Prediabetes

Pre-diabetes is a condition in which blood glucose levels are too high, but not high enough
to be diagnosed as diabetes.

Pre-diabetes has no signs or symptoms.
This makes it challenging to diagnose. It is a
risk factor for developing type 2 diabetes and
cardiovascular diseases, such as heart disease
and stroke. Sixteen out of 100 of adults in
Australia have pre-diabetes.
Who is at risk of pre-diabetes?
Pre-diabetes usually occurs in adults, but younger
people can also develop this condition. Risk
factors for pre-diabetes are the same as those
for type 2 diabetes. These include:
• having a family history of type 2 diabetes
or pre-diabetes
• being above the healthy weight range
• having an inactive lifestyle
• having high blood pressure
• having high blood fats such as cholesterol and
triglycerides
• having little or poor sleep
• being from an Aboriginal or Torres Strait
Islander background
• being from a Pacific Islander, South Asian,
Middle Eastern or North African background
• having gestational diabetes during pregnancy
• having polycystic ovary syndrome
• taking steroids or other medications that can
cause high blood glucose levels.
People who have pre-diabetes can delay and, in
some cases, prevent developing type 2 diabetes
by following a healthy lifestyle. This includes
regular physical activity, making healthy food
choices and maintaining a healthy weight.
How is pre-diabetes diagnosed?
To diagnose pre-diabetes, your doctor or diabetes
nurse practitioner will send you to have your
blood glucose levels checked at a pathology lab.

Three blood tests that can be used:
A fasting blood glucose or a non-fasting
random blood glucose
This involves having blood taken from a vein in
your arm. This test may be done by fasting (after
nothing to eat or drink for at least eight hours) or
non-fasting. If the test shows your blood glucose
levels are above the target range – but not high
enough to be diagnosed as diabetes – you will
need further testing.
A glycosylated haemoglobin (HbA1c)
This involves having blood taken from a vein in
your arm. You do not need to fast. Your doctor
or diabetes nurse practitioner will determine if
your results are above the target range but not
high enough to diagnose diabetes. Your doctor or
diabetes nurse practitioner will decide if you need
further testing.
An oral glucose tolerance test (OGTT)
You will have a fasting blood glucose test first.
You will then be given a sugary drink and have
your blood checked again two hours later. The
results from the OGTT will show whether your
blood glucose levels are in the normal, pre diabetes or diabetes range.
If you have pre-diabetes, you will have one or
both of the following conditions:
Impaired fasting glucose. This is when your
fasting blood glucose level is higher than target
levels, but not high enough to be diagnosed as
diabetes.
Impaired glucose tolerance. This is when your
blood glucose level is higher than the target range
two hours after an OGTT. But it is not high enough
to be diagnosed as diabetes. Your fasting blood
glucose level may still be within target.
How is pre-diabetes managed?
Pre-diabetes is managed by making healthy
lifestyle changes to reduce the risk of developing
type 2 diabetes and heart disease.
Weight loss
If you are above the healthy weight range, losing
as little as 5 to 10% of your weight can help lower
blood glucose levels. For example, if your weight
is 100 kg, try to lose 5 to 10 kg. Weight loss can
reduce your risk of developing diabetes and other
conditions such as heart disease.
Regular physical activity
Being active can help you manage your weight
and reduce your blood glucose levels. It can also
help manage other risk factors such as blood
pressure and cholesterol levels. Aim to do at least
30 minutes of ‘moderate intensity’ physical activity,
such as brisk walking or swimming, every day.
• Include some resistance training, such as
body weight exercises like squats or lunges,
or light weights twice a week. This builds and
improves the way your muscles work.
• Reduce and break up sitting time. Get up and
move around every 30 minutes.
• An exercise physiologist can help you develop
an exercise plan and show you how to
exercise safely.
• Always talk to your doctor before starting any
new type of physical activity.
Healthy eating
Choose a wide variety of foods including fruit,
vegetables, legumes, less processed wholegrains,
lean meats no more than 2-3 times per week,
poultry, fish, eggs, tofu, and low-fat dairy foods.
Include high-fibre, low-glycemic index (GI)
carbohydrate foods. To manage your weight, it is
important to reduce your total energy (kilojoule)
intake. Limiting saturated fat can also help your
body’s insulin work better and keep blood fats in
the target range.
A dietitian can help by recommending the best
food choices for weight loss and for reducing your
risk of developing type 2 diabetes.
Blood pressure and blood fats
It is important to keep these in the target range
that your doctor recommends. Ask your doctor or
diabetes nurse practitioner how often you need to
have your blood pressure and blood fats checked.
No smoking
Smoking also increases your risk of developing
type 2 diabetes and heart disease. If you smoke,
try to quit. Some people find this challenging. Ask
for help if you feel you cannot give up smoking on
your own.