It is a condition that hits millions but causes no symptoms. Most of those suffering from it will feel and look absolutely fine. Yet it is the precursor to type 2 diabetes, one of the world’s biggest causes of death and disability.
It’s called prediabetes, characterised by raised blood sugar that is perilously close to, but isn’t yet quite in, the diabetic range. And it is a problem that no one can afford to ignore.
People with prediabetes are thought to be ten to 15 times more likely to develop type 2 diabetes during their lifetime. The charity Diabetes UK estimates that about 13.5 million people are in this category – a quarter of all adults in this country. This is why, within the decade, one in ten British adults are predicted to have type 2 diabetes, a disease that the NHS already spends £10 billion each year on treating – or ten per cent of its entire budget.
Professor Naveed Sattar, expert in metabolic health, pictured, said long-term uncontrolled high blood sugar plays havoc throughout the body, raising the risk of blindness, kidney failure and erectile dysfunction
People with prediabetes are thought to be ten to 15 times more likely to develop type 2 diabetes during their lifetime
It’s no longer just an illness of middle or older age. The most recent figures suggest 122,000 people across England with type 2 diabetes are under the age of 40. And these younger patients are at substantially higher risk of adverse health repercussions. For many it means a lifetime on medication, and even on treatment there are no guarantees. Long-term uncontrolled high blood sugar plays havoc throughout the body, raising the risk of blindness, kidney failure and erectile dysfunction. It stops wounds healing as they should, leading to chronic infections and amputations. And people with type 2 diabetes are vastly more likely to suffer heart attacks, strokes and dementia.
Prediabetes isn’t only a precursor to problems – it carries its own health risks. Studies show those with blood sugar levels in the prediabetic range are more likely to suffer heart attacks and strokes than the average person. Some even experience damage to the eyes or kidneys, according to recent research by scientists at Imperial College London. This may be linked to excess fat, rather than blood sugar levels.
But in short, you don’t want to get either condition. And the good news is that you don’t have to.
It’s becoming increasingly clear that by spotting prediabetes, and taking steps to safeguard future health, it’s possible to prevent illness before it strikes.
And it doesn’t involve drugs, surgery or expensive treatments – just a few lifestyle tweaks that, with a bit of grit and determination, anyone can make.
The big questions are: exactly what is prediabetes, how do you know if you have it, and what should you do if you do?
As Professor of Metabolic Medicine at the University of Glasgow, I have spent decades treating and studying these conditions. And today, in The Mail on Sunday, we’ll outline the very latest scientific evidence on prediabetes and everything you need to know about how to beat it.
To make this simple, we’ve come up with a five-point plan to tackling prediabetes that anyone can do.
If you’re overweight – particularly if your body mass index (BMI) is 30 or over – you’re more at risk. That’s well known. But the latest evidence suggests when it comes to prediabetes, it’s not simply how much fat you have, it’s where in the body it is that really counts
If you’re overweight – particularly if your body mass index (BMI) is 30 or over – you’re more at risk. That’s well known. But the latest evidence suggests when it comes to prediabetes, it’s not simply how much fat you have, it’s where in the body it is that really counts.
Some people are genetically prone to store excess fat more rapidly in their liver and other organs. This so-called ectopic fat is a big risk factor. But as we’ll explain, genetics do not mean our fate is sealed. Slimming down, or changing the way we eat, can have a radical impact on raised blood sugar. It’s advice many of us could afford to listen to.
Even going into the Covid pandemic, 63 per cent of adults in England were overweight or obese. And the past few years haven’t helped. Roughly 40 per cent of us put on an average of half a stone during the lockdowns, according to one study.
The most recent figures suggest 122,000 people across England with type 2 diabetes are under the age of 40. And these younger patients are at substantially higher risk of adverse health repercussions
I emphasise, that’s an average. A patient came to my clinic who had put on 3st since I last saw him in 2020. He had stopped commuting and was working from home. Instead of walking 10,000 steps a day – which he’d been doing, and which burns about 400 calories – he was just sitting around. Crucially, he was eating the same amount.
You don’t have to be that overweight to develop prediabetes: on average, people with the condition are between half a stone and a stone and a half heavier than people with ideal blood sugar levels. However, on average, people with prediabetes only have to put on a few more pounds before they tip into full-blown diabetes.
You don’t have to be that overweight to develop prediabetes: on average, people with the condition are between half a stone and a stone and a half heavier than people with ideal blood sugar levels
And that’s what presents us with such an ideal opportunity to do something about it before it becomes a problem. And it needn’t be that difficult. Despite what you may have heard, experts agree you don’t need to go on a punishing diet, live on meal-replacement shakes or cut out carbs to turn things around.
I’m Asian and I have a family history of diabetes, which means I’m substantially higher risk.
I do small things to keep off the weight. I always have a salad with my evening meal, as filling up on that means I’ll eat less carbs or meat. I’ve trained myself to stop taking sugar in my tea and to eat only one finger of a KitKat. It means I really savour it and enjoy it much more. It’s a treat, not just something I mindlessly consume.
All of us can make a few simple, sustainable changes. And I’m not exaggerating when I say they can be life-changing.
My research has found that people with prediabetes can also have high blood pressure. They might also have high levels of triglycerides in the blood – fat deposits that are linked to heart disease
My research has found that people with prediabetes can also have high blood pressure. They might also have high levels of triglycerides in the blood – fat deposits that are linked to heart disease.
By staving these things off by keeping your weight down, you’ll live longer and healthier.
Type 2 diabetes isn’t inevitable. I like to look at prediabetes, as serious as it is, as a positive thing: discovering it gives us a chance to take control and avoid the worst.
Read on to find out how…
Prediabetes: What is it – and how do you know if you’re one of the thirteen million at risk
Diabetes doesn’t develop overnight. It begins with very subtle ‘communication problems’ within the body’s cells and can take years before it seriously affects your health. And this gives us plenty of time to do something about it.
But it is vital to understand whether you might be at risk and how the problem develops.
Type 2 diabetes begins life as prediabetes, when blood sugars are abnormally high and, without lifestyle changes, the full-blown disease may well strike. In prediabetes, the hormone insulin, which moves sugars from food into our blood, where it is used for energy, is not working as well as it should. Sugar stays in the blood, raising its levels to higher than normal but not high enough to develop type 2 diabetes or to cause obvious symptoms.
Which begs the question: if there are no symptoms, how do you know if you’re at risk?
It’s becoming increasingly clear that by spotting prediabetes, and taking steps to safeguard future health, it’s possible to prevent illness before it strikes. And it doesn’t involve drugs, surgery or expensive treatments – just a few lifestyle tweaks that, with a bit of grit and determination, anyone can make
First, it’s worth taking a look at the free online questionnaire on the Diabetes UK website (diabetes.co.uk), which analyses your personal diabetes risk by taking into account everything from family history and ethnicity to weight and diet. The results will give you an idea of whether or not prediabetes is something you ought to be concerned about either now or in the future.
And if it is a worry, your GP can organise a blood test, which we’ll explain in more detail later.
But what is crucial is being aware of the most important factors that could already be putting you in harm’s way. Here is how to know if your blood sugar levels are likely to reach the danger zone and what you can do about it.
Check your weight – and your waist
The single biggest risk factor for prediabetes is excess body fat.
Research shows that an accumulation of fat around or in the organs can affect how cells in the body respond to insulin, disrupting blood sugar control. Checking your body mass index, or BMI, gives a good indication of whether this could be happening.
People living with obesity – that is, who have a BMI of 30 or above – are up to 80 times more likely to develop diabetes than those with a healthy BMI of less than 22, according to studies. A BMI calculator is available on the NHS website. Anything over 25 is deemed overweight.
Waist size is also a good indicator of diabetes risk because it is a sign of excess fat close to or in the organs, such as the liver. This type of fat – known as ectopic fat – significantly impairs insulin function.
Men should have a waist measurement of less than 37 inches, while women should keep to a more trim 31½ inches.
Watch out for other heart risks
Prediabetes often goes hand in hand with other obesity-related conditions, such as high blood pressure and high cholesterol.
Nowadays, doctors often diagnose patients with a combination of these problems with metabolic syndrome. In these cases, it is almost always a result of lifestyle factors such as poor diet, high alcohol intake and inactivity. This group carries the highest risk of suffering a life-threatening stroke or heart attack, because all three conditions play into each other.
Cholesterol, produced mostly in the liver, is essential for the healthy functioning of bodily cells.
It is carried around the body in packages called lipoproteins – a combination of cholesterol and other fats and proteins. Low-density lipoproteins (LDL) carry cholesterol from the liver to the body. There are other types of lipoproteins, but it’s the amount of LDL that doctors pay most attention to, because this type is a known risk factor for heart disease.
If you have prediabetes or type 2 diabetes, you may be given medication to reduce that risk. Scientists have found that having high blood pressure makes you 50 per cent more likely to develop type 2 diabetes. Some 4.3 million Britons are living with high blood pressure but don’t know it – because there are no symptoms.
You can check yours at most local pharmacists for free, or at your GP surgery.
Regular exercise, reducing salt intake and eating a healthy, balanced diet are all important steps for keeping your blood pressure down.
Skinny people can get prediabetes too
If you’re a healthy weight, it doesn’t mean you’re out of the woods. In fact, 15 per cent of people with type 2 diabetes are not overweight.
Slim people can have an accumulation of fat inside the abdomen, which infiltrates organs such as the liver and pancreas (where insulin is produced).
This affects how the body’s cells respond to insulin.
Some leading researchers have suggested that everyone has their own fat threshold – the point at which fat levels begin to trigger insulin resistance and affect blood sugar control. But there are other factors that can influence diabetes risk, regardless of weight.
Medication, for instance. Some drugs have side effects that raise your blood sugar levels. These include a group of drugs used to treat asthma and arthritis – anti-inflammatories called corticosteroids – certain diuretics for high blood pressure, beta-blockers to prevent heart attacks, anti-psychotic drugs used to treat schizophrenia and bipolar disorder, and even statins. The risk is slight and benefits often outweigh any small harms, so don’t stop these medicines without discussing it with your GP first.
Gestational diabetes, which happens when pregnancy triggers insulin resistance, can also affect women who are a healthy weight, although it is more common in those who are borderline overweight or heavier.
In some cases blood sugars don’t come back down to normal after giving birth. Since 2009, everyone aged between 40 and 74 is invited for a free NHS health check every five years.
This now includes screening for prediabetes, which usually involves a blood test that indicates whether your blood sugars are consistently high.
This is a good opportunity for everyone – regardless of weight – to get tested.
The Covid backlog has affected routine appointments like this in some local areas, so call your GP to ask for a health check if you are due one.
Diabetes in the family could be a red flag
Some people are predisposed because of their ethnic background or genetic profile.
For these groups, only a small amount of excess fat is needed to develop prediabetes.
It is thought that people from South Asia, the Middle East and those with African and Caribbean heritage are more susceptible to type 2 diabetes because of the way their bodies store and process fat. Meanwhile, genetic factors mean anyone with a mother, father or sibling who has type 2 diabetes are up to 200 per cent more likely than others to develop it.
There are a multitude of genes that influence where we store fat in the body, and how well sugar from our food is absorbed into the blood. Those who inherit genes that programme for the condition usually develop it in their 40s or younger, sometimes without being significantly overweight.
The tests to spot prediabetes
There are tests for diabetes available at GP surgeries and others that can be done at home.
But the most reliable test for prediabetes is a blood test called an HbA1c test, which measures levels of glycated haemoglobin.
This is sugar that has stuck to red blood cells, which gives a good indication of average blood sugar levels over the past two to three months. The test can be done either at a GP’s surgery or with an at-home kit, and should be repeated three to six months later to monitor changes.
If you’re buying an at-home test, make sure it measures HbA1c – some finger-prick kits claim to spot diabetes but actually measure only blood sugar at one point in time so don’t give an accurate picture of your risk.
Results are measured in millimoles of glucose per mole, which is written as mmol/mol.
A mole is a scientific unit often used to measure chemicals.
A normal HbA1c result is below 42mmol/mol, while between 42 and 47 is considered prediabetic. At 48 mmol/mol or above, a patient will be diagnosed with diabetes.