Prediabetes is a clinical inflection point and a modifiable risk state. Small shifts in care can translate to big shifts in health outcomes.
of people are unaware they have it — yet, it’s not to be taken lightly: Untreated over the course of 5 years, many with prediabetes go on to develop type 2 diabetes . “Cellular changes are already happening in prediabetes,” explained Kevin Miller, DO, board-certified family physician and member of the American Diabetes Association’s Primary Care Committee, “but I often tell patients that they are still in my ‘prevention club.
’ I’m trying to protect the cells from further damage and progression.” Mihail Zilbermint, MD, an associate professor of clinical medicine in the Division of Endocrinology, Diabetes, and Metabolism at Johns Hopkins Medicine, Baltimore, said that “we need to treat prediabetes as an actual diagnosis — not just a warning sign.” The condition, he said, marks a critical window for primary care physicians to intervene to improve health. There are no US Food and Drug Administration –approved medications specifically for prediabetes, and due to systemic barriers, prediabetes can be overlooked. With the right tools and systems in place, however, it can be properly addressed to prevent disease progression and improve health.Anne Peters, MD, director of the University of Southern California Clinical Diabetes Programs, Los Angeles, noted that early intervention with prediabetes is key.“It wasn’t until the DPP that we really showed that if you have a healthy lifestyle and/or take metformin, we can help you not progress to diabetes,” said Peters. “In many cases, people would go back to more normal glucose tolerance.”with increased risk for all-cause mortality and both macro- and microvascular disease risk, including cardiovascular disease and chronic kidney disease. “Microvascular complications really begin long before diabetes is diagnosed,” said Zilbermint. People with prediabetes often have other coexisting health concerns, including hypertension, abnormal cholesterol levels, sleep apnea, or gout — all worth treating, said Peters.“My heart goes out to the primary care physicians; we know they don’t have enough time to address all the problems,” said Zilbermint. Peters added that patient adherence to lifestyle interventions has always been difficult. “It’s hard to get patients motivated to adopt healthy habits, and until the recent advent of the GLP-1 receptor agonists, it’s been hard to get people to lose weight.” Yet even in constrained clinical environments, small interventions — such as timely screening, structured referrals, and judicious pharmacotherapy — can translate into long-term reductions in morbidity.indicating prediabetes are a fasting blood glucose of 100-125 mg/dL, a glycated hemoglobin of 5.7%-6.4%, or an oral glucose tolerance test 2-hour blood glucose of 140-199 mg/dL. Peters said that too often, small elevations in glucose — say, a fasting blood glucose of 110 mg/dL — can get written off in primary care settings as “nothing to worry about.” However, she stressed the need to act.can prompt lifestyle changes. Miller educated patients on some of the “ominous octet,” or disruptions in normal bodily processes that contribute to the development and progression of type 2 diabetes. He used numbers as a gauge and explained prediabetes as a yellow zone. “I often tell my patients, ‘Let’s take the car in to get some work done,’” he said. Peters encouraged providers to frame conversations about change around the present and future, noting that modest changes make an impact. For those with prediabetes, a 7% weight loss reduced the risk of developing type 2 diabetes by 58%, per the DPP. “The more someone can shift to a healthier place, the healthier they’ll be,” she said.A prediabetes diagnosis can be overwhelming. Patients may have fears around family history or a resistance to change. Approaching conversations with kindness and empathy is important. “There’s a whole psychology to diabetes,” said Peters. “Diabetes isn’t about shame or blame. Some people are genetically prone to have prediabetes, and this is a manageable issue.”Despite evidence of their effectiveness, only 36% of primary care physicians refer patients to a diabetes prevention lifestyle change program reported prescribing it. Weight loss medications — such as GLP-1 receptor agonists or sodium-glucose cotransporter 2 inhibitors — can treat prediabetes, too, said Peters, who noted that they can improve blood sugars and overall health.All material on this website is protected by copyright, Copyright © 1994-2025 by WebMD LLC. This website also contains material copyrighted by 3rd parties.
Diabetes Mellitus Type Ii Type 2 Diabetes Type 2 DM T2DM T2D Primary Care Prediabetes Borderline Diabetes Blood Weight Loss GLP-1 Receptor Agonists Glucagon-Like Peptide-1 Receptor Agonists Renal Disease Kidney Disease Kidney Disorder Renal Disorder Nephropathy Hypertension
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