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Understanding Prediabetes


According to the Centers for Disease Control and Prevention (CDC), one in three Americans are living with prediabetes – and most don’t even know it.


Prediabetes is a serious health condition where blood sugar levels are higher than average because the body is struggling to produce insulin. Laura Ronen, MS, RD, CDE, a Certified Diabetes Educator at Crystal Run Healthcare shared what a prediabetes diagnosis is, who is most affected, and how a dietitian can help with navigating a prediabetes diagnosis.

Crystal Run Healthcare (CRHC): Are there early symptoms of prediabetes to look out for?


L. Ronen: Prediabetes doesn’t usually have any symptoms, which is why it is important to get screened. Unfortunately, most symptoms associated with impaired glucose tolerance, like extreme thirst, hunger and frequent urination, are present only after it has progressed to diabetes.


CRHC: How is prediabetes diagnosed?


L. Ronen: There are three types of tests providers can perform to check for prediabetes: an A1C test or a blood sugar level test; a fasting plasma glucose test; or a glucose challenge test, which evaluates a person’s glucose levels two hours after consuming a set amount of glucose. These tests can show how well a person’s body tolerates and breaks down sugar.


CRHC: How often should someone get these tests done?


L. Ronen: Laboratory tests to ascertain the blood glucose level of at-risk patients should be repeated every one to three years. Those with a history of gestational diabetes should be screened 6 to 12 weeks postpartum. If prediabetes is diagnosed, it is important to get screened every year after or every three years if the postpartum prediabetes test is negative.


CRHC: Should people still get tested for prediabetes if they are not at-risk?


L. Ronen: Regardless of risk factors, the American Diabetes Association (ADA) recommends getting screened for prediabetes/Type 2 diabetes by age 35. The ADA recommends those at-risk should get screened earlier. The following are risk factors for prediabetes:

  • Overweight or obese: a person is considered overweight if their body mass index is greater or equal to 25 kg/m2 (≥ 23 kg/m2 for Asian Americans) or if they have greater than either a 40-inch waist (for men) or greater than a 35-inch waist (for women)
  • Member of a high-risk population: African American, Hispanic/Latino, American Indian, Alaska Native, Asian American, Pacific Islander
  • Family history of diabetes (e.g. parent or sibling)
  • History of gestational diabetes or giving birth to a baby weighing over 9 lbs.
  • Physical inactivity
  • Hypertension ≥ 140/90 mmHg, or on therapy for hypertension
  • High-density lipoprotein (HDL) cholesterol level < 35mg/dl (0.90 mmol/L)
  • Fasting triglyceride (TG) level > 250 mg/dL (2.82 mmol/L)
  • Other conditions associated with insulin resistance, such as acanthosis nigricans, non-alcoholic steatohepatitis, and polycystic ovary syndrome
  • Atherosclerotic cardiovascular disease
  • Treatment with atypical antipsychotics or glucocorticoids


Those with any risk factors should get tested earlier for prediabetes.


CRHC: How long does it take for prediabetes to evolve into Type 2 diabetes?


L. Ronen: People with prediabetes have up to a 50% chance of developing diabetes over the next five to 10 years. People can reduce their risk of developing Type 2 diabetes by maintaining a healthy weight (or losing weight) and exercising regularly.



CRHC: What are the most effective methods of treating prediabetes?  


L. Ronen: For individuals who are overweight, exercise and weight loss are important. Individuals who smoke should get help to quit smoking. Working with a physician and a dietitian can also help patients manage their diagnoses.


CRHC: How can a dietitian help decrease the risk of prediabetes or manage existing prediabetes?


L. Ronen: After reviewing a person’s diet history, a dietitian will make recommendations for a healthier diet (i.e. how to reduce calories, tips to increase fiber), offer meal planning tips, and suggestions on how to incorporate more exercise into one’s daily lifestyle.  


CRHC: What does a prediabetes diet look like?  


L. Ronen: A diet to reduce the risk of diabetes is usually also a diet that would help someone lose weight if they are overweight. This diet involves avoiding sugary beverages like soda, pre-sweetened teas, and juices. Reducing starchy foods and sweets, while including more fiber, is something that everyone can benefit from.  


Laura Ronen, MS, RD, CDE, is a Registered Dietitian and Certified Diabetes Educator at Crystal Run Healthcare. She earned her bachelor of science from Florida International University in Miami, Florida and earned her master of science in Nutrition and Food Studies from New York University in New York, New York. Ms. Ronen offers comprehensive nutritional care, including counseling for weight control and disease management. She coordinates aspects of the practice’s diabetes education program, where she provides guidance on diabetes prevention and lifestyle modifications for patients. Ms. Ronen is currently seeing patients in Monroe, Newburgh and West Nyack, New York.