Prediabetes and Primary Prevention of

Type 2 Diabetes
Prediabetes is a condition in which blood glucose levels are higher than normal but not in
the diabetes range. PPOD and other health care providers can work with patients who are
diagnosed as having prediabetes to help prevent them from progressing to additional health
complications. Without intervention, people with prediabetes will progress to type 2 diabetes
at a rate of 10% per year. Prediabetes also increases the risk of heart disease and stroke.1
Prediabetes is defined as impaired fasting glucose (IFG) of 100 to 125 mg/dl, impaired
glucose tolerance (IGT) diagnosed by a post 75-gram glucose challenge (oral glucose
tolerance test of >140 to <200 mg/dl or both IFG and IGT), or a hemoglobin A1C of
5.7–6.4%. The Are You at Risk for Type 2 Diabetes? test, from NDEP, can help patients and
providers assess individual risk for prediabetes.

Primary Prevention
Primary prevention refers to preventing diabetes from occurring. Secondary prevention
refers to preventing complications in those who already have diabetes (e.g., prevention of
neuropathy), and tertiary prevention refers to prevention of worsening complications
(e.g., amputation resulting from injury to a neuropathic foot) or death.

Working Together to Manage Diabetes: A GUIDE FOR PHARMACY, PODIATRY, OPTOMETRY, AND DENTISTRY 85
 Trend Is Not Destiny
Progression to diabetes among those with prediabetes is not inevitable. Studies have shown
that people with prediabetes who lose weight and increase their physical activity can prevent
or delay diabetes and return their blood glucose levels to normal.
A major National Institutes of Health (NIH)-supported clinical trial—the Diabetes
Prevention Program (DPP) study—provided scientific evidence that the onset of diabetes
could be prevented or delayed in people at high risk. In the DPP, adults with prediabetes
reduced their risk of developing diabetes during the course of the study by 58% through
lifestyle changes such as:
ƒ Reduced fat and calorie intake.
I ncreased physical activity of at least 150 minutes/week (e.g., brisk walking 30 minutes a
day, 5 days/week).
Loss of at least 5% to 7% of body weight.
These lifestyle changes were effective in preventing or delaying diabetes in all ages and all
ethnic groups in the DPP. Among people ages 60 years and older, progression to type 2
diabetes was reduced by 71%. The DPP showed that moderate changes resulting in modest
weight loss can make a difference.
Interventions to prevent or delay type 2 diabetes in individuals with prediabetes can be
feasible and cost-effective. Research has found that lifestyle interventions are more
cost-effective than medications.1 Further information on prediabetes, testing
recommendations, and more can be found on the National Diabetes Education Program’s
(NDEP) Small Steps. Big Rewards. Prevent Type 2 Diabetes campaign site.

The National Diabetes Prevention Program

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There are four components of the National
Diabetes Prevention Program: Patient Case Example
Training: Increase workforce A 45-year-old African American
Train the workforce that can implement the
woman brings in her mother
program cost-effectively.
for her annual comprehensive
Recognition Program: Assure quality diabetes eye exam. The eye care
Implement a recognition program that will provider asks the woman if she
assure quality, lead to reimbursement, and ever considered that she, too,
allow CDC to develop a program registry. has a family history of diabetes,
Intervention Sites: Deliver program which would place her at risk
Develop intervention sites that will build for developing type 2 diabetes.
infrastructure and provide the program.
The woman is surprised. “Me?
Health Marketing: Support program uptake I just never thought much
Increase referrals to and use of the prevention about it. I’ve always been
program. focused on Mama.”
Participants work with a lifestyle coach in The provider gives the woman
a group setting to receive a 1-year lifestyle the Am I at Risk? brochure
change program that includes 16 core sessions
and NDEP’s toll-free number
(usually 1 per week) and 6 post-core sessions
and website URL and suggests
(1 per month).
she make a follow-up
Partners of the National Diabetes Prevention appointment with her own
Program include the Y (also known as YMCA primary care provider.
of the USA) and United Health Group. These
partner organizations were instrumental in
starting up the national program and continue
to expand the reach of evidence-based lifestyle programs. CDC is enthusiastic about the
numerous organizations becoming involved in the National Diabetes Prevention Program.
Explore the National Diabetes Prevention Program site to learn more about prediabetes and
how to prevent or delay type 2 diabetes.

Working Together to Manage Diabetes: A GUIDE FOR PHARMACY, PODIATRY, OPTOMETRY, AND DENTISTRY 87
 The Role of Pharmacy, Podiatry,
Optometry, and Dentistry Patient Case Example
Providers in Primary Prevention A 50-year-old man, accompanied
All health care providers can play a role in by his overweight teenage
diabetes primary prevention and diabetes son, asks the pharmacist about
management. As a pharmacist, podiatrist, weight loss pills. The teen seems
optometrist, dentist, or dental hygienist, you can embarrassed and unconvinced.
make a difference in primary prevention because: He says, “What am I supposed to
eat when the guys are all eating
ƒ You know your patients.
burgers and fries?”
Your patients trust you.
The pharmacist agrees that
A few words from you can go a long way. changing eating habits is
 ou can determine with just a few
Y hard. He suggests that the son
questions who is at high risk for diabetes try eating smaller portions
(see risk factor list below). or choosing a plain burger
instead of the oversized one
with cheese. He also suggests
Do Your Patients Have Any of the
the family visit NDEP’s website
Following Risk Factors? for tips on healthy eating and
ƒ Family history of type 2 diabetes. physical activity, and that they
talk with a dietitian.
Overweight or obesity.
Dad agrees to play basketball
High blood pressure or cholesterol. with his son a couple of nights
 frican American, American Indian/Alaska
A a week—good exercise for both
Native, Asian American, Hispanic/Latino, or of them.
Native Hawaiian/Pacific Islander ethnicity.
Prediabetes.
Older than 45 years of age.
History of gestational diabetes mellitus.

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A Few Words Can Go a Long Way
You don’t need to do it all—resources are available to help. Your patients will appreciate that
you care about their overall health.
ƒ Ask: “Has anyone ever told you that you are at risk for diabetes?”
Advise: “You can take action to prevent or delay type 2 diabetes.”
Assist: Give your patients resources to help them make healthy changes.
Refer your patients to their primary care provider.
Use the free primary prevention materials available from NDEP online and at
1–888–693–NDEP (1–888–693–6337).

Reference
1. H erman WH, Hoerger TJ, Brandle M, et al. The cost-effectiveness of lifestyle modification or metformin in preventing type 2
diabetes in adults with impaired glucose tolerance. Ann Intern Med. 2005 Mar 1;142(5):323–32.

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