Prediabetes: Practical Information for Retail Clinicians, Patient Education, and Type 2 Diabetes Prevention

October 2014, Vol 2, No 5 - Inside Cardiometabolic: Diabetes
Keri Medlin, PharmD, FASCP

What do people need to do now to help decrease their risk for type 2 diabetes in the future?

Prediabetes can increase the risk for type 2 diabetes and cardiovascular disease.1 In 2012, 86 million Americans 20 years of age and older had prediabetes compared with 79 million in 2010.2 It has been projected that 470 million people worldwide will have prediabetes by 2030.3

The American Diabetes Association (ADA) defines prediabetes as “blood glucose levels that are higher than normal but not yet high enough to be diagnosed as diabetes.”4 Prediabetes can also be known as impaired glucose tolerance or impaired fasting glucose; both are considered risk factors for type 2 diabetes.

Patients can have prediabetes for years before developing type 2 diabetes. They are also more likely to develop diabetes within 10 years after a prediabetes diagnosis.5

Who Is at Risk for Prediabetes?
Physicians may recommend that patients who are 45 years of age and older, and overweight, be tested for prediabetes.6 Patients are also at risk for prediabetes if they are younger than 45 years of age, overweight, and have additional risk factors, including sedentary lifestyle, an immediate family member with diabetes, or high blood pressure.

How Is Prediabetes Diagnosed?
There are several ways for healthcare providers to screen for prediabetes, including A1C, determining fasting blood glucose, and oral glucose tolerance test.4,6

The A1C test measures average blood glucose in the past 3 months.4 The A1C range for prediabetes is between 5.7% and 6.4%. The fasting plasma glucose test ideally is performed early in the morning, and patients should be instructed not to eat for 8 hours prior to the test. A fasting plasma glucose level ranging from 100 to 125 mg/dL is indicative of prediabetes. Another method is the oral glucose tolerance test, which measures blood glucose before and 2 hours after drinking Glucola.4 Patients are diagnosed with prediabetes if their blood glucose 2 hours after drinking Glucola is between 140 and 199 mg/dL.

Patient Awareness Needed
There are no clear symptoms associated with prediabetes,4 and many patients with the condition may be unaware of it.

Patients should be monitored annually and be screened for cardiovascular disease modifiable risk factors, including obesity, hypertension, and dyslipidemia.5 Prediabetes can put the patient at risk for diseases such as retinopathy, neuropathy, and chronic kidney disease, and increase the risk of macrovascular disease.

Working Toward Prevention, Management
The onset of diabetes can be delayed or prevented in patients with prediabetes. Lifestyle modifications have shown to decrease the risk for diabetes by 58%.4

What can patients with prediabetes do now to help decrease their risk for type 2 diabetes in the future? Lose weight. Losing 7% of body weight can help decrease the risk for diabetes.4 Eating a diet that is low in fat with more fruits and vegetables as well as reducing portion size can help with weight loss. In addition, patients should aim to be more physically active. Moderate exercise for 30 minutes a day, 5 days a week can be beneficial. Physical activity can help the body’s muscles use insulin more efficiently.

The ADA has also suggested that some patients with prediabetes may be considered for metformin therapy.Patients with impaired glucose tolerance, impaired fasting glucose, or an elevated A1C (5.7%-6.4%) should be considered for metformin therapy, specifically if they have a body mass index greater than 35 kg/m2, are 60 years of age or younger, and are women who have a history of gestational diabetes.5 Metformin, like exercise, can help the body’s muscles use insulin more efficiently. Metformin, along with lifestyle modifications, may be beneficial for diabetes prevention for high-risk patients.

As pharmacists and retail clinicians, it is our role to educate and encourage our patients. Being diagnosed with prediabetes can be scary, but it is manageable. The ADA and the National Diabetes Education Program have wonderful resources that can be shared with your patients. Explain to your patients that even small steps toward a healthier lifestyle could potentially reverse prediabetes.


  1. Centers for Disease Control and Prevention. Diabetes Public Health Resource: Prevent Diabetes. Accessed September 19, 2014.
  2. American Diabetes Association. Statistics about diabetes. Published September 10, 2014. Accessed September 15, 2014.
  3. Tabak AG, Herder C, Rathman W, et al. Pre-diabetes: a high-risk state for diabetes development. Lancet. 2012;379:2279-2290.
  4. American Diabetes Association. Diagnosing diabetes and learning about pre-diabetes. Published March 27, 2014. Accessed August 24, 2014.
  5. American Diabetes Association. Standards of medical care in diabetes 2014. Diabetes Care. 2014;37:S16-S17.
  6. National Diabetes Information Clearinghouse (NDIC). Diabetes prevention program. Published September 9, 2013. Accessed September 15, 2014.
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Last modified: May 21, 2015
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