Dr Aidin Rawshani

Prediabetes: a precursor to type 2 diabetes


What is prediabetes?

Before a person develops type 2 diabetes, there are different precedes of the disease that lasts for many years. It is therefore important to know the risk factors that contribute to the disease when several are preventable. Obesity and overweight are probably the most well-known risk factors for the development of diabetes. The incidence of obesity and overweight is increasing avalanche throughout the world, and in a few years more than 2 billion people will suffer from these conditions.

The main factors for the development of obesity/excess weight are sedentary lifestyle and poor diets. Lack of exercise and sedentary lifestyle is harmful to health, keeping active strengthens the body’s sensitivity to the hormone insulin and helps the hormone to become more effective in the body’s various tissues.

Population studies show that 90% of all people with type 2 diabetes around the world are overweight. The Western diet with processed foods, poor food fats, high carbohydrate levels and little fiber content is considered to contribute to diabetes and the metabolic syndrome.

What is prediabetes?

The body has several biological systems that control the amount of glucose in the blood (blood sugar) to keep blood sugar levels at a moderate level. The main organs involved in blood sugar metabolism are pancreatic (pancreas), skeletal muscles, liver, adipose tissue and the brain.

The glucose value in the blood should not be too low, the cells of the body cease to function as usual and take great harm at low blood sugar levels (hypoglycemia). High blood sugar levels are also harmful to the tissues of the body, especially the blood vessels, but the damage occurs over a longer period of time.

Diagnosis criteria for prediabetes and type 2 diabetes

The diagnosis is made by analyzing blood samples that measure glucose levels in the blood.

Prediabetes is divided into three different forms:

  • Impaired fasting glucose'(IFG) is defined as a fasting blood sugar level of 6,1—6,9 mmol/l.
  • Impaired glucose tolerance (IGT) is defined as a fasting blood sugar level of 7,8-11,0 mmol/L in venous blood or 8,9 to 12,1 mmol/L as a capillary sample two hours after ingestion of 75 grams of glucose.
  • Intermediate hyperglycaemia (HbA1c between ≥ 42 and 48)

An elevated fasting glucose and impaired glucose tolerance (IGT) can both be identified by a glucose load test. The person first leaves a blood sugar test on an empty stomach, then 75 grams of glucose is taken with water, followed by another blood sugar test two hours later.

Diagnosis criteria for type 2 diabetes:

  • Elevated fasting glucose ≥ 0 mmol/l on two occasions
  • Elevated long-term blood sugar (HbA1c) ≥ 48 mmol/mol at one time
  • Non-fasting blood glucose ≥ 11.1 mmol/l at one time
  • Oral glucose tolerance test (OGTT) where plasma glucose ≥ 12.2 mmol/l

Some people have glucose values that are in a risk zone, which means that blood sugar levels are slightly elevated but not enough to be diagnosed with type 2 diabetes. Research has shown that these people are at greater risk of developing diabetes and the condition is therefore called prediabetes.

Prediabetes is very common, approximately 10 -15% of the population in Sweden meet the criteria. In addition to obesity and overweight, blood pressure, cholesterol and old age contribute to the development of prediabetes. The ability of the pancreas to produce and excrete insulin decreases as we age, in addition, the body’s insulin sensitivity deteriorates with age.

Risk factors for prediabetes

Elevated glucose value in the blood is just one of several risk factors, and therefore it is important not to look only at glucose values. Other risk factors include:

  • Obesity (especially abdominal obesity)
  • Insufficient physical activity.
  • Age 45 years
  • Elevated blood pressure
  • Increased blood fat increase sleep apnea
  • Heredity for type 2 diabetes, obesity or other cardiovascular diseases Non-fasting blood glucose > 8 mmol/l

To reduce the risk of type 2 diabetes, it is important to reduce or remove as many risk factors as possible. An epidemiological research study called the Diabetes Prevention Program (DPP) study showed that approximately 35% of all individuals with impaired glucose tolerance (IGT) develop type 2 diabetes over a four-year period.

The risk of getting sick with diabetes is reduced if the individual changes lifestyle factors such as increased physical activity, improved diet, medication or surgical treatment. A Swedish study from 2009 showed that 40% of individuals who meet the criteria for prediabetes develop later type 2 diabetes. 2 -15% of subjects with prediabetes develop type 2 diabetes annually.


Prediabetes presents a significantly increased risk for the development of type 2 diabetes, if no intervention occurs, the natural course is that a significant proportion of those with prediabetes develop type 2 diabetes within 5-10 years. Most population studies show that prediabetes presents a 3—10-fold increased risk of developing diabetes compared to people with normal blood sugar levels (normoglycaemic individuals). For people with both impaired glucose tolerance (IGT) and elevated fasting glucose (IFG), a synergistic risk increase for the development of type 2 diabetes is seen.

Complication in prediabetes

Individuals with untreated pre-diabetes may develop several conditions in addition to type 2 diabetes.

The complications most associated with prediabetes are as follows:

  • Type 2 Diabetes
  • Cardiovascular disease — atherosclerosis of blood vessels supplying the heart muscle (coronary heart disease), heart failure and several other heart diseases.
  • Stroke — various forms of cerebral hemorrhage, blood vessel fat in the brain
  • Nervous damage — diabetes-related nerve damage (peripheral or autonomic)
  • Diabetes neuropathy (Renal damage) — vascular changes in the kidney cause impaired renal filtration (diabetes nephropathy)
  • Eye damage — vascular changes in the eye that may eventually lead to blindness, high blood sugar levels are also associated with cataract and glaucoma bone disease — vascular disease of the eye lower legs and feet (peripheral vascular disease).
  • Skin infections — increased risk of skin infections and infections of the oral cavity and swallow
  • Alzheimer’s disease — the cause of Alzheimer’s disease is unknown to date but several observational and molecular studies show that diabetes and prediabetes contribute to increased risk on Alzheimer’s disease
  • Osteoporosis (Osteoporosis) — Osteoporosis can lead to various disease conditions where the most common are fractures
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