Nine out of 10 people don’t realize they have prediabetes. Here’s what you need to know

It’s a condition that affects 84 million U.S. adults and an increasing number of children, but many who have prediabetes are unaware of it.

“One in three have it, but 9 in 10 don’t know they have it,” said Amy Kimberlain, diabetes educator at Baptist Health South Florida.

“Typically when patients come in to see me, they’re asymptomatic,” said Dr. Clifford Medina, Mount Sinai Medical Center’s chief of internal medicine. “They have no idea that there’s anything wrong with them and on a routine blood test, I’ll find they have a blood sugar that’s elevated,” Medina said.

“I didn’t even know what that was until they explained it to me,” recalled Bennie Perdue, now 72, who was diagnosed with prediabetes in 1997.

If blood sugar, or glucose, is between 100 and 125 on a fasting blood sugar test, and glucose is high on a second test, a patient is considered prediabetic. The danger is that prediabetes can turn into Type 2 diabetes without warning, leading to possible complications such as nerve damage, heart and kidney disease, vision problems and cancer.

“I’ve been practicing for almost 20 years, and one of the things that is striking to me is you could be prediabetic one day and then, three months later, without warning, you could be diabetic. Once you have that [prediabetes] diagnosis, it should be followed up at least once a year, if not more,” Medina said.

“Prediabetes is a stage. It’s not an isolated health problem,” said Dr. Mauricio Flores, a pediatric endocrinologist with Joe DiMaggio Children’s Hospital, part of Memorial Healthcare System in Broward County.

Flores said of the prediabetic youth he sees, “one in four will progress to diabetes” in about two years without treatment and lifestyle changes. “The good news is, with intervention, more than 50 percent” of these children “will show regression to normal glucose levels.”

Flores said he rarely sees a prediabetic child younger than 8 at his practice at the Joe DiMaggio Children’s Specialty Center in Wellington. Most are teens, with obesity being the key red flag. Obese teens may also have a dark and thickened skin encircling the neck. Called acanthosis nigricans, it is a sign of insulin resistance, Flores said.

Other risk factors for youth include having a parent, brother or sister with Type 2 diabetes, being physically inactive or having a slightly elevated blood pressure combined with obesity. Also, all children born to a mother who had gestational diabetes with any pregnancy have a 1-in-2 chance of becoming prediabetic, Flores said.

A lipid (blood) test or cholesterol test that shows a combination of low HDL (good cholesterol) and high triglycerides can be an indication that the pediatrician should screen for prediabetes.

“The good news about cholesterol screening,” Flores said, is that “in 2015, the American Academy of Pediatrics agreed there should be universal screening between the ages of 9 and 11 years for everyone.”

Red flags for adults include having a family member with diabetes, being obese, or having high cholesterol, cardiovascular disease or gestational diabetes.

Women who had gestational diabetes during a pregnancy have a 50 percent chance of developing prediabetes later in life, Flores said. Mount Sinai’s Medina recommended that beginning at age 30, these women get their blood sugar checked regularly, even if their weight is normal.

Medina said prediabetes tends to strike people in their 40s and 50s where they’re at a greater risk for weight gain than those in their 20s and 30s. The Centers for Disease Control and Prevention (CDC) estimates almost half of all adults ages 65 and older have prediabetes.

Ethnicity also plays a role. Dr. Ronald Goldberg, who has led the Diabetes Prevention Program studies (DPP) at the University of Miami’s Diabetes Research Institute since 1996, said Hispanics, African-Americans, Native Americans, Pacific Islanders and some Asian-American ethnic groups have a “higher risk of diabetes compared to white non-Hispanics.”

In addition to the fasting blood sugar test, the Hemoglobin A1C test and the rarely used two-hour glucose tolerance test can determine prediabetes. Having an A1C between 5.7 and 6.4 is an indication blood sugars are running higher than normal, Medina said.

Goldberg, the principal investigator for the Miami component of the nationwide DPP studies, said the original study placed adults on the upper end of the prediabetes scale into three groups — an intensive lifestyle intervention group that emphasized exercise and healthy eating, a group given the drug Metformin and a control group given a dummy pill. The lifestyle group met individually with counselors with the goal of losing 7 percent of body weight and increasing physical activity to 150 minutes a week.

After three years, the lifestyle intervention group showed a 58 percent reduction in the onset of diabetes, compared to the placebo group.

“It was more than what we expected,” Goldberg said. “We don’t want to underplay the importance of lifestyle change. It is so powerful.”

Vastly exceeding its goal of a 33 percent reduction in diabetes, the original study was ended early and a less-intensive follow-up began.

“Now, 23 years down the road, we’ve followed 3,000 people nationwide,” Goldberg said. One of those people is Perdue of Pembroke Pines, who was in the original lifestyle group. He still gets a comprehensive exam once a year and a midyear phone follow-up.

When asked if he has diabetes, Perdue replied, “No, thank God, thank them.”

Perdue said his counselor guided him away from fattening fried foods and the grits, eggs, bacon or pork chops he was eating for breakfast. “We would talk as often as time would permit about my diet. I transitioned from an unhealthy breakfast to oatmeal and fruit,” Perdue said.

Now semi-retired from Miami-Dade Community College, Perdue walks about three miles, three days a week and tries to work out weekly. He weighs 155, down from 184 in 1997.

“The original [DPP] study showed intensive lifestyle coaching was effective,” said Kimberlain, who created a program at Baptist Health for prediabetics. “Some of our participants have never exercised a day in their lives,” she said.

A married couple in her Beat Diabetes class has started to include a vegetable at dinner. A single mom who drank her frequent coffees with two or three sugars now is drinking it black or with milk.

“Her A1C is down from 5.7 to 5.4,” Kimberlain said. If her mom’s blood sugar stays at that level, she will no longer be prediabetic.

As Medina said, prediabetes is “actually a treatable condition. It can go away.”

“We think the harmful effects of diabetes are related to how long you have it,” Goldberg said, noting that damage to the eyes, nervous system, heart and brain takes time.

“If lifestyle delays the development of diabetes without actually preventing it, that’s a potential benefit,” Goldberg said.

“By delaying diabetes,” Goldberg said, “the expectation is you will delay these harmful complications.”