What is prediabetes?

· Prediabetes describes people who are at risk to develop diabetes. Like patients with diabetes, they often don’t have symptoms. If they do, the most common ones are increased frequency of urination, increased thirst, and blurry vision. These symptoms arise because of higher sugar levels in the blood stream. Fundamentally, the problem in diabetes is that the body either doesn’t produce enough of a signaling hormone called insulin to process sugar (type 1) or the body doesn’t respond to the insulin that is produced (type 2).

· More than 90% of diabetic patients are classified as type 2, and approximately 30% of Americans are can be considered to have prediabetes. Prediabetes can be detected through lab testing. In prediabetes, the blood sugar concentrations are higher than normal (fasting glucose >100, HbA1c >5.7), but do not meet the cut off for to be considered as diabetes (fasting glucose >126; HbA1c > 6.5).

If I have prediabetes, will I automatically get type 2 diabetes?

· No. People with prediabetes do have an increased risk to progress to diabetes. In fact, about one in four people with prediabetes will develop diabetes in five years. However, this progression is preventable through lifestyle modifications.

What changes can I make to prevent getting type 2 diabetes?

· The main risk factors that contribute to diabetes are being overweight and not being active. To prevent diabetes, the first steps would be to adjust diet and exercise.

· For dieting, the goal is to cut back on foods that are high in sugars, especially sugary drinks like sodas, while increasing intake of fruits and vegetables. Additionally, not all carbs are the same. We’ve known since the 80s that eating potatoes will raise the sugar peak much faster than eating the same amount of whole grains. Foods that have complex carbs and those with a higher fiber content release sugar more gradually rather a sharp peak. In contrast, processed foods tend and sugary drinks tend to have more simple sugars that raise the glucose level quicker.

· For exercising, try to be active for 30 minutes each day. Going to the gym is great, but even activities like walking are beneficial. A weight loss goal of 5-10% of body weight can significant decrease the risk of diabetes.

· If you are a smoker, quitting smoking is also helpful to reduce the risk and is beneficial for your cardiovascular health in the long run.

· If these first steps are not effective, the next approach would be to start medications. Metformin is a commonly utilized drug in patients with diabetes and has been shown to decrease the progression from prediabetes to diabetes.

If I have prediabetes, will it affect by ability to get pregnant?

· Yes. While we know that women with diabetes can get pregnant, the complete answer is that people with prediabetes usually have several associated conditions that can make getting pregnant more difficult. They tend to have more irregular periods, often because of the excess weight. Polycystic ovarian syndrome (PCOS) is

frequently found in women who have prediabetes and can also contribute to decreased fertility rates.

· More importantly, we know that women who have poorly controlled diabetes have almost double the miscarriage rate. They are also four times more like to have fetal congenital anomalies. These include cardiac defects and nervous system anomalies such as spinal bifida. Diabetic women who are able to get good glucose control do not have this risk.

· Later in the pregnancy, maternal complications from poorly controlled diabetes are mainly cardiovascular. These include preeclampsia and kidney damage. From the fetal perspective, because more sugar is in the blood stream, the baby tends to put on more weight. This excess weight increases the risk of birth injury, with shoulder and nerve injuries being the most common.

· After birth, babies born to diabetic moms can have fluctuations in their own sugar levels. This is because baby was more previously in a higher sugar environment, and the removal of that environment can lead them to develop low sugars.

What can I do to manage prediabetes during pregnancy?

· The best approach would be to control prediabetes before you even get pregnant. If you plan to get pregnant, it is helpful to meet with your physician for a preconception visit to review your medical history and perform a risk assessment. Every patient who intends to get pregnant should be screened for diabetes, thyroid function, and have their medication list thoroughly reviewed.

· During pregnancy, the first step is dietary. The goal should be to avoid single large meals with foods that quickly raise the blood sugar. This means choosing complex carbs such as whole grain over highly refined foods. I recommend three normal meals with additional snacks interspersed. I also recommend dietary counseling with a certified diabetes educator. Moms should be checking their sugars sugar fasting as well as after meals to gauge the efficacy of the dietary management.

· If dietary changes alone are insufficient, then the next step would be medications. These can come in the form of pills or insulin injections.

What is the relationship between prediabetes and gestational diabetes?

· These two are very closely connected. Gestational diabetes (GDM) is often the first sign that a woman will have prediabetes or diabetes down the road. The best data comes from a 2018 international, multiethnic study that looked at moms with gestational diabetes about 10 years after their initial diagnosis during pregnancy. In patient’s who had a GDM history, nearly 1 in 2 were diagnosed with prediabetes or diabetes. By contrast, in patients without a GDM history, only 1 in 5 developed prediabetes or diabetes.

What else should I know?

· The data is rather limited on the use of sugar substitutes in pregnancy. So far, there isn’t any data that suggest that the common substitutes (Aspartame, Sucralose, Saccharine, etc) increases the risk of birth defects. However, there are some studies that suggest that maternal consumption of these is linked with childhood obesity, so their intake should be limited.