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What is Prediabetes?

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What is Prediabetes?

You’ve probably heard of type-2 diabetes before, but have you ever heard of prediabetes?

Some peoples’ bodies cannot control blood glucose levels correctly because of a defect in the way that they produce or respond to insulin, the hormone that usually helps to return elevated blood glucose levels to normal. If your blood glucose levels are consistently high enough, your doctor will diagnose you as being diabetic. Having your blood glucose levels elevated for a long time can cause damage to many of the body’s organs,1 so it is important to correctly manage diabetes to maintain an appropriate blood glucose level, or better yet, to avoid the onset of diabetes entirely!

If your blood glucose is higher than normal, but not quite high enough to be considered diabetic, you are prediabetic.

People who are prediabetic are more likely to become diabetic than people who are not prediabetic. The good news is that even if you are prediabetic, diabetes can be avoided. Simple changes to your lifestyle can delay, and in some individuals, prevent diabetes from developing. So rather than being bad news, being identified as prediabetic gives you a second chance to make the changes necessary to hopefully avoid developing diabetes.

Prediabetes Vs. Diabetes

Prediabetes

In prediabetes, blood glucose levels are raised above healthy levels, but are not high enough to be in the diabetic range, indicating increased risk for developing diabetes.

There are no obvious signs or symptoms – 9 out of 10 people with prediabetes are completely unaware they are prediabetic.

Finding out you are prediabetic gives you the opportunity to control your blood glucose levels before it progresses to diabetes; prediabetes may be your opportunity to turn things around.

Diabetes

Diabetes is a disease that occurs when there is not enough insulin in the blood to reduce blood glucose to a safe level.

Symptoms include tiredness, increased thirst and hunger, and more frequent urination.

Managing diabetes is vital to prevent irreversible damage to your organs due to high blood glucose levels.

The Assessments

Fasting plasma glucose 5.6–6.9 mmol/L (100–125 mg/dL)

2-hour plasma glucose 7.8–11.0 mmol/L (140–199 mg/dL)

HbA1c 5.7–6.4%

Fasting plasma glucose ≥7.0 mmol/L (≥126 mg/dL)

2-hour plasma glucose ≥11.1 mmol/L (≥200 mg/dL)

HbA1c ≥6.5%

Adapted from the American Diabetes Association (ADA)

Will diabetes progress to prediabetes?

25 Percent (%)

Prediabetes will progress to overt type 2 diabetes (T2DM) in approximately 25% of people within 3-5 years.

70 Percent (%)

As many as 70% of individuals with prediabetes will develop overt diabetes within their lifetime.

Unawareness

Many people with prediabetes are completely unaware they have it.

Good News

The good news is that prediabetes may be reversible through the implementation of lifestyle modification programmes based on the adaptation of a healthier diet and increased levels of physical activity as well as treatment intervention where required.

Impaired glucose tolerance and impaired fasting glucose

In 2021, 541 million adults, or 10.6% of adults worldwide, are estimated to have impaired glucose tolerance (IGT). By 2045, this figure is projected to increase to 730 million adults or 11.4% of all adults.

In 2021, there are an estimated 319 million adults, or 6.2% of the global adult population, with impaired fasting glucose (IFG). An estimated 441 million adults or 6.9% of the global adult population are projected to have IFG in 2045.

Regional distribution

The age-adjusted prevalence of IGT in 2021 was highest in the Western Pacific Region and lowest in the South-East Asia Region (Table 3.15). The age-adjusted prevalence of IFG in 2021 was highest in South and Central America and lowest in the Western Pacific (Table 3.16).

Age distribution

The prevalence of IGT is estimated to increase with age (Figure 3.10). In 2045, the prevalence of IGT is expected to increase in young adults (aged 45 years or younger) and the very old (aged 70 years or older), and slightly decrease among middle-aged adults (aged 45–69 years). The 2021 prevalence of IFG was higher in older age categories and peaked among persons aged 60-64 at 8.1%. The prevalence of IFG is projected to increase across all age categories by the year 2045 (Figure 3.11).

Income distribution

For IGT, the age-adjusted prevalence in 2021 was highest for low-income countries and lowest for middle and high-income countries (Table 3.17). The age-adjusted prevalence estimates of IFG in 2021 were similar across high (5.7%), middle (5.7%), and low income (5.8%) countries (Table 3.18).

Summary

The 2021 global prevalence estimates of IGT and IFG are substantial and are projected to increase by 2045. Currently, however, there is no consensus definition of “prediabetes”. There are at least five different definitions endorsed by different clinical organisations and guidelines. Studies that reported only the American Diabetes Association (ADA) threshold for IFG (5.5–6.9 mmol/L [100–125 mg/dL]) were not included in this report.

The prevalence estimates of IFG based on ADA IFG would be higher than for estimates based on the WHO IFG criterion. Regardless of how defined, intermediate states of hyperglycaemia are common and a growing problem, suggesting major challenges for future risk of diabetes across the globe.

Figure 3.10 Prevalence of impaired glucose tolerance in adults (20–79 years) in 2021 and 2045, by age group

Table 3.15 Age-adjusted prevalence of impaired glucose tolerance (20–79 years) by IDF regions, ranked by 2021 prevalence (%)

 2021 2045 (projected)

Rank

IDF Region

Age-adjusted comparative IGT prevalence (%)

Number of people with IGT (millions)

Age-adjusted comparative IGT prevalence (%)

Number of people with IGT (millions)
1 WP 12.9 253.0 14.0 291.8
2 AFR 12.6 52.5 14.1 116.7
3 NAC 11.6 47.0 13.0 56.6
4 MENA 11.2 47.6 11.7 80.5
5 SACA 10.9 39.6 11.7 52.7
6 EUR 7.1 54.8 7.8 55.3
7 SEA 5.4 46.9 5.8 76.6

IGT: Impaired glucose tolerance; IDF: International Diabetes Federation; AFR: Africa; EUR: Europe; MENA: Middle East and North Africa; NAC: North America and Caribbean; SACA: South and Central America; SEA: South-East Asia; WP: Western Pacific

Table 3.16 Age-adjusted prevalence of impaired fasting glucose in adults (20–79 years) by IDF regions, ranked by 2021 prevalence (%)

 2021 2045 (projected)

Rank

IDF Region

Age-adjusted comparative IGT prevalence (%)

Number of people with IGT (millions)

Age-adjusted comparative IGT prevalence (%)

Number of people with IGT (millions)
1 SACA 10.0 47.0 10.6 62.8
2 SEA 8.8 95.2 9.3 125.4
3 NAC 8.3 31.6 8.7 37.6
4 AFR 8.0 40.9 7.6 84.7
5 MENA 6.1 28.9 6.3 47.5
6 EUR 3.3 25.6 3.7 26.7
7 WP 2.5 49.7 2.7 56.0

IFG: Impaired fasting glucose; IDF: International Diabetes Federation; AFR: Africa; EUR: Europe; MENA: Middle East and North Africa; NAC: North America and Caribbean; SACA: South and Central America; SEA: South-East Asia; WP: Western Pacific

Table 3.17 Age-adjusted prevalence of impaired glucose tolerance in adults (20–79 years), by World Bank income classification

Impaired Glucose Tolerance 2021 2045

World Bank income classification

Age-adjusted comparative IGT prevalence (%)

Number of people with IGT (millions)

Age-adjusted comparative IGT prevalence (%)

Number of people with IGT (millions)
High-income countries 10.4 116.6 11.6 124.4
Middle-income countries 10.0 391.5 10.7 531.0
Low-income countries 12.7 33.0 14.3 75.0

IGT: Impaired glucose tolerance

Table 3.18 Age-adjusted prevalence of impaired fasting glucose in adults (20–79 years), by World Bank income classification

Impaired Glucose Tolerance 2021 2045

World Bank income classification

Age-adjusted comparative IGT prevalence (%)

Number of people with IGT (millions)

Age-adjusted comparative IGT prevalence (%)

Number of people with IGT (millions)
High-income countries 5.7 64.6 6.3 69.2
Middle-income countries 5.7 236.9 6.3 331.3
Low-income countries 5.8 17.5 6.0 40.3

IGT: Impaired glucose tolerance

Figure 3.11 Prevalence of impaired fasting glucose in adults (20–79 years) in 2021 and 2045, by age group

Map 3.6 Age-adjusted comparative prevalence of impaired fasting glucose in adults in 2021

Map 3.7 Age-adjusted comparative prevalence of impaired glucose tolerance in adults in 2021

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