Pre-diabetes Pre-diabetes describes a condition in which blood glucose levels are higher than normal, although not high enough to be diagnosed with type 2 diabetes. Pre-diabetes has no signs or symptoms. People with pre-diabetes have a higher risk of developing type 2 diabetes and cardiovascular (heart and circulation) disease. Two million Australians have pre-diabetes and are at high-risk of developing type 2 diabetes. Without sustained lifestyle changes, including healthy eating, increased activity and losing weight, approximately 5-10% of people with pre-diabetes will go on to develop type 2 diabetes each yeari. Any glucose test, fasting or not, that shows higher than normal blood glucose levels, needs to be checked further. The doctor may therefore order an Oral Glucose Tolerance Test (OGTT) to find out more. There are two pre-diabetes conditionsii: Impaired glucose tolerance (IGT) is where blood glucose levels are higher than normal but not high enough to be classified as diabetes Impaired fasting glucose (IFG) is where blood glucose levels are escalated in the fasting state but not high enough to be classified as diabetes It is possible to have both Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance (IGT) Risk factors Risk factors for pre-diabetes are similar to those for type 2 diabetes which are: Modifiable: Being overweight – especially those who have excess weight around the waistline – having a waistline more than 94cm for men and more than 80cm for women Being physically inactive Having high triglycerides (blood fats) and low HDL-C (good cholesterol) and/or high total and LDL cholesterol Having high blood pressure Smoking Non-modifiable: Having a first degree relative with type 2 diabetes Having a family background of Aboriginal and Torres Strait Islander, Pacific Islander, South-East Asian, Asian (the sub-continent), Arabic, or north African. Women with Polycystic Ovarian Syndrome (PCOS)* Women who have had diabetes in pregnancy (gestational diabetes) or given birth to a big baby (more than 4.5kgs) *For more information refer to the Polycystic Ovarian Syndrome and Diabetes information sheet. Treatment If you are diagnosed with pre-diabetes, the treatment involves the same lifestyle changes that are recommended for people diagnosed with diabetes. For most, this will include regular physical activity, healthy eating and if necessary losing weightiii. You can learn about the type 2 diabetes prevention programs available in your state here. People with pre-diabetes are also at increased risk of heart disease, so managing blood pressure and blood cholesterol and triglycerides is also important. Healthy eating Enjoy a healthy eating pattern to reduce your risk of type 2 diabetes: Reduce energy intake (kilojoules) Enjoy vegetables and fruit daily Choose lean proteins such as meat and chicken with fat removed, fish, eggs, nuts, legumes and tofu. Aim for high-fibre, low glycaemic index (GI) carbohydrate (carb) foods, such as wholegrain breads and cereals, legumes and fruit. Replace saturated fats with unsaturated fats such as extra virgin olive oil or avocado. Limit foods high in sugar, saturated fat and salt. Avoid high sugar drinks such as soft-drinks, cordial, iced coffee or flavoured milk Limit alcohol intake if you choose to drink. To work out a meal plan that’s right for you, visit an accredited practising dietitian. Dietitians Australia can help you find a dietitian in your area. Regular physical activity Regular physical activity helps your body to use insulin better and to feel fit and healthy. Aim to do at least 30 minutes of ‘moderate intensity’ physical activity (such as brisk walking or swimming) on most, if not all, days of the week or three 20-minute sessions of ‘vigorous intensity’ exercise per week (such as jogging, aerobics class, strenuous gardening)iv. Include resistance training twice a week to improve the way your muscles work, such as body weight exercises or lifting weights or using resistance bands. Starting a regular activity program – and sticking to it – can often be made a lot easier by joining up with a group or motivated friend to encourage you to keep going. *Before starting any new type of physical activity, always talk to your doctor. Can Type 2 diabetes be avoided? Being diagnosed with impaired glucose metabolism doesn’t mean that you will get type 2 diabetes but you are at a 10-20 times greater risk than those with normal blood glucose levels. See our programs and services for Prevention programs in your local area. Strong evidence shows that type 2 diabetes can be prevented in up to 58% of cases in the high risk (pre-diabetes) population by losing excess weight, eating healthily and exercising regularly. A Type 2 diabetes risk assessment is easy using the Diabetes Australia Risk Calculator based on the AUSDRISK – the Australian Type 2 Diabetes Risk Test. A score of 12 or more means a person is at high risk, should see their doctor for blood pathology and seek a diabetes prevention program (lifestyle behaviour change). For more information see the NDSS Information Sheet: Pre-diabetes [i] Tabák, A. G., Herder, C., Rathmann, W., Brunner, E. J., & Kivimäki, M. (2012). Prediabetes: a high-risk state for diabetes development. The Lancet, 379(9833), 2279–2290. https://doi.org/10.1016/s0140-6736(12)60283-9 [ii] Royal Australian College of General Practitioners. (2020). Management of type 2 diabetes: A handbook for general practice. https://www.racgp.org.au/getattachment/41fee8dc-7f97-4f87-9d90-b7af337af778/Management-of-type-2-diabetes-A-handbook-for-general-practice.aspx, p 7 [iii] Royal Australian College of General Practitioners. (2020). Management of type 2 diabetes: A handbook for general practice. https://www.racgp.org.au/getattachment/41fee8dc-7f97-4f87-9d90-b7af337af778/Management-of-type-2-diabetes-A-handbook-for-general-practice.aspx, p xvii [iv] Australian Government Department of Health. (2021, May 7). Physical Activity and Exercise Guidelines for All Australians. Australian Government Department of Health. https://www.health.gov.au/health-topics/physical-activity-and-exercise/physical-activity-and-exercise-guidelines-for-all-australians
