Risk factors for prediabetes

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

Risk factors that you cannot control include:

• Family history. People who have a parent, brother, or sister with prediabetes or type 2 diabetes have a greater chance of getting these conditions. In the United States, adults who have a parent with type 2 diabetes are four times more likely to get the disease than adults without a parental history of the disease. The risk is nearly eight times higher when both parents have type 2 diabetes.¹
• Age. The risk for developing prediabetes and type 2 diabetes increases with age. The American Diabetes Association reports that over 54 million Americans ages 40 to 74 have prediabetes.² And the number of children being diagnosed with the disease is increasing. Usually, children who develop 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 greater risk 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 increased 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.¹

Risk factors that you can change or get treatment for include:

• Being overweight. The risk for prediabetes and type 2 diabetes increases as weight (or body mass index, BMI) increases. People who have a large percentage of body fat in the abdominal area [waist circumference greater than 40 in. (102 cm) in men and greater than 35 in. (88 cm) in women] are at increased risk for type 2 diabetes, even if their BMI is within the normal range.⁵ In addition, weight gain of more than 22 lb (10 kg) after age 18 in women or 18 lb (8 kg) after age 21 in men further increases the risk for type 2 diabetes.¹
• Lack of physical exercise. Participating in physical exercise less than once a week increases your chance of developing type 2 diabetes by 20% to 40%.¹ One large study found that women who were sedentary, especially those who watched a lot of television, were at higher-than-average risk of obesity and type 2 diabetes.⁶
• High blood pressure (hypertension). People who have blood pressure levels above 140/90 millimeters of mercury (mm Hg) are at greater risk for developing prediabetes and type 2 diabetes than people who have normal blood pressure.⁴ The United States Preventive Services Task Force (USPSTF) recommends diabetes testing for people who have blood pressure higher than 135/80.⁷
• 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 higher risk for developing type 2 diabetes.⁴
• An unhealthy diet. A diet high in sugary foods and low in fiber content raises your risk for prediabetes and type 2 diabetes.¹ One large study found that a diet high in red meat, processed meat, high-fat dairy products, french fries, refined grains, and sweets increased men's risk for type 2 diabetes compared with a diet high in vegetables, fruits, fish, poultry, and whole grains.⁸

Other risk factors for prediabetes and type 2 diabetes, which are also associated with obesity and a lack of physical activity, include:

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

If you have prediabetes, you are more likely to get heart and large blood vessel (cardiovascular) disease than a person who doesn't have this condition.⁹ Lowering your cholesterol to the recommended levels, keeping your blood pressure under 140/90 millimeters of mercury (mm Hg), and (if you smoke) giving up smoking may reduce your risk.

Citations

1. 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.

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

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. National Heart, Lung, and Blood Institute, National Institutes of Health (2000). The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults (NIH Publication No. 00-4084). Available online: http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_c.pdf.

6. Hu FB, et al. (2003). Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA, 289(14): 1785-1791.

7. 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.

8. 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.

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