Prediabetes: You may be at risk and not know it
By Dr. James Aw, Chief Medical Officer, OMERS
December 1, 2025
I learned a lot about diabetes from Africa. Before the pandemic, I volunteered in rural Africa annually for several years leading clinical teams in medical camps, field research and education with a focus on non-communicable chronic diseases. Sadly, we would see patients with end-stage complications of diabetes because of lack of screening and early treatment. Late-stage diabetes can lead to blindness, kidney failure, heart attacks, strokes, nerve damage and lower leg amputations from poor circulation. Our focus was on training local community health care workers to screen individuals in their homes using a novel mHealth tool (via mobile phones) to identify those at risk before they had symptoms. We trained and partnered with local health care providers to track people at risk of diabetes and get them medication and education early on. Early detection improves outcomes!
What is prediabetes?
Prediabetes occurs when your blood sugars are trending high, but don’t fit the clinical criteria of diabetes. Approximately 20-50% of cases progress to type 2 diabetes and prediabetes itself is a risk factor for cardiovascular disease and metabolic syndrome (high blood glucose, hypertension, low HDL, high triglycerides, high waist circumference). Prediabetes is common (38% in overall U.S. population, 49% of those over age 65, 28% in 18-44 years old, 18% in adolescents). The global prevalence of diabetes is growing.
What are the risk factors for prediabetes?
The most common risk factors are being overweight, male, of an advanced age, physically inactive, poor diet and genetics (family history of type 2 diabetes in a first-degree relative). Other risk factors include a history of gestational (pregnancy) diabetes, polycystic ovarian syndrome, high blood pressure, high cholesterol and certain ethnicities (Indigenous, Asian [particularly South Asian/Filipino, Black, Hispanic/Latino]).
What are the symptoms for prediabetes?
Globally, 40% of adult individuals are living with diabetes, but may be unaware of their diagnosis. About one-third of adults are diagnosed with type 2 diabetes later than their earliest symptom (i.e. thirst, hunger, frequent urination, blurry vision, weight loss, fatigue). Prediabetes doesn’t usually present symptoms. Underdiagnosis is a problem.
How do you screen for prediabetes?
You can ask your doctor for one of three types of blood tests: a fasting glucose, oral glucose tolerance test (two-hour plasma glucose after a 75g oral glucose challenge) and/or an A1C (measurement of your blood glucose level over the previous three months). Prediabetics and high-risk ethnicities should be screened annually, and others with risk factors should be screened at least every three years. Screening should begin at age 35 or sooner if you are overweight/obese or have additional risk factors.
How does lifestyle affect prediabetes?
The Diabetes Prevention Program, (DPP study) found that intensive lifestyle interventions can reduce the incidence of type 2 diabetes by 58% over three years in adults with prediabetes, while medication (metformin) reduced the incidence by 31%. The lifestyle interventions focus on maintaining at least 7% weight loss (maintain an ideal body weight) and a minimum of 150 minutes of moderate-intensity physical activity per week (brisk walking). Incorporating a healthy diet (Mediterranean, low carbohydrate, plant based or DASH diet with a focus on whole grains, legumes, nuts, fruits, vegetables and minimizing ultra-processed foods) and avoiding smoking are also important. A recent study found a fully automated AI-led diabetes prevention program was just as good as a human-led DPP in achieving weight reduction, physical activity and A1C targets. Digital diabetes programs may improve access to individuals at risk without the need for human lifestyle coaches.
Prediabetes is common, and you might be at risk and don’t know it. Focus on healthy lifestyle habits and get screened to avoid late complications of diabetes!
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