choendocrine pre-diabetes
Pre-diabetes is a condition characterised by higher-than-normal blood sugar levels but not high enough to be classified as type 2 diabetes. It is a warning sign that you are at increased risk of developing type 2 diabetes and other health complications if steps are not taken to manage your blood sugar levels and adopt a healthier lifestyle.
Pre-diabetes is a crucial stage to address, as it offers an opportunity to make positive changes to prevent or delay the onset of type 2 diabetes.

What Is Pre-Diabetes?

Pre-diabetes occurs when your blood sugar levels are elevated but not yet in the diabetic range. The primary indicator of pre-diabetes is a condition known as impaired glucose tolerance (IGT) or impaired fasting glucose (IFG):

Impaired Glucose Tolerance (IGT)

This means your blood sugar levels are higher than normal but not high enough to be diagnosed with diabetes. It’s typically assessed through an oral glucose tolerance test (OGTT).

Impaired Fasting Glucose (IFG)

In this case, your fasting blood sugar levels are elevated, indicating a risk for diabetes. Fasting blood sugar levels are measured after an overnight fast.
Pre-diabetes is a critical stage because individuals with pre-diabetes are at an increased risk of developing type 2 diabetes, heart disease, and other health issues.

How Does Pre-Diabetes Differ From Other Types of Diabetes?

Pre-diabetes is distinct from other types of diabetes, such as type 1 diabetes, type 2 diabetes, and gestational diabetes:

Type 1 Diabetes

This is an autoimmune condition in which the immune system attacks and destroys the insulin-producing cells in the pancreas. It typically develops in childhood or adolescence and requires lifelong insulin therapy.

Type 2 Diabetes

This is a metabolic disorder characterised by insulin resistance and inadequate insulin production. It often develops in adulthood and is influenced by genetics, obesity, and lifestyle choices.

Gestational Diabetes

This type of diabetes occurs during pregnancy and is usually temporary. It is caused by hormonal changes that lead to insulin resistance during pregnancy.

Key Differences

  • Pre-diabetes involves blood sugar levels higher than normal but not yet in the diabetic range.
  • Type 1 diabetes is an autoimmune condition that requires insulin therapy from an early age.
  • Type 2 diabetes is characterised by insulin resistance and may require lifestyle changes, oral medications, and sometimes insulin.
  • Gestational diabetes occurs during pregnancy and usually resolves after childbirth.

What Are the Risk Factors Associated With Pre-Diabetes?

Several risk factors are associated with an increased likelihood of developing pre-diabetes. These risk factors can help identify individuals at a higher risk of progressing to type 2 diabetes and guide preventive measures. Some common risk factors for pre-diabetes include:

Family History

If you have a family history of type 2 diabetes, especially in first-degree relatives (parents, siblings), your risk of developing pre-diabetes is increased.

Obesity or Excess Weight

Being overweight or obese, especially with excess abdominal fat, is a significant risk factor for pre-diabetes. Excess weight contributes to insulin resist

Lack of Physical Activity

A sedentary lifestyle increases the risk of pre-diabetes. Regular physical activity helps improve insulin sensitivity and blood sugar control.

Unhealthy Diet

Diets high in sugary foods, refined carbohydrates, and unhealthy fats can contribute to weight gain and insulin resistance.


The risk of pre-diabetes increases with age, particularly after the age of 45.

Ethnic Background

Certain ethnic groups, including African Americans, Hispanics, Native Americans, Asian Americans, and Pacific Islanders, have a higher risk of pre-diabetes and type 2 diabetes.

Gestational Diabetes History

Women with gestational diabetes during pregnancy are at an increased risk of developing pre-diabetes and type 2 diabetes later in life.

Hormonal Imbalances

Polycystic ovary syndrome (PCOS) can increase the risk of insulin resistance and pre-diabetes.

High Blood Pressure

High blood pressure or a history of hypertension is associated with an increased risk of pre-diabetes.

High Cholesterol and Triglycerides

Abnormal lipid levels, including high LDL cholesterol, triglycerides, and low HDL cholesterol, can contribute to insulin resistance and pre-diabetes.

Metabolic Syndrome

Metabolic syndrome, characterised by abdominal obesity, high blood pressure, high triglycerides, low HDL cholesterol, and insulin resistance, increases pre-diabetes risk.

Sleep Disorders

Sleep apnea and other sleep disorders are linked to insulin resistance and an increased risk of pre-diabetes.

What Are the Signs of Pre-Diabetes?

Pre-diabetes often doesn’t present with noticeable symptoms in its early stages, so routine screenings are essential for its detection. However, some individuals may experience mild symptoms or subtle changes that could indicate the presence of pre-diabetes.
Experiencing these signs doesn’t necessarily mean you have pre-diabetes, but they can prompt you to undergo testing and consult your doctor. Some potential signs and symptoms include:

Increased Thirst and Urination

Feeling unusually thirsty and needing to urinate more frequently than usual can be signs of higher blood sugar levels. This symptom is similar to that seen in diabetes.


Feeling more tired than usual, even after adequate rest, can be associated with fluctuations in blood sugar levels.

Blurred Vision

Changes in blood sugar levels can affect the eye’s lens, leading to temporary blurred vision.

Increased Hunger

Elevated blood sugar levels can trigger increased hunger or sudden cravings for sugary or carbohydrate-rich foods.

Slow Healing

Wounds or cuts may take longer due to impaired blood sugar control.

Numbness or Tingling

Some individuals with pre-diabetes may experience numbness or tingling, particularly in the hands and feet. This can be due to nerve damage associated with higher blood sugar levels.

Recurrent Infections

High blood sugar levels can weaken the immune system, making you more susceptible to infections like urinary tract infections.

Unexplained Weight Changes

Some individuals might experience unexplained weight loss or gain, even without significant diet or physical activity changes.

What Medical Tests and Criteria Are Used to Diagnose Pre-Diabetes?

Diagnosing pre-diabetes involves specific medical tests and criteria to determine if your blood sugar levels are higher than normal but not yet in the diabetic range. The primary tests used to diagnose pre-diabetes are similar to those used for diagnosing diabetes, but the specific pre-diabetes thresholds differ. Commonly used tests include:

Fasting Plasma Glucose Test (FPG)

  • This test measures your blood sugar level after an overnight fast (typically 8 hours or more).
  • You may be diagnosed with pre-diabetes if your fasting blood sugar level is between 5.6 mmol/L (100 mg/dL) and 6.9 mmol/L (125 mg/dL).

Oral Glucose Tolerance Test (OGTT)

  • This test involves fasting overnight, followed by consuming a sugary solution.
  • Blood sugar levels are measured at intervals after consuming the solution (usually 1 and 2 hours).
  • If your blood sugar level at 2 hour after the glucose drink is between 7.8 mmol/L (140 mg/dL) and 11.0mmol/L (199 mg/dL), you may have pre-diabetes.

Hemoglobin A1c Test (HbA1c)

  • This test provides an average measure of your blood sugar levels over the past 2-3 months.
  • A HbA1c level between 6.0% to 6.9% may indicates pre-diabetes. Further testing with OGTT is required.

How Is Pre-Diabetes Treated?

The treatment of pre-diabetes is focused on making lifestyle changes to manage blood sugar levels and reduce the risk of progressing to type 2 diabetes. Pre-diabetes offers a critical opportunity to intervene and prevent the development of full-blown diabetes and its associated complications. The primary treatment strategies for pre-diabetes include:

Healthy Eating

Adopt a balanced and nutritious diet that includes a variety of whole foods, such as fruits, vegetables, lean proteins, whole grains, and healthy fats. Focus on controlling portion sizes, reducing refined carbohydrates and added sugars, and choosing foods with a lower glycemic index.

Physical Activity

Engage in regular physical activity, aiming for at least 150 minutes of moderate-intensity aerobic weekly exercise. Incorporate cardiovascular exercise and strength training to improve insulin sensitivity and support weight management.

Weight Management

If you’re overweight, losing a modest amount of weight (typically 5-10% of your body weight) can significantly improve insulin sensitivity and reduce the risk of type 2 diabetes.

Blood Sugar Monitoring

Your doctor may recommend periodic blood sugar monitoring to track your progress and determine how your lifestyle changes affect your blood sugar levels.


In some cases, especially if you have other risk factors or comorbidities, your doctor might consider prescribing certain medications to help manage blood sugar levels. These may include metformin or other medications.

Regular Follow-Up

Schedule regular check-ups with your doctor to monitor your progress, make necessary adjustments to your treatment plan, and address any concerns.

What Is the Role of Healthcare Professionals in Managing Pre-Diabetes?

Healthcare professionals are crucial in managing pre-diabetes by providing guidance, education, support, and medical interventions to help individuals reduce their risk of developing type 2 diabetes and its associated complications. The collaborative efforts of healthcare professionals ensure that individuals with pre-diabetes receive personalised care and strategies to make positive lifestyle changes.

Dr. Cho Li Wei 朱丽薇医生

Consultant Endocrinologist
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