Prediabetes: Do You Need Medication or Dietary Changes?

Q: Prediabetes: Do You Need Medication or Dietary Changes?

●Conclusion first： Not necessarily, but there is a high chance of not having diabetes, and medication is not required. <br>●The diagnostic criteria for diabetes include four criteria： (1) Fasting blood glucose ≥ 126 mg/dL (2) Two-hour blood glucose ≥ 200 mg/dL after a 75 g oral g

Is it prediabetes, and is there a need for medication management?

Hello Doctor: I had a routine check-up last June, where my fasting blood glucose was 88, but my hemoglobin A1c spiked to 9.4.
The doctor advised that the testing lab should recheck the results.
Later, I was asked to have another blood test three months later, and by the end of November, my fasting blood glucose was 77, and my hemoglobin A1c had decreased to 8.9.
However, this is still high compared to the normal range of 3.1-6.1.
The doctor found it strange but did not diagnose me with diabetes; instead, he advised me to monitor my diet and return for another blood test in six months.
Today, I received my test results, and my fasting blood glucose is 72, with a hemoglobin A1c of 8.2.
I asked the doctor if I have diabetes, and he said that since my fasting levels are not high, I shouldn't worry, and that I should continue to observe and monitor my condition.
I would like to ask—since I have read that hemoglobin A1c is generally a more accurate indicator than fasting blood glucose, do these results suggest that I am in the prediabetic stage? How can I more effectively control my diet, and is it true that I might not need medication? I am 160 cm tall, weigh 51 kg, and my cholesterol and triglyceride levels are normal.

TinaHong, 30~39 year old female. Ask Date: 2017/05/26

Dr. Chen Taicheng reply Family Medicine

●Conclusion first: Not necessarily, but there is a high chance of not having diabetes, and medication is not required.
●The diagnostic criteria for diabetes include four criteria: (1) Fasting blood glucose ≥ 126 mg/dL (2) Two-hour blood glucose ≥ 200 mg/dL after a 75 g oral glucose tolerance test (3) Random blood glucose ≥ 200 mg/dL with symptoms of hyperglycemia (4) Hemoglobin A1c (HbA1c) ≥ 6.5% ●Hemoglobin A1c measures the amount of glucose attached to hemoglobin and generally reflects the average blood glucose levels over the past three months (the lifespan of red blood cells is approximately 120 days, but it can vary).
However, in certain situations, changes in the production rate or lifespan of red blood cells can lead to inaccurate HbA1c results.
●Conditions that can cause falsely low HbA1c levels include acute blood loss, hemolytic anemia, recent blood transfusions, certain hemoglobinopathies (such as sickle cell disease), favism, medications, chronic liver disease, and smoking (which can increase the production rate of red blood cells).
●Conditions that can cause falsely high HbA1c levels include iron deficiency anemia, vitamin B12 deficiency, folate deficiency, alcoholism, uremia, and medications (such as high doses of aspirin).
●Other causes of HbA1c distortion include fetal hemoglobin, variant hemoglobins, and certain hemoglobinopathies.
●In your case, it is important to rule out causes of falsely elevated HbA1c such as iron deficiency anemia (common in women of childbearing age), vitamin B12 deficiency, and folate deficiency; if HbA1c remains high, the most likely cause would be a hemoglobinopathy.
The diagnosis of diabetes can be easily ruled out; your fasting blood glucose is normal, and as long as you undergo a glucose tolerance test (75 g oral glucose, with blood glucose measured two hours later) and the results are normal, diabetes can be excluded.
●In my personal experience, conditions that can distort HbA1c include iron deficiency anemia (which may cause a slight increase) and hemoglobinopathies (which may cause a false decrease); for hemoglobinopathies, it is recommended to seek further evaluation and treatment at a major hospital.
●Wishing you good health, Dr.
Chen Tai-Cheng from Taoyuan Hospital Family Medicine Department cares about you~

Reply Date: 2017/05/26

More Info

Understanding prediabetes is crucial for preventing the progression to type 2 diabetes. Your situation, with fluctuating blood sugar levels and elevated hemoglobin A1c (HbA1c), suggests that you may be in the prediabetes range, especially considering your HbA1c values of 9.4, 8.9, and 8.2. According to the American Diabetes Association, an HbA1c level between 5.7% and 6.4% indicates prediabetes, while a level of 6.5% or higher is diagnostic for diabetes. Your latest HbA1c of 8.2% is concerning and indicates that you should take proactive steps to manage your blood sugar levels.

Your doctor’s advice to monitor your diet is essential. Dietary changes can significantly impact blood sugar control. Here are some strategies you can implement:
1. Balanced Diet: Focus on a diet rich in whole foods, including vegetables, fruits, whole grains, lean proteins, and healthy fats. This can help stabilize blood sugar levels.

2. Carbohydrate Management: Pay attention to carbohydrate intake. Opt for complex carbohydrates (like whole grains) over simple sugars (like candy and soda), as they have a lower glycemic index and cause a slower rise in blood sugar.

3. Portion Control: Be mindful of portion sizes to avoid overeating, which can lead to spikes in blood sugar levels.

4. Regular Meals: Eating at regular intervals can help maintain steady blood sugar levels. Skipping meals can lead to overeating later and can cause fluctuations in blood sugar.

5. Physical Activity: Regular exercise is vital. Aim for at least 150 minutes of moderate-intensity aerobic activity per week, such as brisk walking, swimming, or cycling. Exercise helps improve insulin sensitivity and can lower blood sugar levels.

6. Weight Management: Although your weight seems to be within a healthy range, maintaining or slightly reducing body weight can further improve insulin sensitivity.

7. Monitor Blood Sugar: Keep track of your blood sugar levels at home. This can help you understand how different foods and activities affect your blood sugar.

Regarding medication, many individuals with prediabetes can manage their condition effectively through lifestyle changes alone. However, if your HbA1c continues to rise or if you have other risk factors for diabetes, your healthcare provider may consider medication such as Metformin. Metformin is often prescribed to help lower blood sugar levels and improve insulin sensitivity, especially in those who are at high risk for developing type 2 diabetes.

In summary, while your current blood sugar levels are not classified as diabetes, your elevated HbA1c indicates that you are at risk. Implementing dietary changes and lifestyle modifications can significantly impact your health and may help you avoid medication. It’s essential to continue regular follow-ups with your healthcare provider to monitor your condition and make adjustments as necessary. If you have further concerns or if your HbA1c levels do not improve, discussing medication options with your doctor may be warranted.

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