The People's Perspective on Medicine

What Is the Outcome of Prediabetes?

Prediabetes does not lead inevitably to diabetes. Despite the name, many people with this metabolic disorder are able to reverse their condition.
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Doctors are increasingly diagnosing people with prediabetes. These individuals have slightly elevated blood sugar levels that don’t yet meet the criteria for frank diabetes.

How Is Prediabetes Diagnosed?

A blood test called hemoglobin A1C or HbA1c measures glucose in blood over a three-month time period. When the number is consistently over 6.5%, the physician diagnoses the patient with diabetes. Someone with an HbA1c between 5.7% and 6.4% has prediabetes.

Does It Always Lead to Diabetes?

Doctors have assumed that such a diagnosis inevitably means the person will develop diabetes. However, a Swedish study shows that this is not always the case (Journal of Internal Medicine, online June 4, 2019).

In fact, a group of 918 individuals who were 60 years old or older had blood sugar in that gray zone. Of that group, 13 percent went on to develop diabetes. An additional 22 percent saw their blood sugar drop to normal. The rest stayed in the prediabetes category. While this still conveys some risk, it is not quite as dangerous as diabetes.

The lead author noted:

“Lifestyle changes such as weight management or blood pressure control may help stop prediabetes from progressing.”

Will Vitamin D Help Prevent Progression?

Researchers are interested in ways to keep this condition from progressing to outright diabetes. People with low levels of vitamin D circulating in their bloodstreams seem more susceptible to prediabetes. Will giving people vitamin D supplements reverse the problem?

A study from India suggested that those people who have low levels of vitamin D might be able to reverse prediabetes with vitamin D and calcium supplements (Diabetes Research and Clinical Practice, March 2014). Investigators randomly assigned 125 subjects with prediabetes to receive either vitamin D plus calcium or calcium alone.

Half the volunteers took vitamin D3 in doses of 60,000 International Units once weekly for eight weeks. People getting vitamin D were significantly less likely to have diabetes at the end of two years than those taking calcium alone. Although the study was small, it suggested that vitamin D supplements might reduce insulin resistance and improve blood sugar levels in people with prediabetes.

Scientists need to follow up this type of interesting research to see how well it holds up. Subsequently, a systematic review of ten randomized controlled trials found that vitamin D supplementation reduced fasting blood sugar and HbA1c (Diabetic Medicine, March 2016).

However, the investigators concluded:

“No beneficial effect of vitamin D in improving insulin resistance was identified.”

Consequently, people with elevated HbA1c measurements may want to try taking vitamin D3 supplements if their blood levels are low. They should not count on this to reverse prediabetes, however.

Other Approaches to Warding Off Diabetes:

Get Enough Magnesium:

Research suggests several possible options for keeping people diagnosed with prediabetes from actually developing diabetes. As with vitamin D, people who have low circulating levels of magnesium may be at greater risk for prediabetes (Diabetologia, May 2017). People who consume the most magnesium in their daily diets are 15 percent less likely to develop type 2 diabetes (Diabetes Care, Dec. 2017). We don’t know whether those who take supplements also benefit.

Lose Weight:

Perhaps the most promising approach is simple in concept, but difficult to accomplish. Scientists have found that people who lose weight can keep their prediabetes from progressing (Diabetic Medicine, March 2019).

Consider Taking Citrus Flavonoids:

Beyond that, a single randomized controlled trial of citrus flavonoids (Eriomen®) found that some people taking this supplement were able to reverse their metabolic condition (Phytotherapy Research, online June 11, 2019). Scientists need to do more research to confirm whether this herbal supplement is truly effective.

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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Citations
  • Shang Y et al, "Natural history of prediabetes in older adults from a population‐based longitudinal study." Journal of Internal Medicine, online June 4, 2019. https://doi.org/10.1111/joim.12920
  • Dutta D et al, "Vitamin-D supplementation in prediabetes reduced progression to type 2 diabetes and was associated with decreased insulin resistance and systemic inflammation: an open label randomized prospective study from Eastern India." Diabetes Research and Clinical Practice, March 2014. DOI: 10.1016/j.diabres.2013.12.044
  • Poolsup N et al, "Effect of vitamin D supplementation on insulin resistance and glycaemic control in prediabetes: A systematic review and meta-analysis." Diabetic Medicine, March 2016. DOI: 10.1111/dme.12893
  • Kieboom KCT et al, "Serum magnesium and the risk of prediabetes: A population-based cohort study." Diabetologia, May 2017. DOI: 10.1007/s00125-017-4224-4
  • Hruby A et al, "Magnesium intake, quality of carbohydrates, and risk of type 2 diabetes: Results from three U.S. cohorts." Diabetes Care, Dec. 2017. DOI: 10.2337/dc17-1143
  • Taylor R & Barnes AC, "Can type 2 diabetes be reversed and how can this best be achieved? James Lind Alliance research priority number one." Diabetic Medicine, March 2019. DOI: 10.1111/dme.13851
  • Ribeiro CB et al, "Effectiveness of Eriomin® in managing hyperglycemia and reversal of prediabetes condition: A double-blind, randomized, controlled study." Phytotherapy Research, online June 11, 2019. DOI: 10.1002/ptr.6386
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I had prediabetes for 4 years but this year my numbers dropped back to the (top of the) normal range. I don’t recall doing anything differently. But I am sure that if I had done something different, like start taking a new supplement, I would attribute the change to it.

Cinsulin helped control my prediabetes.

Other than adding a few supplements, I would argue that losing weight is probably the biggest factor in gaining control over diabetes. How can that be accomplished? The real question should be is there a diet/weight loss program I can use for the rest of my life? Most diets work to some degree, but are not designed to be used for decades and decades. Stop the diet, and in most cases the weight comes back.

One option is fasting. Contrary to majority thinking, this is not starvation. It is scheduled eating (hopefully healthier foods) and control of snacking and over-eating. And it is something that can be done on-off, or regularly, for a lifetime. Think about this 6,000 year old quote…“Humans live on one-quarter of what they eat; on the other three-quarters lives their doctor.” – Egyptian pyramid inscription, 3800 B.C. You now have your answer to healthier living, in my view.

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