Prediabetes Findings May Be False Hope

A new study from the United Kingdom found that between 2010 and 2015, fewer individuals diagnosed with prediabetes went on to develop type 2 diabetes than in the five years prior. While this may sound promising, these findings may not actually mean that fewer people are developing diabetes. Instead, experts say it could just be a reflection of changing criteria needed for a prediabetes diagnosis. 

The study, published on September 6 in the British Medical Journal, evaluated the number of prediabetes patients developing type 2 diabetes from 2000 to 2015. Researchers found that annually, 7% of prediabetes patients went on to develop type 2 diabetes.

From 2010 to 2015, researchers noticed a reduction in the number of people with prediabetes developing type 2 diabetes.

“This reduced conversion from NDH [non-diabetic hyperglycemia, or prediabetes] to type 2 diabetes appears to be more indicative of a lower threshold for NDH diagnosis criteria and more people of lower diabetes risk being diagnosed, rather than an increased rate of diet and lifestyle changes reducing conversion to type 2 diabetes,” Dione Milauskas, MS, RDN, LD, a registered dietitian in Kentucky specializing in prediabetes nutrition, tells Verywell.

Limitations of The Study

Hailey Crean, MS, RDN, CDCES, a registered dietitian specializing in diabetes care in Massachusetts, echos Milauskas concern, telling Verywell that the researches of this study "encourage examination of the study limitations, which include a change to the coding practices used to report cases, as well as a change to the definition of prediabetes, during the study period."

Crean notes that the criteria for prediabetes vary slightly between the U.K. and the U.S., with a 6% to 6.4% hemoglobin A1C—a measurement of average blood sugar level for the past three months—needed for a diagnosis in the U.K.

In general, U.S. criteria includes:

• An A1C level below 5.7% is considered normal
• An A1C level between 5.7% and 6.4% is considered prediabetes
• An A1C level of 6.5% or higher on two separate tests indicates type 2 diabetes

From this data, it is unclear whether the reduced rate of diabetes diagnosis is due to changes in screening criteria or a result of a true reduction in the progression of prediabetes. While we know that the U.K. modified their criteria for diagnosis during the study, Crean also points out that the work done by primary care providers in the U.K. in recommending lifestyle changes to prediabetes patients is cited by researchers as a possible contributor to the results. 

“Prediabetes can be managed easily with diet and lifestyle changes and without medication or weight loss," Milauskas says. 

The Benefit of a Prediabetes Diagnosis

Having a reduced rate of prediabetes patients developing type 2 diabetes is only meaningful if individuals are actually making lifestyle changes to prevent the progression of the disease.

“From a population health perspective, increased diagnosis can be beneficial," Milauskas says. "If diagnosed at the NDH (prediabetes) level of impaired glucose metabolism, diet and lifestyle changes can be made earlier on, delaying or preventing a conversion to type 2 diabetes." She adds that it is easier to lower blood glucose at the prediabetes level than at the type 2 diabetes level.

If you've been diagnosed with prediabetes, the good news is that there are steps you can take to help reduce the risk of developing type 2 diabetes. 

Milauskas suggests that those with prediabetes can focus on adding more protein and healthy fat to their diet, walking five days per week, and managing stress. She says that walking for 30 minutes per day reduces conversion from prediabetes to type 2 diabetes by 30%.

“Even just a few small changes has the ability to put someone on the path to better blood glucose control,” Holly Falke, MS, RDN, LD, CDCES, a registered dietitian in Texas and certified diabetes care and education specialist, tells Verywell. She adds that choosing foods that are higher in fiber, such as vegetables, fruits, and whole grains is a positive change that people can make to help reduce the risk of developing type 2 diabetes. 

Making Lifestyle Changes With a Prediabetes Diagnosis

Learning that you have prediabetes can be a motivator to make some lifestyle changes to reverse the diagnosis and reduce the risk of developing type 2 diabetes. 

The Diabetes Prevention Program highlights the power of lifestyle changes in the progression of the disease. They found that attaining a 5% to 7% weight loss goal and engaging in 150 minutes of moderate-intensity physical activity per week lowered the risk of progression to type 2 diabetes by 58%. So, if you are diagnosed with prediabetes, now is the time to brush off your walking shoes and get your body moving—it may help keep your health in check in a simple and low-risk way.