Diagnosing Prediabetes: 4 Key Methods

According to the Ministry of Health Malaysia (2020) & National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (2020), 4 methods can be used to diagnose pre-diabetes:

1. Fasting plasma glucose test (FPG): This test measures the blood glucose level after an 8-hour fast. Pre-diabetes or impaired fasting glucose (IFG) can be diagnosed if the blood glucose level shows 5.6 to 6.9 mmol/L (100 to 125 mg/dL).
2. Oral glucose tolerance test (OGTT): In this test, a solution of 75 g of anhydrous glucose in water is taken after 2 hours. A value between 7.8 and 11.0 mmol/L (140 to 199 mg/dL) indicates prediabetes or impaired glucose tolerance (IGT).
3. HbA1C test: This method evaluates the mean blood glucose concentrations of the last 2-3 months. The diagnosis of pre-diabetes can be made if the results are in the range of 5.7 % to 6.4 %.
4. Random plasma glucose test (RPG): DM can be confirmed if the test is performed at
   any time of the day without fasting and the blood glucose level falls by ≥11.1
   mmol/L.

Managing Pre-diabetes

This is why we must learn how to control this condition and prevent ourselves from developing diabetes by following these key strategies and indirectly promoting a healthier lifestyle.

• Lifestyle Modification

To manage prediabetes, regular health screenings, a balanced diet, and physical activity are key. Early screening can detect elevated blood sugar levels, especially in high-risk individuals (Jonas et al., 2021). A diet rich in nutrients and balanced portions of carbohydrates, proteins, and fats helps maintain stable blood sugar (Mohamed Nor, 2017). Regular exercise, including 20 minutes of moderate-intensity activity and strength training, can reduce the risk of developing diabetes by 25%–40% (Ismail et al., 2023; Zhang et al., 2024). Weight management is also crucial; losing just 5% of body weight improves insulin sensitivity, helping regulate blood sugar (Magkos et al., 2016).

• Pre-diabetes Management Medication

According to Magalhães et al (2010), medication becomes necessary when lifestyle interventions fail to control blood sugar. The prescription of medication for prediabetes is on lowering of blood sugar and prevention of T2DM. The most used drug for this purpose is Metformin which decreases glucose production by the liver and has a 45% decrease in the risk of developing T2DM in persons with IGT (Ministry of Health Malaysia, 2020; Tabák et al., 2012)

• Emerging Medication

Newer treatments, such as SGLT2 inhibitors (Dapagliflozin, Canagliflozin, Empagliflozin), have demonstrated additional benefits in T2DM care (Ministry of Health Malaysia, 2020). Although they are not widely used for pre-diabetes, these drugs offer cardiovascular and kidney protection. Recent studies, such as those by Hüttl et al. (2021), indicate that Empagliflozin may reduce insulin resistance and improve fat metabolism, suggesting potential benefits for pre-diabetic individuals. This shows the potential ability to treat pre-diabetes individuals.

Summary

Preventing pre-diabetes entails routine check-ups, dietary modification, increased physical activity, and weight control in the initial stages. Metformin to this date continues to be the most recommended drug for preventing Type 2 diabetes in high-risk individuals, while comparatively newer SGLT2 inhibitors hold potential for managing other health issues. More importantly, people with prediabetes should consult their healthcare provider for individualized advice.

Reference

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2. Hüttl, M., Markova, I., Miklankova, D., Zapletalova, I., Poruba, M., Haluzik, M., Vaněčková, I., & Malinska, H. (2021). In a Prediabetic Model, Empagliflozin Improves Hepatic Lipid Metabolism Independently of Obesity and before Onset of Hyperglycemia. International Journal of Molecular Sciences, 22(21), 11513-. https://doi.org/10.3390/IJMS222111513
3. Institute for Public Health. (2024). National Health and Morbidity Survey (NHMS) 2023: Non-Communicable Diseases and Healthcare Demand—Key Findings.
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8. Ministry of Health Malaysia. (2020). CPG – Management of Type 2 Diabetes Mellitus (6th Edition). Ministry of Health Malaysia. https://mems.my/wp-content/uploads/2021/03/CPG-T2DM_6th-Edition-2020_210226.pdf
9. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2020). Diabetes & Prediabetes Tests. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). https://www.niddk.nih.gov/health-information/professionals/clinical-tools-patient-management/diabetes/diabetes-prediabetes
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