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The World Health Organization (WHO) has defined prediabetes as a state of intermediate hyperglycemia based on two specific parameters, impaired fasting glucose(IFG) and impaired glucose tolerance (IGT). Impaired fasting glucose (IFG) is defined as fasting plasma glucose (FPG) of 6.1-6.9 mmol/L (110 to 125 mg/dL); while impaired glucose tolerance (IGT) has been defined as 2-hour plasma glucose level of 7.8-11.0 mmol/L (140-200 mg/dL) after ingestion of 75 g of oral glucose load or a combination of the two based on a 2-hour oral glucose tolerance test (OGTT). The American Diabetes Association (ADA), on the other hand has the same cut-off value for IGT (140-200 mg/dL) but has a lower cut-off value for IFG (100-125 mg/dL) and has additional hemoglobin A1c (HbA1c) based criteria of a level of 5.7% to 6.4% for the definition of prediabetes. To confirm a diagnosis, two tests with results in the same range may be required. There is a slight overlap between IGT and IFG; thus -only 20–25% of people with IGT have IFG, and 30–45% of individuals with IFG have IGT3.
Prediabetes usually occurs in people who already have some insulin resistance or whose beta cells in the pancreas are not able to produce enough insulin to keep the blood glucose in the normal range. Consequently, without enough insulin, the extra glucose remains in the bloodstream rather than entering the cells It has been estimated that about 8 out of 10 people with prediabetes are unaware of their condition. This is because the symptoms of prediabetes do not usually manifest until the blood sugar levels increase enough to be diagnosed as diabetes4. It is however instructive to know that prediabetes, whether identified as impaired fasting glucose or impaired glucose tolerance, can lead to type 2 diabetes.
Although, prediabetes is generally an asymptomatic condition, it always precedes the onset of diabetes. In this regard, the elevation of blood sugar is a continuum, therefore prediabetes cannot be considered an entirely benign condition.
As a follow-up to their systematic review, Rooney et al (2024)6, estimated that by 2045, the prevalence of IGT will increase in adults aged 20–74 years but will decline slightly among those aged 75–79 years. The prevalence of IFG in 2021 was higher in older age, peaking among adults aged 60–64 years at 7.4%. By the year 2045, the global prevalence of IFG in adults is projected to increase across most age categories, but the prevalence of IFG among adults aged 75–79 years is projected to be similar to that in 2021.
They also estimated that across the World Bank income classification categories, the age-adjusted IGT prevalence in 2021 was highest for high-income countries (11.2%) and was lowest for middle-income countries (8.5%). For IFG, the age-adjusted prevalence estimates in 2021 were highest among high-income countries (6.4%) and lowest among low-income countries (5.0%). The age-adjusted prevalence of IFG and IGT is projected to increase across all income classification categories, with the largest relative growth in the number of people with prediabetes occurring in low-income countries. Rooney et al. also projected that the prevalence of IGT will increase by 130% among people in low-income countries from 2021 to 2045 versus 38% in middle-income and 8% in high-income countries. The IFG is projected to increase by 122% from 2021 to 2045 in LMICS as opposed to 41% in middle-income countries and 6% in high-income countries.
The risk factors for prediabetes are to a large extent predicated on genetic or lifestyle risk factors. Other risk factors include being overweight or obese; age 45 or older, a positive family history such as-a parent, brother, or sister with diabetes, physical inactivity, underlying medical condition such as high blood pressure and abnormal cholesterol levels; a history of gestational diabetes, a history of heart disease or stroke, polycystic ovary syndrome, also called PCOS and being diagnosed with metabolic syndrome, which is a combination of high blood pressure, abnormal cholesterol levels, and large waist size, are more likely to have prediabetes.
In addition, other situations or things that may contribute to insulin resistance include-certain medicines, such as glucocorticoids, some antipsychotics and some HIV mediations. Including hormonal disorders, such as Cushing’s syndrome and acromegaly and sleep problems, especially sleep apnea.
Urbanization is associated with an increased prevalence of obesity and diabetes. Consistent with prior research, we found that the prevalence of IGT was higher in urban (vs. rural) settings. The adoption of sedentary behaviors and “Western” dietary patterns may explain the link between urbanization and worse cardio-metabolic health.
Aladeniyi et al. (2017) conducted a study to determine the Prevalence and Correlates of Pre-Diabetes and diabetes mellitus among public sector workers in Akure, South West Nigeria. A total of 2299 men and 2529 women aged 19 to 76 years participated in the study. The mean age of the participants was 40.4 years (SD±9.7). The prevalence of pre-diabetes and DM was 11.7% (n=563) and 5.3% (n=254), respectively. Women had a higher prevalence of pre-diabetes than men (12.5% versus 10.8%). The multivariate model, after adjusting for confounding variables, showed that: age ≥45 years (OR=1.8, 95%CI 1.3-2.4), lower level of education (OR=1.7, 95% CI 1.2-2.4), hypertension (OR=2.0, 95% CI 1.5-2.6) and overweight/obesity (OR=2.2, 95%CI 1.6-3.0) were the independent and significant predictors of DM.
Bashir et al. (2021), carried out a systematic review and meta-analysis of the burden of pre-diabetes in Nigeria. The study involved 15 eligible studies that were conducted between 2000 and 2019. A total of 14,206 individuals were included in the meta-analysis. The researchers used the American Diabetic Association (ADA) and World Health Organization (WHO) diagnostic criteria separately in pooling the prevalence of prediabetes. The pooled prevalence of prediabetes in Nigeria was found to be 13.2% (95% CI: 5.6–23.2%, I2 = 98.4%) using the ADA criteria and 10.4% (95% CI: 4.3–18.9%, I2 = 99.2%) using the WHO criteria. The result by the United Nations estimation translates to an estimated 15.8 and 12.5 million adults with prediabetes in Nigeria using the ADA and WHO criteria, respectively. The prevalence rates for women and men were similar at 12.1% (95% CI: 5–21%). The pooled prevalence rates for urban and rural settlements were also similar at 9% (95% CI: 2–22%). This finding showed that the prevalence of prediabetes in Nigeria was almost two times higher than the 7.3% estimate obtained in 2003 by the International Diabetes Federation.
The reviewed data from the studies on prediabetes has shown that worldwide and particularly in Nigeria, with an estimated 12-15 million adults have prediabetes. The trajectory of the burden of prediabetes has been found to be on a steady rise. This increase underscores the urgent need to institute and effectively implement diabetes prevention policies and interventions to stem this tide. The enhancement of surveillance for tracking prediabetes has become a global imperative for effectively implementing diabetes prevention policies and interventions.
Evidence from observational studies, suggests that there is an association between prediabetes and complications of diabetes such as early nephropathy, early retinopathy and risk of macrovascular disease and small fiber neuropathy. Several studies have also shown the efficacy of lifestyle interventions in preventing or delaying the onset of diabetes; with a relative risk reduction of 40%-70% in adults with prediabetes.
Since 2010, several high-income countries including the US have set up national programs at the population level for diabetes prevention aimed at slowing the progression from prediabetes to diabetes. Similar diabetes prevention programs have been set up in some middle and low-income countries. It has however been asserted that lower-income countries with limited resources would not have the requisite human and financial resources including public health and health care infrastructure to implement and maintain these efforts at a national level; therefore, it has been advocated that LMICs could adopt the community-based and group-based lifestyle intervention strategies by using lay personnel.
Other diabetes prevention strategies that have been put forward as plausible measures for addressing prediabetes at the population-level include public health policies (regulation of sugar content in drinks, taxation, food labelling) the use of governmental (public) channels of communication, school educational and community campaigns.
Compared to diabetes, prediabetes due to impaired fasting glucose is relatively mild, consequently people having IFG may not be aware and therefore see no need to seek medical care. There is need however for people with prediabetes to be closely monitored so that if the condition degenerates and there is need for medication, treatment can be readily accessed. Meanwhile, it is recommended that those with prediabetes remain physically active and eat the right amount of healthy foods to lose weight, to possibly reverse the and reduce the risk of developing diabetes. It is important that those with prediabetes are made to know that the best way to cope with impaired fasting glucose is to make lifestyle changes that can help to reduce weight and improve health. Other lifestyle modification practices apart from exercise, include: limiting the intake of alcohol, sugary beverages or processed foods and abstaining from smoking. There is compelling evidence to support early prevention measures and management of patients with pre-diabetes in order to reduce the incidence and complications of DM.
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