The hidden dangers of prediabetes

Prediabetes, a condition affecting over 98 million Americans—more than one in three adults—often goes unnoticed. 

While it is a precursor to type 2 diabetes, experts warn it is far from benign, significantly raising the risk of cardiovascular, kidney, and liver diseases, according to Harvard Health Publishing.

What is prediabetes?

Prediabetes occurs when the body's cells become less responsive to insulin, a hormone produced by the pancreas that helps transport sugar (glucose) from the blood into cells for energy. This condition, known as insulin resistance, leads to glucose accumulation in the bloodstream.

"The difference between diabetes and prediabetes is the level of blood sugar," explains Dr. Howard LeWine, assistant professor of medicine at Harvard Medical School. "If left unmanaged, prediabetes can be dangerous on its own, even if it never progresses to diabetes."

Cardiovascular disease

Research reveals that individuals with prediabetes have a 15% higher risk of cardiovascular disease compared to those with normal blood sugar levels. Prediabetes can exacerbate other risk factors, such as high blood pressure and LDL cholesterol levels, requiring vigilant management.

Dr. LeWine advises individuals with prediabetes to aim for blood pressure levels closer to 120/80 mmHg, compared to the general target of 140/90 mmHg. Similarly, he recommends reducing LDL cholesterol levels to below 70 mg/dL to offset the increased risk of heart disease and stroke.

Chronic kidney disease

The kidneys, tasked with filtering excess sugar and waste from the blood, face increased strain in individuals with prediabetes. Over time, this can lead to chronic kidney disease. Studies indicate that people with prediabetes are up to twice as likely to develop kidney damage compared to those with normal glucose levels.

Fatty liver disease

Prediabetes also heightens the risk of fatty liver disease, now called metabolic dysfunction-associated steatotic liver disease (MASLD). Excess glucose is often converted into fat and stored in the liver, while insulin resistance impairs the liver's ability to process fats, further contributing to fat accumulation.

Preventing and managing prediabetes

Lifestyle modifications remain the cornerstone of managing prediabetes and its associated risks.

Weight Loss: Losing just 5% to 10% of body weight can improve blood sugar levels, blood pressure, and cholesterol, while reducing the risk of fatty liver disease.

Exercise: Federal guidelines recommend 150 minutes of moderate-intensity aerobic exercise weekly, combined with two to three hours of resistance training. This combination improves blood sugar control and reduces cardiovascular and liver disease risks.

Diet: Avoid simple carbohydrates like white bread and soda, replacing them with complex carbs such as whole grains and legumes. Increasing fiber intake can also smooth out blood sugar spikes and promote satiety.

"Healthy lifestyle choices not only lower blood sugar but also reduce risks of heart, kidney, and liver diseases," emphasizes Dr. LeWine.

Although some individuals may require medication to meet blood pressure and cholesterol goals, focusing on lifestyle changes can reduce reliance on higher doses of medication, according to experts.

Prediabetes is more than a warning sign for diabetes—it is a serious condition with systemic implications. By addressing the risks early, individuals can significantly improve their health outcomes and prevent complications.