Prediabetes

Topic Overview

What is prediabetes?

Prediabetes is a warning sign that you are at risk for getting type 2 diabetes. It means that your blood sugar is higher than it should be. Most people who get type 2 diabetes have prediabetes first. The good news is that lifestyle changes may help you get your blood sugar back to normal and avoid or delay diabetes.

Type 2 diabetes is a lifelong disease that happens when the pancreas can't make enough insulin and/or when the body's tissues can't use insulin properly. Insulin is a hormone that helps the body's cells use sugar (glucose) for energy. It also helps the body store extra sugar in muscle, fat, and liver cells.

Without insulin, the sugar cannot get into the cells to do its work. It stays in the blood instead. This can cause high blood sugar levels. A person has diabetes when the blood sugar stays too high too much of the time.

Over time, high blood sugar can cause serious problems with the eyes, heart, blood vessels, nerves, and kidneys. High blood sugar also makes a person more likely to get serious illnesses or infections.

What causes prediabetes?

Doctors do not know exactly what causes prediabetes. Experts believe that people who are overweight, not physically active, or have a family history of diabetes are more likely to get prediabetes. Experts also believe that women who have had gestational diabetes are more likely to get prediabetes.

What are the symptoms?

Most people with prediabetes don't have any symptoms. But if you have prediabetes, you need to watch for signs of diabetes, such as:

• Feeling very thirsty.
• Urinating more often than usual.
• Feeling very hungry.
• Having blurred vision.

How is prediabetes diagnosed?

A blood test can tell if you have prediabetes. You have prediabetes if your fasting blood sugar levels are between 100 and 125 milligrams per deciliter.

How is it treated?

The key to treating prediabetes and preventing type 2 diabetes is getting your blood sugar levels back to a normal range. You can do this by making some lifestyle changes.

• Make healthy food choices.
  • Limit how much fat you eat and try to eat foods high in fiber.
  • Try to eat about the same amount of carbohydrate at each meal. This helps keep your blood sugar steady. Carbohydrate affects blood sugar more than other nutrients. It is found in sugar and sweets, grains, fruit, starchy vegetables, and milk and yogurt.
  • Talk to your doctor, a diabetes educator, or a dietitian about an eating plan that will work for you. There are many ways to manage how much and when you eat.
• Watch your weight. If you are overweight, losing just a small amount of weight may help.
• Be active. You can do moderate activity, vigorous activity, or both. Bit by bit, increase the amount you do every day. You may want to swim, bike, or do other activities. Walking is an easy way to get exercise.
• Include your family in your lifestyle changes. For example, take a family walk after dinner instead of watching TV. It will be easier for you if the rest of the family also eats well and gets regular exercise. This may also reduce the chance that other family members will get prediabetes.

Making these changes may help delay or prevent diabetes. You may also avoid or delay some of the serious problems that you can get when you have diabetes, such as heart attack, stroke and heart, eye, nerve, and kidney disease.

Some doctors may use medicine to control blood sugar in people with prediabetes. If your doctor prescribed medicine to help control your blood sugar, take it as prescribed.

Can prediabetes be prevented?

Staying at a healthy weight, eating healthy foods, and getting regular exercise can help prevent prediabetes.

Health Tools

Health Tools help you make wise health decisions or take action to improve your health.

	Actionsets are designed to help people take an active role in managing a health condition.
	Diabetes: Using a plate format for eating
	Fitness: Adding more activity to your life
	Healthy eating: Cutting unhealthy fats from your diet
	Interactive tools are designed to help people determine health risks, ideal weight, target heart rate, and more.
	Interactive Tool: Is Your Weight Increasing Your Health Risks?

Frequently Asked Questions

Cause

Prediabetes occurs when the body does not respond properly to the hormone insulin and therefore cannot keep blood glucose (sugar) levels within a normal range. Blood sugar is higher than normal, but not high enough to be diabetes.

The food you eat turns into blood glucose, or sugar. The bloodstream transports glucose to all the cells in your body to be used for energy. Normally, the pancreas produces insulin, which allows the sugar in the blood to enter the body's cells. When your body's tissues are not responding properly to insulin, it becomes difficult for cells to get glucose from the blood for energy. This is called insulin resistance. When this happens, the cells cannot use the glucose, which then remains in the blood.

The buildup of sugar in the blood causes prediabetes. Over time, if not treated, the condition may get worse and lead to type 2 diabetes and other serious complications such as heart and large blood vessel disease, stroke, impaired vision, and nerve and kidney disease.

Symptoms

Prediabetes is most often a silent condition with no symptoms.

But certain risk factors, such as obesity or lack of exercise, may put you at a higher risk of developing prediabetes. If you have any of the risk factors for prediabetes-which are similar to the risk factors for type 2 diabetes-ask your doctor whether you should be tested.

What Happens

Being diagnosed with prediabetes is a warning sign that you are at risk for developing type 2 diabetes. Each year about 4% to 9% of people with prediabetes go on to develop type 2 diabetes.¹ Although you may still be healthy, moderate and persistent elevated blood sugar levels greatly increase your risk for getting diabetes and heart and blood vessel (cardiovascular) disease. Compared to people with normal blood sugar levels, people with prediabetes have a higher risk of developing cardiovascular disease, such as heart attackor stroke.²

If you have been diagnosed with prediabetes, you are also at higher risk for eye, nerve, and kidney disease. For more information on these complications, see the topic Type 2 Diabetes: Living With Complications.

You can help prevent or delay the start of type 2 diabetes by doing all of the following:

• Limit the amount of fat you eat.
• Limit the calories you eat.
• Limit sweets.
• Lose weight.
• Add more activity to your life.

These healthy habits can also lower your risk of complications. For more information, see the Treatment Overview section of this topic.

What Increases Your Risk

The risk factors for prediabetes are similar to the risk factors for type 2 diabetes. Most people who get type 2 diabetes had prediabetes first.

Risk factors that you cannot control include:

• Family history. If you have a parent, brother, or sister who has type 2 diabetes, you have a greater chance of developing the disease.
• Age. The risk for getting prediabetes and type 2 diabetes increases with age. And the number of children being diagnosed with type 2 diabetes is increasing. Usually, children who get type 2 diabetes have a family history of the disease, are overweight, and are physically inactive.³
• Race and ethnicity. African Americans, Hispanics, Native Americans, Asian Americans, and Pacific Islanders are at higher risk for type 2 diabetes than whites.⁴
• History of gestational diabetes or having a baby weighing more than 9 lb (4 kg). Women who have had gestational diabetes or who have had a large baby are at higher risk for developing type 2 diabetes later in life.⁴
• Low birth weight. People who weighed less than 5.5 lb (2.5 kg) at birth are more likely to develop type 2 diabetes later in life.⁵

There are some things you can do to reduce your chances of getting prediabetes and diabetes:

• Lose weight. Your risk for prediabetes and type 2 diabetes increases as your weight (or body mass index, BMI) increases. Your risk also increases if most of your body fat is in your belly area . Reaching and staying at a healthy body weight can reduce your risk.
• Get more exercise. The less you exercise, the greater your risk of developing prediabetes and type 2 diabetes.⁶ Try to do moderate activity at least 2½ hours a week. Or try to do vigorous activity at least 1¼ hours a week. It's fine to be active in blocks of 10 minutes or more throughout your day and week.⁷ For more information, see the topic Fitness.
• Eat foods that are good for you. Eating a lot of sugary foods, red meat, soft drinks, and fast food can increase your risk of getting prediabetes and type 2 diabetes. Eating whole grains, nuts, and vegetables can decrease your risk.⁸
• Get treatment if you have prediabetes. If your fasting blood sugar levels are in the range from 100 mg/dL to 125 mg/dL, you are at increased risk for developing type 2 diabetes.⁹
• Quit smoking. This change may reduce your chance of developing complications from diabetes.

Other conditions that put you at risk for prediabetes and type 2 diabetes-and that are also linked with obesity and a lack of physical activity-include:

• Polycystic ovary syndrome (PCOS), a hormone imbalance that interferes with normal ovulation.
• Metabolic syndrome, a group of abnormal physical findings related to the body's metabolism.

If you have prediabetes, you are more likely to get cardiovascular disease than someone with normal blood glucose levels.² By lowering your cholesterol to the recommended levels, not smoking, and keeping your blood pressure under 140/90 millimeters of mercury (mm Hg), you may reduce your risk of heart and large blood vessel disease.

If you are concerned about diabetes, you can take a test to determine your risk of getting the disease. If you are at risk, you can discuss with your doctor how to make healthy changes in your life. If you want, your doctor can refer you to health professionals who are trained to help you make your own easy-to-follow plan for eating and exercising. No matter how and when you start, it is important to remember that even small changes can lower your chances of getting diabetes.

When to Call a Doctor

The American Diabetes Association recommends screening for prediabetes, which may lead to type 2 diabetes, if you:²

• Are overweight and are age 45 or older. Get checked for prediabetes during your next routine office visit.
• Are at a healthy weight and are age 45 or older. During a routine office visit, ask your doctor if testing is appropriate.
• Are younger than 45 and overweight-your body mass index (BMI) is 25 or greater-and you have one or more other risk factors for type 2 diabetes. These include:
  • High blood pressure, over 140/90 millimeters of mercury (mm Hg).
  • Low high-density lipoprotein (HDL) cholesterol and high triglyceride.
  • A family history of type 2 diabetes. People who have a parent, brother, or sister with prediabetes or type 2 diabetes have a greater risk of getting the disease than adults who do not have a family history of the disease.
  • A history of gestational diabetes or having a baby weighing more than 9 lb (4 kg). Women who have had gestational diabetes or who have had a large baby are at greater-than-average risk for getting type 2 diabetes later in life.⁴
  • Risk due to race or ethnicity. African Americans, Hispanics, Native Americans, Asian Americans, and Pacific Islanders are at greater risk than whites for getting type 2 diabetes.⁴
• Are overweight and get little or no exercise and want to help reduce your risk for getting type 2 diabetes.

The United States Preventive Services Task Force (USPSTF) recommends diabetes testing for people who have blood pressure higher than 135/80.¹⁰

Exams and Tests

Your doctor will use a medical history, physical examination, and blood glucose testing to determine whether you have prediabetes and are at risk for developing type 2 diabetes.

Blood glucose testing is usually done after fasting overnight for 8 hours. In some cases, an oral glucose tolerance test (OGTT) may be done. For an OGTT, your blood sugar is measured after fasting and then again 2 hours after drinking a special glucose solution. This test is not done as often as the fasting glucose test, which is more convenient.

If the results of your glucose tests are in one of the following ranges, you have prediabetes and are at risk of developing type 2 diabetes:

• Fasting glucose of 100 to 125 milligrams per deciliter (mg/dL)
• Oral glucose tolerance (OGT) of 140 to 199 mg/dL (2 hours after the beginning of the test)

Phrases such as "a touch of diabetes,' 'borderline diabetes,' or 'your sugar is a little high' are unclear. If you hear these phrases, ask whether your blood sugar level falls within the prediabetes or diabetes range.

If you are diagnosed with prediabetes or type 2 diabetes, your doctor may also do a thorough examination of the cardiovascular system and check your blood pressure and cholesterol levels. Your doctor may also test your blood sugar periodically to check for diabetes.

Early Detection

The American Diabetes Association recommends screening for prediabetes, which may lead to type 2 diabetes, if you²:

• Are 45 years of age or older-particularly if you are overweight-and you have never had your blood glucose (sugar) tested or you have not been tested in more than 3 years.
• Are younger than 45, overweight-body mass index, BMI, of 25 or greater-and have one or more other risk factors for type 2 diabetes. These include:
  • High blood pressure, over 140/90 millimeters of mercury (mm Hg).
  • Abnormal cholesterol. People who have high-density lipoprotein (HDL) cholesterol levels of 35 milligrams per deciliter (mg/dL) or less or triglyceride levels of 250 mg/dL or more are at increased risk for developing type 2 diabetes.⁴
  • A family history of type 2 diabetes. People who have a parent, brother, or sister with prediabetes or type 2 diabetes have a greater risk of developing the disease than adults without a parental history of the disease.
  • History of gestational diabetes or having a baby weighing more than 9 lb (4 kg). Women who have had gestational diabetes or who have had a large baby are at greater risk for getting type 2 diabetes later in life.⁴
  • Race and ethnicity. African Americans, Hispanics, Native Americans, Asian Americans, and Pacific Islanders are at greater risk for getting type 2 diabetes than whites.⁴
• Are overweight and get little or no exercise and want to help reduce your risk for getting type 2 diabetes.

The United States Preventive Services Task Force (USPSTF) recommends diabetes testing for people who have blood pressure greater than 135/80.¹⁰

Treatment Overview

If you have been diagnosed with prediabetes, you will play a key role in your treatment and have an opportunity to reverse the condition or delay the progression to type 2 diabetes. Losing weight, eating a healthy diet, and getting regular exercise are very effective in preventing or delaying the onset of diabetes as well as lowering your risks for other complications, such as coronary artery disease or stroke. These measures may sound simple, but they are very important for your overall health and for preventing diabetes.

In some cases, your doctor may prescribe medicine in addition to diet and exercise. But research has shown promising results in preventing diabetes through diet and exercise alone. One large study done in the U.S. (Diabetes Prevention Program) showed that making these lifestyle changes was more effective at lowering the risk of getting type 2 diabetes than taking medicine:⁶

• Those who lost a modest amount of weight (5% to 10% of total body weight) and exercised lowered their risk by 58%.
• Those who took medicine lowered their risk by 31%.

Monitor your weight

Most people with prediabetes are overweight and have a body mass index, BMI, of 25 or greater. If you have a BMI of 25 or higher, losing just 5% to 10% of your body weight may help you prevent or delay type 2 diabetes.¹¹ A healthy weight helps your body use insulin properly. One recent study showed that losing weight improves insulin resistance in people with prediabetes. The degree of improvement is related to the amount of weight lost.¹²

For more information on determining your BMI, use the Interactive Tool: Is Your Weight Increasing Your Health Risks?

Eat a balanced diet

If you have prediabetes, you may be able to prevent or delay the disease by doing all of the following:

• Limit the amount of fat you eat. Eat foods low in saturated fat and high in soluble fiber.
• Eat less calories.
• Limit sweets to avoid sudden peaks in blood sugar. Of the three major nutrients (carbohydrate, protein, and fat), carbohydrate has the greatest effect on blood sugar.

Talk to your doctor about developing a plan for healthy eating.

One large study found that men who ate a diet high in vegetables, fish, poultry, and whole grains had a lower risk for getting type 2 diabetes compared with men who ate a diet high in red meat, processed meat, high-fat dairy foods, refined grains, and sweets.¹³

Planning meals to manage prediabetes often means looking at food in a new way. There are several easy ways to adapt your diet. A registered dietitian can help you build a meal plan that fits your lifestyle. For more information on one type of meal planning, see:

Diabetes: Using a plate format for eating.

Exercise regularly

Experts say to do either of these things for exercise:⁷

• Moderate activity for at least 2½ hours a week. One way to do this is to be active 30 minutes a day, at least 5 days a week. Moderate activity means things like brisk walking, brisk cycling, or ballroom dancing. But any activities-including daily chores-that raise your heart rate can be included. You notice your heart beating faster with this kind of activity.
• Vigorous activity for at least 1¼ hours a week. One way to do this is to be active 25 minutes a day, at least 3 days a week. Vigorous activity means things like jogging, cycling fast, or cross-country skiing. You breathe rapidly and your heart beats much faster with this kind of activity.

It's fine to be active in blocks of 10 minutes or more throughout your day and week. You can choose to do one or both types of activity.

Moderate activity is safe for most people, but it's always a good idea to talk to your doctor before you start an exercise program.

Exercise helps control your blood sugar by using glucose for energy during and after activity. Exercise helps your body respond better to insulin and lowers your risk of getting diabetes. It also helps you maintain a healthy weight; lower high cholesterol; raise high-density lipoprotein (HDL), or "good," cholesterol; and lower high blood pressure. These benefits also help prevent heart and blood vessel (cardiovascular) disease. You may lower your risk of getting diabetes even more by exercising for longer periods of time during each exercise session.

Exercise can consist of moderate walking or more vigorous activities such as jogging, running, bicycling, or playing tennis. Research has also shown that other activities, such as gardening or snow shoveling may be beneficial.¹⁴ Work with your doctor to plan a safe exercise program.

Take medicine if needed

In some cases a doctor may prescribe an oral medicine-most commonly metformin. Metformin reduces the amount of sugar made by the liver in a person who is insulin resistant. This may be appropriate in people with polycystic ovary syndrome. If your doctor has prescribed medicine for prediabetes, be sure to take it as directed.

Stop smoking

If you smoke cigarettes, talk with a doctor about ways to quit. Smoking may play a role in the development of type 2 diabetes, and it contributes to early development of diabetes complications.¹⁵ For more information on how to quit, see the topic Quitting Smoking.

Monitor blood pressure and cholesterol levels

If you have prediabetes you are more likely to get cardiovascular disease than someone with normal blood glucose levels.² Your doctor may take your blood pressure and test your blood periodically to check your cholesterol levels. By lowering your cholesterol to the recommended levels and keeping your blood pressure under 140/90 millimeters of mercury (mm Hg), you may reduce your risk of heart and large blood vessel disease.

By eating a healthy diet and getting regular exercise, you may be able to keep your blood pressure and cholesterol levels within the recommended ranges. People who have high-density lipoprotein (HDL) cholesterol levels of 35 milligrams per deciliter (mg/dL) or less or triglyceride levels of 250 mg/dL or more are at higher risk for getting type 2 diabetes.⁴

Prevention

If you have any of the risk factors for prediabetes, you can take steps to prevent this condition as well as the progression to type 2 diabetes. The best ways to prevent prediabetes are to:

• Manage your weight.
• Eat a healthy diet.
• Get regular exercise.

You can play a key role in controlling your blood sugar levels by:

• Losing weight if you are overweight. Studies have shown that losing just 5% to 10% of your body weight may help you prevent or at least delay type 2 diabetes.¹¹ A healthy weight helps your body use insulin properly. One recent study showed that losing weight improves insulin resistance in people with prediabetes. The degree of improvement is related to the amount of weight lost.¹² For more information on weight and body mass index (BMI), use the Interactive Tool: Is Your Weight Increasing Your Health Risks?
• Limiting fat and eating a balanced diet by limiting carbohydrate throughout the day to avoid sudden peaks in blood sugar and by eating foods low in saturated fat and high in soluble fiber. Talk to your doctor about making a plan for healthy eating.
  • One large study found that men who ate a diet high in vegetables, fish, poultry, and whole grains had a lower risk for getting type 2 diabetes compared with men who ate a diet high in red meat, processed meat, high-fat dairy foods, refined grains, and sweets.¹³
• Exercising. Exercise helps control your blood sugar by using glucose for energy during and after activity. Exercise helps your body respond better to insulin and lowers your risk of getting diabetes. It also helps you maintain a healthy weight; lower high cholesterol; raise high-density lipoprotein (HDL), or "good," cholesterol; and lower high blood pressure. These benefits also help prevent cardiovascular disease. If you do not get regular exercise, talk with your doctor about beginning an exercise program. Lack of regular exercise raises the chances that your blood sugar level will increase from normal to prediabetes to type 2 diabetes. Any type of physical activity may be beneficial, including:^{14, 16, 17}
  • Sports or other types of exercise, such as walking, jogging, swimming, or biking.
  • Household work, such as vacuuming or gardening.
  • Work-related activities.

For more information on exercise, see the topic Fitness.

The National Diabetes Education Program's Small Steps Big Rewards program outlines several ways to make minor changes to your lifestyle that can have a big impact on preventing prediabetes and type 2 diabetes. These include setting goals for moderate weight loss and exercise and tracking your progress. For more information about this program, visit the National Diabetes Education Program Web site at www.ndep.nih.gov.

If you smoke cigarettes, talk with a doctor about ways to quit. Smoking may play a role in the development of type 2 diabetes, and it contributes to early development of diabetes complications.¹⁵ For more information, see the topic Quitting Smoking.

Home Treatment

Several studies have shown that home treatment for prediabetes is the most effective way to treat prediabetes and prevent the progression to type 2 diabetes.^{14, 6} Home treatment consists of:

• Controlling your weight.
• Eating a healthy diet.
• Exercising regularly.

Monitor your weight

Most people with prediabetes are overweight (body mass index [BMI] of 25 or greater). If you have a BMI of 25 or higher, losing just 5% to 10% of your body weight may help you prevent or delay type 2 diabetes.¹¹ A healthy weight helps your body use insulin properly. One recent study showed that losing weight improves insulin resistance in people with prediabetes. The degree of improvement is related to the amount of weight lost.¹²

For more information on determining your BMI, use the Interactive Tool: Is Your Weight Increasing Your Health Risks?

Eat a balanced diet

If you have prediabetes, you may be able to prevent or delay the disease by eating a balanced diet. Of the three major nutrients (carbohydrate, protein, and fat), carbohydrate has the greatest effect on blood sugar.

Limit fat in your diet. Eat foods low in saturated fat and high in soluble fiber. Talk to your doctor about developing a plan for healthy eating.

Planning meals to manage prediabetes often means looking at food in a new way. There are several easy ways to adapt your diet. A registered dietitian can help you make a meal plan that fits your lifestyle. For more information on one type of meal planning, see:

Diabetes: Using a plate format for eating.

Exercise regularly

Experts say to do either of these things for exercise:⁷

• Moderate activity for at least 2½ hours a week. One way to do this is to be active 30 minutes a day, at least 5 days a week. Moderate activity means things like brisk walking, brisk cycling, or ballroom dancing. But any activities-including daily chores-that raise your heart rate can be included. You notice your heart beating faster with this kind of activity.
• Vigorous activity for at least 1¼ hours a week. One way to do this is to be active 25 minutes a day, at least 3 days a week. Vigorous activity means things like jogging, cycling fast, or cross-country skiing. You breathe rapidly and your heart beats much faster with this kind of activity.

It's fine to be active in blocks of 10 minutes or more throughout your day and week. You can choose to do one or both types of activity.

Moderate activity is safe for most people, but it's always a good idea to talk to your doctor before you start an exercise program.

Exercise helps control your blood sugar by using glucose for energy during and after activity. Exercise helps your body respond better to insulin and lowers your risk of getting diabetes. It also helps you maintain a healthy weight; lower high cholesterol; raise high-density lipoprotein (HDL), or "good," cholesterol; and lower high blood pressure. These benefits also help prevent cardiovascular disease. You may lower your risk of getting diabetes even more by exercising for longer periods of time during each exercise session.

If you do not get regular exercise, talk with your doctor about beginning an exercise program. Lack of regular exercise raises the risk that your blood sugar level will increase from normal to prediabetes to type 2 diabetes. Any type of physical activity may be beneficial, including:^{14, 16, 17}

• Sports or other types of exercise, such as walking, jogging, swimming, or biking.
• Household work, such as vacuuming or gardening.
• Work-related activities.

The National Diabetes Education Program's Small Steps Big Rewards program outlines several ways to make minor adjustments to your lifestyle that can have a big impact on preventing type 2 diabetes. These include setting goals for moderate weight loss and exercise and tracking your progress. For more information about this program, visit the National Diabetes Education Program Web site at www.ndep.nih.gov.

If you smoke cigarettes, talk with a doctor about ways to quit. Smoking may play a role in the development of type 2 diabetes, and it contributes to early development of diabetes complications.¹⁵ For more information on how to quit, see the topic Quitting Smoking.

Medications

Most people with prediabetes get better results by making lifestyle changes, such as losing weight, eating a healthy diet, and getting regular exercise, than with diabetes medicine.⁶

But a doctor may prescribe a biguanide, usually metformin (Glucophage), because it can reduce how much glucose is made by the liver and lower insulin levels, especially in patients with polycystic ovary syndrome. In some cases a doctor may prescribe thiazolidinediones (Actos or Avandia) to lower insulin resistance. One study (the DREAM trial investigation) shows that Avandia prevents type 2 diabetes as effectively as lifestyle change but can cause you to gain weight and/or retain fluid.¹⁸ Metformin is used much more frequently.

Ask your doctor whether diet and exercise are sufficient treatment or whether you should take medicine to lower your insulin resistance.

Other Treatment

Avoid products that promise a cure for prediabetes and are advertised only by testimonials of satisfied customers. These products or remedies may be harmful and costly. The best way to treat prediabetes is by eating a healthy diet and getting regular exercise.

If you have questions about a product for prediabetes or diabetes, check with your local American Diabetes Association office, your doctor, or a diabetes educator.

Other Places To Get Help

Organizations

Related Information

• Type 2 Diabetes
• Type 2 Diabetes in Children
• Type 2 Diabetes: Living With Complications
• Type 2 Diabetes: Living With the Disease
• Type 2 Diabetes: Recently Diagnosed

References

Citations

1. Swinburn BA, et al. (2001). Long-term (5-year) effects of a reduced-fat diet intervention in individuals with glucose intolerance. Diabetes Care, 24(4): 619-624.

2. American Diabetes Association (2004). Frequently asked questions about pre-diabetes. Available online: http://www.diabetes.org/pre-diabetes/faq.jsp.

3. American Diabetes Association (2000). Type 2 diabetes in children and adolescents. Pediatrics, 105(3): 671-680.

4. American Diabetes Association (2004). Screening for type 2 diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S11-S14.

5. Capes S, Anand S (2001). What is type 2 diabetes? In HC Gerstein, RB Haynes, eds., Evidence-Based Diabetes Care, pp. 151-163. Hamilton, ON: BC Decker.

6. Diabetes Prevention Program Research Group (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine, 346(6): 393-403.

7. U.S. Department of Health and Human Services (2008). 2008 Physical Activity Guidelines for Americans (ODPHP Publication No. U0036). Washington, DC: U.S. Government Printing Office. Available online: http://www.health.gov/paguidelines/pdf/paguide.pdf.

8. American Diabetes Association (2004). Magnesium intake and risk of type 2 diabetes in men and women. Diabetes Care, 27(Suppl 1): 134-140.

9. American Diabetes Association (2008). Standards of medical care in diabetes. Diabetes Care, 31(Suppl 1): S12-S54.

10. U.S. Preventive Services Task Force (2008). Screening for type 2 diabetes mellitus in adults: U.S. Preventive Services Task Force recommendation statement. Annals of Internal Medicine, 148(11): 846-854.

11. American Diabetes Association (2004). Prevention or delay of type 2 diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S47-S50.

12. Uusitupa M, et al. (2003). Long-term improvement in insulin sensitivity by changing lifestyles of people with impaired glucose tolerance: 4-year results from the Finnish diabetes prevention study. Diabetes, 52(10): 2532-2538.

13. Van Dam RM, et al. (2002). Dietary patterns and risk for type 2 diabetes mellitus in U.S. men. Annals of Internal Medicine, 136(3): 201-209.

14. Lindstrom J, et al. (2003). The Finnish diabetes prevention study (DPS): Lifestyle intervention and 3-year results on diet and physical activity. Diabetes Care, 26(12): 3230-3236.

15. American Diabetes Association (2004). Smoking and diabetes. Clinical Practice Recommendations 2004. Diabetes Care, 27(Suppl 1): S74-S75.

16. Lindstrom J, et al. (2003). Prevention of diabetes mellitus in subjects with impaired glucose tolerance in the Finnish diabetes prevention study: Results from a randomized trial. Journal of the American Society of Nephrology, 14(7, Suppl 2): S108-S113.

17. Tuomilehto J, et al. (2001). Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. New England Journal of Medicine, 344(18): 1343-1350.

18. Gerstein HC, et al. (2006). Effects of rosiglitazone on the frequency of diabetes in patients with impaired glucose tolerance or impaired fasting glucose: A randomised controlled trial. Lancet, 368(9541): 1096-1105.

Other Works Consulted

• Liao D, et al. (2002). Improvement of BMI, body composition, and body fat distribution with lifestyle modification in Japanese Americans with impaired glucose tolerance. Diabetes Care, 25(9): 1504-1510.

• Mirza SA (2007). Metabolic disorders. In RE Rakel, ET Bope, eds., Conn's Current Therapy, pp. 675-682. Philadelphia: Saunders Elsevier.

• National Diabetes Education Program (2006). Small steps, big rewards: Your game plan for preventing type 2 diabetes. Available online: http://ndep.nih.gov.

• Norris SL, et al. (2005). Long-term non-pharmacological weight loss interventions for adults with prediabetes. Cochrane Database of Systematic Reviews. Oxford: Update Software.

• Rao SS, et al. (2004). Impaired glucose tolerance and impaired fasting glucose. American Family Physician, 69(8): 1961-1968.

• Riddle MC, Genuth S (2007). Type 2 diabetes mellitus. In DC Dale, DD Federman, eds., ACP Medicine, section 9, chap. 2. New York: WebMD.

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