Many miss prediabetes wake-up call

Anthony Komaroff, MD

Editor in Chief, Harvard Health Letter

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Type 2 diabetes doesn’t usually appear all of a sudden. Many people have a long, slow, invisible lead-in to it called prediabetes. During this period, blood sugar levels are higher than normal. However, they’re not high enough to cause symptoms or to be classified as diabetes. It’s still possible at this stage to prevent the slide into full-blown diabetes. Think of prediabetes as a wake-up call.

Unfortunately, few people ever hear the alarm. A new report from the Centers for Disease Control and Prevention shows that among Americans age 20 and older, only 10% of those with prediabetes know they have it. Given that as many as 73 million Americans have prediabetes, that’s a lot of missed opportunities to prevent the ravages of diabetes.

One reason many people don’t know that they may be headed toward diabetes is they’ve never had their blood sugar tested. This simple test isn’t part of routine preventive care. The U.S. Preventive Services Task Force recommends blood sugar “screening” only in individuals with high blood pressure. (Screening means hunting for hidden disease in the absence of any outward signs or symptoms.) That’s important, because recommendations from the Task Force, an independent panel of experts, are used by many health-care organizations to determine preventive care. In addition, Task Force recommendations will help determine what services are covered under the Affordable Care Act.

Expanding the net

The American Diabetes Association and other organizations recommend routine blood sugar testing in people at high risk for developing diabetes. These include:

  • everyone over age 45
  • younger people who are overweight and who also have one of these diabetes risk factors:
    • little or no physical activity
    • family history of diabetes
    • high blood pressure or high cholesterol
    • previous diagnosis of heart disease or polycystic ovary syndrome
    • diabetes during pregnancy (gestational diabetes) or having delivered a baby weighing more than nine pounds

Some experts are encouraging the U.S. Preventive Services Task Force to expand its recommendation on blood sugar screening.

Why bother?

Not everyone with prediabetes will go on to develop diabetes. Over the short term (three to five years), about 25% of people with prediabetes develop full-blown diabetes. The percentage is significantly larger over the long term.

Getting the wake-up call of prediabetes can be very useful. A three-part strategy can keep many people with it from ever getting diabetes. The strategy includes modest weight loss, increased physical activity, such as walking 30 minutes a day, and choosing a healthier diet. In addition to helping stave off diabetes, these lifestyle changes can also help protect against heart attack, stroke, bone-thinning osteoporosis, and a host of other chronic conditions.

Those efforts are worth it, because diabetes can cause damage throughout the body. Extra glucose (blood sugar) can change the way blood vessels behave, increasing the chances of having a heart attack, stroke, or other form of cardiovascular disease. Diabetes-related damage to small blood vessels can lead to blindness, kidney disease, and loss of feeling. It is a leading cause in the United States of hard-to-treat infections and amputations.

Providing more people with a wake-up call that diabetes may be looming, and heeding that call, could help battle the epidemic of diabetes.


  1. Bob

    My family has a history of diabetes, just like some of the other people on the blog. I do try to take the best care of myself as possible, such as dedicating to fitness and regular eating. The shame in my opinion is that eating right and taking the right steps to prevent or reduce diabetic concerns really costs a lot of money (thinking about organic foods and things like that).

    Thanks for the great inside behind the prediabetic info. We can battle this for sure!


  2. michael Pall

    Many people in my family have Diabetes and i have learned to watch for signs so i don’t fall in the same steps and i watch my health very carefully

  3. Charles L. Marino

    Diabetes is the most dangerous disease which is growing very rapidly. In our already my Dad, Sister, Uncle and mother-in-law are suffering in this disease. So I saw that’s very closely how it effects on eyes, legs, heart, kidneys etc. Almighty save us from this disease.

  4. Jose Agustin Visaez

    Many people in my family have Diabetes and i have learned to watch for signs so i don’t fall in the same steps and i watch my health very carefully. People need to start watching for signs because this can be treated early so things dont get worse then needed.

  5. Stalina Dsouza

    So I have something called Metabolic syndrome or prediabetes, not sure which it is but I can tell you when I eat pizza, ice cream or cake that two hours later my blood sugar is in the 150’s to 160’s but normally I manage to keep it under 130 during the days.

    My morning fastings run around 96 and 117. So I read something that said to take BS at 3 a.m. to see if too low and rising later to compensate…so I did just that.

    When I went to bed my BS was 154 (stupidly had too much pizza) at 3 a.m. I was at 82 and felt wide awake, great and hungry. Of course too early to get up so went back to bed, didnt sleep well anyways, but got up at my usual 5:00 a.m. and took my BS at same time as always and now it was 101 again as pretty par for the course.

    I know about the dawn phenonemen thing, so if I wait another hour to check it again i will be up to about 111….ok so does all of this mean anything? Is this all the way its suppose to be? I’m just curoius is all.

    I just started on metformin and am only taking 1/2 of a 500 mgs pill and working my way up to the 500 slowly so as not to get too many side effects that i’ve heard of…thanks for any replies.

  6. DiabetesCureGuide

    Exactly. It does happen many times. Even though there are number of ways to recognize people still don’t which is obviously the reason for increase rate of diabetes

  7. Ian

    I appreciate the emails I get from this service. Especially as I have recently been diagnosed with diabetes.

    I have a comment though. The adjective “full-blown” as in “Over the short term (three to five years), about 25% of people with prediabetes develop full-blown diabetes.” See above). is utterly meaningless and confusing. We went though this with AIDS when people talked about “full-blown AIDS”. One either has the disease or doesn’t. Please ditch the useless, confusing and scientifically-stupid term.

  8. removalist gold coast

    My family doesnt have familial history of diabetes Am i likely to have this disease? I gain weight and constantly overweight my metabolism are slow and sits on computer for more than 8 hours, no exercise.

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