diabetes sets in, beta cells lose their function progressively, resulting in the onset of diabetes. Type 2 diabetics characteristically have high blood sugar levels — a condition that, over time, damages blood vessels and nerves, giving rise to complications such as heart disease, kidney failure, lower-limb amputation, stroke, and blindness, among others. Research has shown that a majority of pre-diabetics become diabetic within a ten-year span if they fail to alter their existing lifestyle. Lifestyle modifications typically involve losing 5–7% of current body weight — for example, between 10 and 14 lbs. for an individual weighing 200 lbs. — through changes in physical activity levels and diet (Prediabetes and Insulin Resistance, 2009).

Current Prevalence and Global Burden

Pre-diabetics are increasing at an alarming rate in the United States. Department of Health and Human Services (DHHS) figures from 2012 reported that a minimum of 86 million citizens above the age of twenty were pre-diabetic (Prediabetes and Insulin Resistance, 2009).

On a global scale, pre-diabetes is growing in prevalence and can set in anywhere between seven and ten years prior to a clinical diabetes diagnosis. At this stage, risk factors typically exist and grow, including elevated risks of contracting cardiovascular disease. The onset of cardiovascular disease — particularly coronary artery disease (CAD), cerebrovascular disease, and peripheral vascular disease — may also occur, contributing to elevated global mortality and morbidity levels (Magalhaes, Cavalcanti & Cavalcanti, 2010).

Several sources have reported pre-diabetes prevalence figures ranging between 5.8% and 35% in individuals aged 20 and older. Reported rates differ depending on the criteria used to define pre-diabetes. Nevertheless, the condition has grown considerably in prevalence over the past few decades. A comparison of National Health and Nutrition Examination Survey (NHANES) data from 1988–94 and 1999–2010 reveals that pre-diabetes prevalence grew from approximately 5.8% to 12.4% during this period. It is predicted that, in the absence of intervention, between 15% and 30% of pre-diabetics will contract type 2 diabetes within five years (Endocrine Society, 2015).

Etiology and Distribution of Pre-Diabetes

Individuals who develop insulin resistance become increasingly prone to developing pre-diabetes. While insulin resistance is not the only factor leading to pre-diabetes, it normally sets the stage for its onset by greatly taxing insulin-generating beta cells. Beta cells of pre-diabetics stop secreting sufficient insulin to overcome insulin resistance, resulting in slightly elevated blood sugar levels (Prediabetes and Insulin Resistance, 2009).

The condition develops when an individual's body loses the capacity to properly maintain normal blood sugar levels. Although blood sugar levels are elevated compared to normal figures, they are not sufficiently high to be classified as diabetes. Whatever a person consumes is converted into sugar, which the body uses for energy. Under ordinary conditions, the pancreas secretes insulin — a hormone that facilitates blood sugar entry into the body's cells. However, when the body cannot utilize insulin properly, glucose fails to move into body cells and remains in the bloodstream, a state known as insulin resistance.

Sugar accumulation in the bloodstream leads to pre-diabetes. This condition will develop into type 2 diabetes mellitus if sustained elevated blood sugar levels persist. Physically inactive individuals, those who are obese or overweight, and individuals with a family history of diabetes are highly susceptible to pre-diabetes. Women with a history of gestational diabetes are also considered a high-risk group (Prediabetes, 2014).

A difference in pre-diabetes distribution has been observed among ethnically distinct populations. A 2005–08 NHANES data analysis found similar pre-diabetes rates among Non-Hispanic White (35%), Mexican-American (36%), and Non-Hispanic Black (35%) individuals. A subsequent analysis using 2010 NHANES data identified gender differences based on ethnicity: pre-diabetes rates were consistent across women from different ethnic groups; however, rates were lower among Non-Hispanic Black men compared to Mexican-American or Non-Hispanic White men (Endocrine Society, 2015).

References

Endocrine Society. (2015). Prediabetes. Retrieved October 1, 2016, from

Magalhaes, M. E. C., Cavalcanti, B. A., & Cavalcanti, S. (2010). Could pre-diabetes be considered a clinical condition? Opinions from an endocrinologist and a cardiologist. Diabetology & Metabolic Syndrome, 2(1), 1.

Mayo Clinic. (2014). Prediabetes treatments and drugs. Retrieved October 1, 2016, from http://www.mayoclinic.org/diseases-conditions/prediabetes/basics/treatment/con-20024420

Prediabetes and Insulin Resistance. (2009). Retrieved October 1, 2016, from

Prediabetes. (2014). Retrieved October 1, 2016, from WebMD: http://www.webmd.com/diabetes/tc/prediabetes-cause

Thomaskutty, C., & Dwivedi, P. K. (2011). Burden of diabetes in Indiana. Indiana State Department of Health.