Prediabetes and Diabetes Prevention

Prediabetes is dysglycemia that has not yet reached diagnostic thresholds for diabetes. Insulin-resistant muscle, liver, and adipose tissue require more insulin to manage glucose. At the same time, pancreatic beta cells gradually lose the capacity to increase insulin secretion enough to compensate. Glucose rises first after meals, then may rise in the fasting state as hepatic glucose output becomes less effectively suppressed. This state can move in either direction. Sustained changes in activity, eating pattern, and weight can improve insulin sensitivity and return glucose values to normal. Without intervention, beta-cell function may continue to decline and type 2 diabetes can emerge. Prediabetes is usually silent. A person may feel well despite glucose values that already predict increased risk for type 2 diabetes and cardiovascular disease. The absence of symptoms is precisely why screening and risk-factor assessment matter.