Prediabetes & insulin resistance

What it is

In insulin resistance, muscle, liver and fat respond poorly to insulin, so the pancreas makes more to keep glucose normal. When it can no longer keep up, glucose rises into the prediabetes range.

How it's diagnosed

• A1c 5.7% to 6.4%

• Fasting glucose 100 to 125 mg/dL

• 2-hour glucose 140 to 199 mg/dL on an oral glucose tolerance test

Why it matters

Prediabetes raises the risk of type 2 diabetes and cardiovascular disease. In the Diabetes Prevention Program, an intensive lifestyle program reduced progression to diabetes by 58% and metformin by 31% compared with placebo.

Treatment

Modest weight loss (about 5% to 7%), at least 150 minutes a week of activity and better sleep are first-line. Metformin can be considered, especially under 60 with a BMI of 35 or higher or a history of gestational diabetes. GLP-1 medicines also prevent progression in people with obesity.

Clinical pearls

• Recheck at least yearly.

• Screen for fatty liver, high blood pressure and abnormal lipids at the same time.