Everyone's talking about prediabetes and Type 2 Diabetes - two health conditions that are closely related, but with very different treatments and consequences. Prediabetes is an early warning red flag: it means your blood glucose levels are higher than normal, but they haven't yet reached the threshold for Type 2 diabetes. Still, it's often overlooked because it's a "silent" condition that can go unnoticed for years. Understanding this distinction - and that prediabetes can be reversed - is key to taking action promptly and avoiding serious complications.
Prediabetes vs. Type 2 Diabetes: What to know
The two conditions are progressive stages of the same underlying condition that disrupts how the body processes sugar, differing primarily "in the degree of blood sugar elevation and the resulting severity of metabolic impairment," explains Dr Samar Elgeadi, Head of Internal Medicine at Madrid's Elgeadi Clinic.
Prediabetes is characterised by blood glucose levels that are elevated above the normal threshold but have not yet reached the diagnostic range for diabetes. This phase is intermediate and often reversible through aggressive lifestyle modifications, including adopting a healthy diet, engaging in regular physical activity, and achieving effective weight management.
Type 2 diabetes, in contrast, involves a persistent and significantly more severe elevation of blood sugar. This advanced stage carries a higher risk of serious macro- and microvascular complications affecting the eyes, kidneys, nerves and heart. It mandates a more stringent treatment approach, which typically involves oral medications or, in some cases, insulin therapy.
"Before either of these conditions fully manifests, a state known as insulin resistance typically takes hold. During this phase, the body does produce insulin (the hormone that regulates blood sugar), but the body's cells do not respond to it effectively.
"To compensate, the pancreas ramps up insulin production. Eventually, if the situation is not addressed, the pancreas becomes overburdened or 'exhausted', and glucose levels begin to climb - initially towards prediabetes, and then towards full diabetes if no appropriate action is taken," the expert points out.
"Prediabetes serves as a crucial warning sign and an opportunity to prevent Type 2 diabetes... It's is an intermediate phase that can be reversed primarily through lifestyle modifications"
"In essence, prediabetes serves as a crucial warning sign and an opportunity to prevent Type 2 diabetes," she adds. Identifying it early allows you to take action and halt its progression, especially if the underlying insulin resistance, which is the silent cause of the problem, is recognised and managed.
In essense, explain the doctor: "Prediabetes is an intermediate phase that can be reversed primarily through lifestyle modifications, such as a balanced diet, regular exercise and effective weight control."
Risk factors for developing prediabetes
Dr Elgeadi explains that the primary risk factors for the onset of prediabetes - and subsequently Type 2 diabetes - are typically a combination of genetic, metabolic and lifestyle elements.
- Being overweight: Particularly the accumulation of visceral fat (fat around the abdominal organs), which is strongly linked to insulin resistance.
- Sedentary lifestyle: A lack of regular physical activity reduces the body's sensitivity to insulin.
- Unhealthy diet: Diets high in sugar, refined carbohydrates and saturated fats, and low in fibre, contribute to metabolic imbalance.
- Family history of Type 2 diabetes: Having a parent or sibling with the condition significantly increases personal risk.
- Aged 45 and up: You should be vigilant if you're older - but concerningly, the incidence is also rising among young adults and adolescents due to modern lifestyles.
- High blood pressure (Hypertension): Raised blood pressure frequently coincides with insulin resistance.
- Elevated blood lipids: High levels of LDL ('bad' cholesterol) and triglycerides, alongside low levels of HDL ('good' cholesterol), are key warning signs
- Polycystic Ovary Syndrome (PCOS): This condition is closely associated with insulin resistance in women.
- History of gestational diabetes: If you developed diabetes during pregnancy, you face a greater long-term risk of developing Type 2 diabetes.
- Ethnic background: Certain populations exhibit a greater genetic predisposition, including individuals of South Asian, African-Caribbean, Black African and Middle Eastern origin.
If you possess two or more of these risk factors, it is strongly advisable to arrange a blood glucose screening with your doctor
"Many of these risk factors are asymptomatic - they produce no visible signs - so regular medical checks are essential, especially if you have more than one risk factor," the doctor advises. "My recommendation is that if you possess two or more of these factors, it is strongly advisable to arrange a blood glucose screening and consult a healthcare professional to fully assess your metabolic risk."
What symptoms might indicate prediabetes?
Dr Elgeadi highlights that prediabetes frequently presents with no obvious symptoms, meaning a significant number of people are unaware they have the condition.
However, she notes that there are warning signs that could indicate a person is at risk or is already experiencing significant insulin resistance:
- Persistent fatigue: A feeling of constant tiredness, even after sufficient rest.
- Increased thirst (Polydipsia): Drinking more water than usual without a clear explanation.
- Increased urination (Polyuria): Having to urinate more frequently, particularly at night.
- Constant hunger: Feeling hungry soon after finishing a meal.
- Skin darkening (Acanthosis Nigricans): The appearance of dark or thickened patches of skin, especially on the neck, armpits and elbows.
- Difficulty losing weight: Struggling to shed weight despite dieting or increasing your exercise.
- Occasional blurred vision: Temporary fluctuations in eyesight with no obvious cause.
- Slow wound healing: Changes in how quickly minor cuts or wounds repair themselves.
The reality is that most people do not experience symptoms until prediabetes has advanced to Type 2 diabetes. This is why the following actions are crucial:
- Regular blood glucose screening.
- Understanding your personal risk factors.
- Paying close attention to subtle physical changes in your body.
"Prediabetes often presents no clear symptoms, meaning many people have it and don't realise it," the specialist reiterates.
How is prediabetes diagnosed?
The most routine method for diagnosing prediabetes is via a blood test.
"The Fasting Plasma Glucose (FPG) test and the Glycosylated Haemoglobin (HbA1c) test are the most widely employed diagnostics in clinical practice," the doctor states. "An Oral Glucose Tolerance Test (OGTT) may also be requested, particularly if there is a clinical suspicion [the patient is at risk] but the initial fasting results fell within the normal range."
The pillars of prevention: Lifestyle management
When asked if making lifestyle changes can help prevent the progression from prediabetes to Type 2 diabetes, Dr Elgeadi emphasised what she considers the basic pillars of prevention: maintaining a healthy weight, increasing daily physical activity and consuming a balanced diet.
"There's no need for extreme diets: small, sustained modifications over time can have a huge impact. Simple actions like brisk walking every day, reducing added sugar intake and prioritising better sleep are a significant step forward. These measures have been clinically shown to reduce the risk of developing Type 2 diabetes by up to 58%," she confirms.
Regarding diet, the doctor recommends an eating plan rich in vegetables, legumes, quality protein and healthy fats - such as those sourced from olive oil or nuts - as this significantly aids in glucose control.
Avoiding ultra-processed foods and simple sugars is essential. "More than talking about a 'diet,' we should be talking about nutritional education and sustainable habits," she comments.
Exercise directly improves the body's sensitivity to insulin and helps glucose enter the cells more efficiently. "Activities like brisk walking, swimming, dancing or cycling not only help prevent diabetes but also improve mood and sleep quality," she notes.
The consequences of ignoring prediabetes
The doctor issues an important warning: "While prediabetes is a reversible phase, ignoring this warning sign can have serious consequences."
The primary risk is the progression to Type 2 diabetes but she stresses that silent damage to blood vessels, the heart and kidneys can also begin even before a formal diabetes diagnosis. "Taking early action is key to preventing this silent damage," she emphasises.
Regular monitoring of glucose levels is essential, as it allows for the prompt identification of deviations and the necessary adjustment of preventative measures.
"For people with prediabetes, annual or semi-annual check-ups are usually sufficient," she concludes, "but if the risk is particularly high or other illnesses are already present, closer monitoring may be more appropriate."