Prediabetes: An Epidemic That’s Reversible -- Here’s What You Need to Know

Prediabetes — a condition that if left unchecked often leads to type 2 diabetes — is so common that U.S. public health officials often attempt to boost awareness about this relatively silent epidemic. The COVID-19 pandemic has spurred a new warning about prediabetes because the condition — along with fully diagnosed diabetes — puts individuals at higher risk for severe illness from COVID-19. 

In the U.S., some 88 million Americans — more than 1 in 3 — are living with prediabetes, and more than 80 percent don’t even know they have it. Prediabetes can increase a person’s risk of developing type 2 diabetes, heart disease, and stroke. It often has no symptoms and goes undetected because those with the condition often don’t see a doctor for regular check-ups that can detect prediabetes in a basic blood work up.

“About one-third of the American population is actually prediabetic, whether they know it or not, and sometimes in the context of being hospitalized for another problem, like a heart attack or pneumonia, they find out,” explains Pascual De Santis, M.D., endocrinologist at Baptist Health South Florida.

Recently, the American Medical Association (AMA), the U.S. Centers for Disease Control and Prevention (CDC) and the Ad Council launched a series of new public service announcements (PSAs) taking a serious look at prediabetes. As part of the Do I Have Prediabetes? campaign, anyone can go online to answer a few questions and determine their risk for prediabetes.

“Raising awareness of prediabetes and stressing the importance of people knowing their risk is critical, particularly now as the COVID-19 pandemic amplifies the negative health risks associated with chronic health conditions,” said AMA President Gerald E. Harmon, MD. “Through our latest campaign, we aim to help more of the millions of Americans living with prediabetes find out whether they have the condition.”

Prediabetes seems to be a major factor for many who patients hospitalized with COVID-19, studies have shown. Some patients are being newly diagnosed with diabetes. Most like it wasn’t COVID-19 that caused the chronic condition. Most likely, these patients went undiagnosed with type 2 diabetes because of a lack of regular screenings, said Dr. De Santis.

A fasting blood glucose level of less than 100 mg/dl is considered normal. A reading of 100 mg/dl to 125 mg/dl qualifies as prediabetes. After a two-hour test that checks your blood sugar levels before and after drinking a special sweet drink, a reading of 140 mg/dl to 199 mg/dl is considered prediabetic.

“That happens a lot, especially in men who just don’t go to the doctor,” Dr. De Santis said. “He may be obese, or is part of an ethnicity that puts him at risk for diabetes — and anything other than Caucasian is pretty much an ethnic group that is at risk for diabetes — and they are sedentary, then they are likely diabetic and may not know it until they get a severe form of COVID.”

In August, an updated guideline issued by the U.S. Preventive Services Task Force  calls for adults to be screened for type 2 diabetes or prediabetes starting at age 35, five years earlier than previous advised.

The new recommendation, which does not apply to pregnant women, came as rates of both prediabetes and diagnosed type 2 diabetes have reached new highs in the U.S. Under the new guidance, more than 40 percent of the adult population should be screened, according to some estimates.

Just weeks before the beginning of the COVID-19 pandemic, a study in the JAMA Pediatrics, published by the American Medical Association, found that nearly a quarter of young adults, ages 19 to 34, and a fifth of adolescents, ages 12 to 18, in the U.S. have “prediabetes” — a possible precursor to type 2 diabetes.

The following are prediabetes risk factors, according to the CDC:

• Being overweight
• Being 45 years or older
• Having a parent, brother, or sister with type 2 diabetes
• Being physically active less than 3 times a week
• Ever having gestational diabetes (diabetes during pregnancy) or giving birth to a baby who weighed more than 9 pounds