Does Prediabetes Lead to Type 2 Diabetes?

Not very often

But let prediabetes alert you to make better lifestyle choices

Prediabetes is a condition, based on modestly elevated blood sugar levels, which can precede type 2 diabetes. But prediabetes does not inevitably lead to type 2 diabetes. Researchers used data from 2,575 participants over age 60 without diabetes (36 percent with prediabetes) at baseline in the Swedish National Study on Aging to follow the natural history of prediabetes. Participants were followed for up to 12 years. During this time, 42 percent of participants with prediabetes remained in this condition, 23 percent died, 22 percent reverted to normal blood sugar levels, while only 13 percent progressed to type 2 diabetes. Factors that predicted greater likelihood of reverting to normal blood sugar levels included weight loss, increased physical activity, and reduced systolic blood pressure. Thus, a diagnosis of prediabetes does not consign you to type 2 diabetes. If you get a diagnosis of prediabetes, particularly if you have overweight or obesity, embrace healthy lifestyle choices, especially Keep Moving and Eat Better, to stave off diabetes and otherwise live better.

Unfortunately, no single, widely accepted definition of prediabetes exists. As the previous study found, prediabetes may not lead to diabetes. A team of researchers used four different definitions of prediabetes to determine the risk that prediabetes progresses to type 2 diabetes. The four definitions included: 1) HbA1c between 5.7-6.4 percent, 2) fasting blood glucose between 100-125 mg/dL, 3) HbA1c between 5.7-6.4 percent or fasting blood glucose between 100-125 mg/dL, and 4) HbA1c between 5.7-6.4 percent and fasting blood glucose between 100-125 mg/dL. HbA1c is a protein whose concentration reflects blood sugar levels over the preceding 2-3 months.

Researchers used data from 3,412 participants with an average age of 76 years at baseline in the Atherosclerosis Risk in Communities Study. At baseline, the prevalence of prediabetes varied from 20-73 percent depending on the definition. Over an average follow-up of 5 years, less than 12 percent of participants with prediabetes progressed to diabetes, regardless of definition. Higher percentages of participants regressed to normal conditions (13 percent according to definition 1 and 44 percent according to definition 2). Prediabetes, regardless of definition, did not predict mortality risk. Progression of prediabetes to type 2 diabetes appears to a smaller concern than risk of cardiovascular disease for older adults.

The American Diabetes Association annually publishes “Prevention or Delay of Type 2 Diabetes: Standards of Medical Care.” The 2021 version recommends that doctors refer patients with prediabetes to an intensive lifestyle behavior change program modeled on the Diabetes Prevention Program. It emphasizes increasing physical activity and eating better to achieve and maintain a 7 percent drop in body weight. Such a program can reduce the risk of progression of prediabetes to type 2 diabetes and, more importantly, reduce the risk of cardiovascular and other chronic diseases. If you get a diagnosis of prediabetes, let it serve as a wake-up call to make healthy lifestyle choices to avoid type 2 diabetes, cardiovascular disease, and other chronic diseases.

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