If you have received a diagnosis of prediabetes—your blood sugar is higher than normal, but not high enough to be classified as type 2 diabetes—you've already been told you are at increased risk of getting type 2 diabetes.
You may be freaking out. And you're probably wondering: So how high is my risk?
To find out, researchers evaluated 77,000 people with prediabetes, ages 18 to 75, and all members of the Kaiser Permanente health plan, for two years. By tracking which people were likely to get diabetes soon after the prediabetes diagnosis, the researchers could develop a plan for which patients need the most intervention from their doctors to reduce their risk.1
Bottom line? Most had a very small risk of progressing to full-blown diabetes, at least in that two-year period. "A little over five percent (5.2%) went on to get type 2 diabetes right away," says study co-author Gregory A. Nichols, PhD, a senior investigator at Kaiser Permanente Health Research Center, Portland. The others did not, and at the end of the two years, 13.3% of them were classified as moderate risk for getting it, and 81.5% were at much lower risk, at least during the two-year follow up.1
The degree of risk depended on two factors, they found: how high the A1C was when they were diagnosed with prediabetes and what the person's body mass index or BMI was.
"The range [for A1C] for a diagnosis of prediabetes is 5.7 to 6.4%," Dr. Nichols says. A healthy BMI is defined as one that is 18.5 to 24.9.
The highest risk of developing type 2 diabetes during the follow-up was among those ''who had a very high BMI--of 36 or greater--and an A1C of 6.3 or 6.4," Dr. Nichols says. A fifth of this group, 20.7%, developed diabetes.
(Perspective: A 5' 8" person who weighs 237 has a BMI of 36, considered obese. If that person weighs 160, their BMI would be 24.3, or healthy. Calculate BMI here.)
No one should ignore a diagnosis of prediabetes, of course, Dr. Nichols tells OnTrack Diabetes, but the study suggests some people are at higher risk of getting it, at least in the immediate period after the diagnosis, than others.
His finding that the higher the A1C, the higher the risk is not surprising.
But did a healthy BMI protect against getting diabetes? Somewhat, it appears, at least in the two-year study period. For instance, while 20% of those who had an A1C of 6.3 or 6.4 and were obese developed diabetes, 8% of those with the same high A1C but a BMI below 25 developed it during the follow-up.
And of those who had a healthy BMI, below 25, and an A1C of 5.7-5.8, the beginning of the prediabetes range, less than 1% —.4%—got diabetes in the next two years.
Because the health care plan members studied came from the U.S Northwest, Hawaii and Georgia, many ethnicities, cultures and lifestyle habits were included, Dr. Nichols says.
The study findings suggest that if people pay attention to a prediabetes diagnosis and view it as an opportunity to make changes, it may at least delay a diabetes diagnosis, says Amy Hess-Fischl, MS, RD, LDN, CDE, the transitional program coordinator at Kovler Diabetes Center in Chicago and an editorial board member for OnTrackDiabetes. She reviewed the findings.
"This could be considered a wakeup call that by making some small lifestyle changes, it can keep their blood glucose levels in line for 5-10 years or more," she says. She bases that statement on studies such as the Diabetes Prevention Program, which found that reducing excess weight and increasing physical activity greatly reduced the chances of getting diabetes in those diagnosed with prediabetes.2
"Not everyone [with prediabetes] will escape diabetes, though, so it is important that if they get on this now, they have a fighting chance," Hess-Fischl says.
The tricky part may be finding affordable or free diabetes education, beyond the advice your doctor gives you, Hess-Fischl says. That challenge is changing, she says, citing the recent decision by the Centers for Medicare & Medicaid Services (CMS) to cover diabetes prevention education, effective April 1, for certain people who meet the criteria and if the education is given as specified.3
Some diabetes centers offer annual diabetes prevention classes free of charge, too, she says. Check to see if your health plan does. Or, another possibility is to attend diabetes expos, Hess-Fischl says.
She says that the education on how to achieve healthy blood sugar levels and get to a healthy weight must be frequent and ongoing, such as weekly classes for six months and then monthly for another six months.
Hess-Fischl reports work as a consultant for Abbott Diabetes Care.