What is prediabetes and why should employers focus on it?

Prediabetes is a condition in which blood sugar, whether measured as hemoglobin A1c (HBA1c), a test that measures your blood glucose over a 2-3 month timespan, or glucose, is higher than normal, but not high enough to be considered type 2 diabetes. The American Diabetes Association defines diabetes as HbA1c measuring 6.5% or higher, while an HbA1c result of 5.7% to 6.4% means a person has prediabetes. A fasting glucose measurement of 100 mg/DL to 125 mg/dL is also considered prediabetes.³

Today, the CDC estimates that one third of the American adult population has prediabetes. There are no clear symptoms, which is why nearly 90% of individuals with prediabetes do not know they have the condition.⁴ However, certain risk factors mean a person may have a predisposition for prediabetes. These include:

• Being overweight or obese
• Having a family history of diabetes
• Being physically active less than 3 times per week
• Having a history of gestational diabetes
• Being of minority descent (including African American, Hispanic, American Indian, or Asian American)

In response to the growing rate of diabetes in the United States, the CDC and its partners created the National Diabetes Prevention Program (DPP) to expand the availability of effective, affordable diabetes prevention programs.⁵ Currently, the CDC funds 6 organizations, as well as multiple state and local health departments, to support diabetes-prevention efforts.

The main component of the National DPP is the focus on lifestyle change to prevent and/or delay a type 2 diabetes diagnosis. The program focuses specifically on adopting a healthier diet and adding regular physical activity to one’s day. The National DPP holds certain standards that lifestyle change programs must meet in order to be CDC-recognized.⁶ Participating programs must follow an approved curriculum and submit data to the CDC to ensure the program is having an impact. One CDC-recognized provider of DPPs is Omada, which is available as part of the suite of Quest Diagnostics employer population health solutions. 

There are many medications that treat diabetes, so why does the National DPP focus on lifestyle changes? There are two reasons: availability and effectiveness.

First, lifestyle changes are readily available treatments. Changing one’s diet or adding physical activity to one’s daily routine may be more cost effective than requiring an individual to purchase a medication. Additionally, a variety of organizations can be involved in lifestyle change programs, including churches, schools, health organizations, worksites, and community organizations. These types of programs can reach a broader audience, including individuals who may not regularly go to a primary care physician.

Second, behavior change has been proven to be more effective than medication in preventing and/or delaying a type 2 diabetes diagnosis. The National DPP conducted a study of overweight participants with prediabetes to determine which method of treating prediabetes was most effective: lifestyle change programs, prescription drug therapy, or educational programs about diabetes.

The study found that lifestyle change programs, including exercise groups and diet plans, had the best outcome. These participants lost an average of 15 pounds during the first year, and, over the course of the 3-year study, reduced their risk of developing type 2 diabetes by 58%.⁷ Those who only received drug therapy reduced their risk of developing type 2 diabetes by only 31%, while individuals in the education-only category had even poorer results. Those enrolled in the lifestyle change programs also had other long-term health benefits, including reduced risk of heart disease, lower blood pressure, and lower triglyceride levels by the end of the study. ⁸

While treating diabetes remains very important for reducing healthcare costs and improving the quality of life for individuals affected by the disease, treating prediabetes and preventing or delaying type 2 diabetes is moving to the forefront of public health concerns. Institutions like the CDC and the American Diabetes Association are encouraging individuals to get screened for prediabetes and take action to prevent and/or delay a type 2 diabetes diagnosis. Additionally, employers are offering glucose or HbA1c screenings through their employer-sponsored well-being programs so employees can determine their prediabetes risk. Armed with knowledge, individuals can adopt lifestyle changes that will positively impact their lives, prevent and/or delay diabetes, and help reduce the cost impact of diabetes care.