Dr Aidin Rawshani

Prediabetes — Treatment


Prediabetes — how to prevent prediabetes from developing into type 2 diabetes

Treatment in prediabetes is similar to treatment in type 2 diabetes. The most important component in the treatment of prediabetes is lifestyle changes. Studies have shown that lifestyle changes such as increased physical activity and better nutrition can reduce the risk of developing type 2 diabetes.


Lifestyle measures

  • Smoking – cigarette smoking contributes to impaired blood circulation and reduced sensitivity to insulin (insulin resistance) outside the body’s various tissues (especially skeletal muscles, liver and adipose tissue). Smoking has been shown to increase the risk of type 2 diabetes by 30%. Smoking cessation is extremely important to reduce the risk of type 2 diabetes in individuals with prediabetes. Quitting smoking cigarettes has been shown to reduce the risk of developing diabetes by up to 50%.
  • Nutritional habits such as high consumption of fruits and vegetables, legumes, fish, whole grain products and nuts are an important cornerstone in the treatment of prediabetes. Research shows that individuals with reduced glucose tolerance (IGT) have approximately 60% reduced risk of developing type 2 diabetes if they increase their low-fat diet intake, increase fibre intake while improving their physical activity level. Low calorie diet combined with low fat intake seems to have synergistic effect to counteract the development of type 2 diabetes in people with prediabetes.
  • Exercise physical activity of moderate intensity, i.e. at least 150 minutes of physical activity per week or at least 30 minutes daily at moderate The level of intensity has been shown to reduce the risk of developing diabetes in individuals with impaired glucose tolerance (IGT). Increased physical activity level should be combined with improved diet habits. Doctors most often recommend training at a moderate intensity level for 30 minutes a day, for example, cycling, swimming or fast walking. It helps prevent and deal with prediabetes and even diabetes.
  • Weight loss is a difficult challenge, but studies show that the beneficial effects of weight loss occur very early in weight loss. If you are overweight and lose about 5 to 10 percent of your body weight (4.5 to 9 kilos on average), the risk of developing type 2 diabetes is significantly reduced. In addition, once you lose weight, several other risk factors for cardiovascular disease are improved. To maintain your weight loss and avoid regaining the excess weight you lost, it is recommended that the person focus on permanent changes in their eating and training habits. It helps to motivate yourself by remembering the benefits of weight loss, such as improving self-esteem, getting more energy and a healthier body.

In addition, it is important to treat other risk factors, such as increased blood pressure (hypertension), elevated blood lipidemia (hyperlipidemia) and overweight/obesity.

Pharmacological treatment

Note that no medicine in Sweden has pre-diabetes as an approved indication, which does not prevent qualified users from exercising their free prescribing right.

  • Metformin
    Metformin is a medicine that lowers blood sugar levels by reducing liver sugar production (gluconeogenesis), increases insulin sensitivity (insulin resistance) and at the same time reduces sugar absorption from the gastrointestinal tract. In the US DPP study, treatment with metformin reduces the risk of developing type 2 diabetes by approximately 30% in people with impaired glucose tolerance (IGT).
  • Orlistat
    Orlistat is a drug that blocks enzymes in the gastrointestinal tract (lipases) that decompose fats to fewer constituents. This means that the body gets worse on absorbing shortening fat. Studies have shown that treatment with orlistat for 4 years resulted in 37% lower risk for the development of type 2 diabetes in individuals with impaired glucose tolerance (IGT)
  • Acarbose
    Acarbose is a drug that blocks enzymes of the gastrointestinal tract (alpha-glucosidases) that break down carbohydrates to less molecules. Akarbose has been shown to be an effective method of treatment in reducing the transition from reduced glucose tolerance (IGT) to type 2 diabetes by 25%. 
  • Pioglitazon
    Pioglitazones increase insulin sensitivity in the body by binding to a specific molecule (PPAR gamma). Treatment with pioglitazone for people with impaired glucose tolerance (IGT) reduced the risk by 72% for the development of type 2 diabetes.
  • Antihypertensive drugs
    Some antihypertensive drugs (thiazide diuretics and beta-blockers) are known to contribute to the development of diabetes. On the other hand, there are other antihypertensive therapies that have shown a clear inhibitory effect on the development of diabetes (ACE inhibitors and ARBs) 
  • Statins
    New research shows that long-term treatment with blood-lowering therapy (statins) is likely to increase the risk of developing type 2 diabetes with approximately 10%, regardless of whether you have reduced glucose tolerance or not. However, statins have a clear protective effect against cardiovascular diseases that exceed the risk of developing diabetes.

Surgical treatment

Various forms of obesity surgery (obesity surgery) can lead to a powerful and prolonged weight loss in patients with BMI 40 kg/m2 or individuals with type 2 diabetes and BMI 35 kg/m2. Surgery has also been shown to produce powerful anti-diabetic effects, as well as return of type 2 diabetes in several cases.

Losing as little as 5% to 10% of your body weight makes a clear difference, this is particularly evident when examining how different risk factors are improved by a light weight reduction.

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