Prediabetes is a serious health condition where blood sugar levels are higher than normal, but not high enough yet to be diagnosed as type 2 diabetes. Many people wonder how long they can have prediabetes before it progresses to full-blown diabetes. Here is an in-depth look at the progression from prediabetes to diabetes, risk factors, and ways to help prevent or delay its onset.
What is Prediabetes?
Prediabetes occurs when blood sugar levels are above normal but below the diabetes threshold. Specifically:
- Fasting blood sugar between 100-125 mg/dL (5.6-6.9 mmol/L). Normal is less than 100 mg/dL (5.6 mmol/L).
- Hemoglobin A1c between 5.7-6.4%. Normal is less than 5.7%.
- Two hour plasma glucose during an oral glucose tolerance test between 140-199 mg/dL (7.8-11.0 mmol/L). Normal is less than 140 mg/dL (7.8 mmol/L).
Prediabetes indicates insulin resistance or reduced insulin production occurring in the body. Without intervention, most people with prediabetes will eventually progress to type 2 diabetes, typically within 10 years.
Progression from Prediabetes to Diabetes
On average, about 5-10% of people with prediabetes will develop diabetes each year. However, some people progress faster than others depending on risk factors.
According to research, approximately (1):
- Over 5 years, 25-50% of people with prediabetes progress to diabetes.
- Over 10 years, 50-70% of people with prediabetes progress to diabetes.
Progression rates appear especially high for certain groups (2):
- People with an A1c of 6.0-6.5% had a 5-year risk of developing diabetes around 50-80%.
- People over age 65 with prediabetes had a 3-5 year progression rate of 74%.
- People with severe insulin resistance progressed within 1-2 years.
In summary, most people have at least 5 years before their prediabetes is likely to turn into full blown type 2 diabetes. However, progression can be more rapid depending on risk factors.
Risk Factors for Progression
Certain factors appear to speed up the progression from prediabetes to diabetes. These include:
- A1c level – The higher the A1c, the greater the risk. A1c over 6.0% predicts faster progression.
- Age – Older adults tend to progress faster than younger adults.
- Obesity – High BMI predicts faster progression.
- Fat distribution – Abdominal/visceral fat increases risk.
- Lack of physical activity – Sedentary lifestyles predict faster progression.
- Family history – Having a close relative with diabetes increases risk.
- Ethnicity – Hispanic, African American, Native American, Asian American, and Pacific Islanders have higher risk.
- Gestational diabetes – Women with a history of gestational diabetes during pregnancy have higher risk.
- Polycystic ovary syndrome (PCOS) – Women with PCOS tend to progress faster.
- High blood pressure – Hypertension predicts increased progression.
- High triglycerides – Elevated triglycerides hasten progression.
- Low HDL cholesterol – Reduced “good” HDL cholesterol increases risk.
The more risk factors that apply, the faster prediabetes is likely to advance to diabetes. Regular screening and risk reduction efforts are important, especially for high-risk individuals.
Lifestyle Changes to Delay Progression
Progression from prediabetes to diabetes is not inevitable. Making certain lifestyle changes can significantly reduce your risk. Recommended strategies include:
- Weight loss – Losing 5-10% of body weight helps improve insulin sensitivity and blood sugar control.
- Healthy diet – Focus on whole, minimally processed foods like vegetables, fruits, whole grains, beans, legumes, nuts, seeds, and healthy fats.
- Reduce added sugars – Limit sugar-sweetened foods and beverages which can spike blood sugar.
- Increase physical activity – Aim for at least 150 minutes per week of moderate exercise like brisk walking.
- Stress management – Chronic stress elevates cortisol and blood sugar. Try relaxation techniques.
- Adequate sleep – Get 7-9 hours of quality sleep per night to help regulate blood sugar.
- Smoking cessation – Quit smoking to improve insulin sensitivity and reduce diabetes risk.
- Moderate alcohol intake – If you drink alcohol, limit consumption to 1 drink or less per day for women and 2 drinks or less for men.
Making healthy lifestyle changes can substantially slow down progression from prediabetes to diabetes. Losing weight and increasing physical activity appear most important.
Medical Interventions
In addition to lifestyle modifications, some medical interventions may help delay diabetes onset in people with prediabetes. These include:
- Metformin – Metformin improves insulin sensitivity and reduces progression risk by around 25-30% over 3-5 years.
- Other glucose-lowering medications – Medications like sulfonylureas, DPP-4 inhibitors, GLP-1 agonists, SGLT2 inhibitors, and thiazolidinediones may also decrease progression risk.
- Bariatric surgery – Weight loss surgery in obese individuals with prediabetes can promote remission and significantly delay diabetes onset.
- Intensive diet and lifestyle interventions – Structured programs with weight loss goals, personalized diet plans, exercise prescriptions, and behavioral support can reduce progression risk by around 50% over 3 years.
Drug therapy or weight loss surgery should be considered for people at high risk of rapid progression, especially those with multiple risk factors. Structured lifestyle intervention programs are also very effective.
Screening Recommendations
Due to the high risk of progression, regular screening for diabetes is important if you have prediabetes. Current guidelines recommend (3):
- Screening every 1 year for people with prediabetes.
- Screening at least twice per year for people with A1c over 6.0%, older adults, and others at very high risk.
- Repeat screening should be done with the same test initially used to diagnose prediabetes (FPG, OGTT, or A1c).
Talk to your doctor about individualized screening based on your risk factors. More frequent monitoring may be recommended for some individuals to catch progression as early as possible.
Risk of Complications
Letting prediabetes progress to full blown diabetes substantially increases your risk of complications down the road. People with diabetes are more vulnerable to problems like (4):
- Heart disease and stroke
- Nerve damage (neuropathy)
- Kidney disease (nephropathy)
- Eye damage (retinopathy)
- Foot damage
- Skin conditions
- Hearing impairment
- Alzheimer’s disease
The risks of these devastating complications provide powerful motivation to take early action when you have prediabetes. Making lifestyle changes and following medical advice can help safeguard your long-term health.
Can Prediabetes Resolve?
Yes, prediabetes can be reversed and normal blood sugar restored in many cases through lifestyle interventions or bariatric surgery. According to research:
- Weight loss of 5-7% can lower diabetes risk by up to 70% over 10 years.
- About 50% of people enrolled in intensive diet and lifestyle interventions have achieved normal blood sugar at the end of study periods.
- Bariatric surgery can normalize blood sugar in 50-80% of severely obese patients with prediabetes.
Sustained lifestyle changes resulting in moderate weight loss appear most effective for reversing prediabetes. Lowering body weight by just 5-10 pounds can substantially improve insulin sensitivity and prevent progression to diabetes.
Key Takeaways
In summary, key points about progression from prediabetes to diabetes include:
- Most people have up to 5-10 years before prediabetes progresses to diabetes.
- Higher risk individuals may progress within 1-2 years.
- Losing a modest amount of weight through diet and exercise can prevent or delay diabetes by up to a decade.
- Metformin and intensive lifestyle intervention also slow progression.
- People with prediabetes should be screened annually or biannually.
- Reversal to normal blood sugar is achievable with sustained lifestyle changes or bariatric surgery.
Being diagnosed with prediabetes is a serious health warning sign. However, it also presents a valuable opportunity to take preventive action through lifestyle changes and medical care. With proper management, progression to diabetes is not inevitable.
Conclusion
On average, people with prediabetes have about 10 years before their condition is likely to advance to type 2 diabetes. However, for those with multiple risk factors, progression can occur much faster, sometimes within 1-2 years. Regular screening is important to monitor for changes. The good news is diabetes onset can often be delayed or reversed through achievable lifestyle modifications. Losing 5-10% of body weight and increasing physical activity appear particularly helpful for preserving long-term health.