Linda Tilton, MS, RD, CDE, is a Certified Diabetes Educator at the University of Vermont Medical Center.

Linda Tilton, MS, RD, CDE, is a Certified Diabetes Educator at the University of Vermont Medical Center.

Approximately 29.1 million people or about 9.0 percent the United States population have diabetes.

Type 2 diabetes is a common and increasingly prevalent chronic disease, which accounts for 90 to 95 percent of all diagnosed cases of diabetes. Another 79 million, or 35 percent of adults in the United States age 20 years or older, have pre-diabetes and are at increased risk of developing type 2 diabetes. This number increases to 50 percent for Americans who are age 65 years or older.

Type 2 diabetes may be prevented, or the onset significantly delayed if people with pre-diabetes are diagnosed and have an opportunity to make simple lifestyle changes.

What is pre-diabetes?

Pre-diabetes is a condition in which blood glucose (sugar) levels are higher than normal, but not high enough to be diagnosed as diabetes. This condition significantly increases the risk of developing type 2 diabetes and cardiovascular disease.

Type 2 diabetes often develops slowly and blood glucose levels increase gradually over time without people feeling ill. Before blood glucose levels are high enough to be diagnosed as type 2 diabetes, people often have pre-diabetes for 5-10 years.

Unfortunately, nearly 90 percent of adults with pre-diabetes don’t know they have it. Because there are no clear symptoms of pre-diabetes, people usually feel well and are unaware they are in the process of developing type 2 diabetes.

Does pre-diabetes always progress to type 2 diabetes?

Pre-diabetes is an early warning sign of increased risk; however, it does not automatically progress to type 2 diabetes. If pre-diabetes is diagnosed, people have an important opportunity to make lifestyle changes which can improve blood glucose levels and may decrease their risk of developing type 2 diabetes. For some people with pre-diabetes, early diagnosis and lifestyle modifications can actually return blood glucose levels to the normal range.

Who should be screened for pre-diabetes?

  • People who are 45 years of age or older;
  • People who are overweight;
  • People with a family history of type 2 diabetes;
  • People who have high blood pressure;
  • People who are physically active fewer than three times per week; and
  • Women who had diabetes while pregnant (gestational diabetes), or gave birth to a baby that weighed more than 9 pounds

How do I find out if I am at risk for pre-diabetes?

To find out if you could have pre-diabetes, answer these seven simple questions from the Center for Disease Control (CDC) National Diabetes Prevention Program.

If your score shows that you are at high risk for pre-diabetes, please talk to your health care provider and ask to be tested for pre-diabetes.

How are people tested for pre-diabetes?

Pre-diabetes is diagnosed by a simple blood test in which the A1c, or fasting plasma glucose (FPG) is measured. The A1C test measures your average blood glucose for the last three months, while the FPG test checks your fasting blood glucose levels on the day the test is done. The advantage of the A1c test is fasting glucose levels may vary from day to day, so a diagnosis of pre-diabetes may be missed if only this test is done.

In pre-diabetes, the results of both tests are higher than normal levels but not high enough to be called diabetes.

Pre-diabetes is an A1C of 5.7 percent – 6.4 percent.


Pre-diabetes is fasting blood glucose of 100 – 125 mg/dl.


How can I prevent pre-diabetes from progressing to type 2 diabetes?

Studies have shown that people with pre-diabetes can prevent or delay the development of type 2 diabetes by up to 58 percent by lifestyle changes that include healthy food choices, modest weight loss, and participating in regular physical activity.

You may not be able get to your ideal body weight ,or run a marathon; however, losing 5-7 percent of your current weight (or about 10 to 15 pounds for most people), along with walking for 30 minutes, five days per week can make a huge difference in decreasing your risk of developing type 2 diabetes.

Where can I find help?

  • Join the YMCA’s Diabetes Prevention Program, which is part of the CDC-led National Diabetes Prevention Program. This free program is designed to help those at high risk adopt and maintain healthy lifestyles and reduce their chances of developing type 2 diabetes.
  • Meet with Certified Diabetes Educator (CDE) to learn more about pre-diabetes and develop an individual plan to reduce your risk of developing type 2 diabetes.
  • Meet with a Registered Dietitian (RD) to review your current eating habits and set goals for healthy weight management.
  • Meet with a Health Coach or Personal Trainer to develop a program of physical activity that you will enjoy.

Registered dietitians, health coaches, and a CDE are part of your community health team if you are a patient at The University of Vermont Medical Center. You can also schedule an appointment with a registered dietitian or CDE in Endocrinology & Diabetes clinic.

Linda Tilton, MS, RD, CDE, is a Certified Diabetes Educator at the University of Vermont Medical Center. The University of Vermont Medical Center, Endocrinology & Diabetes Self-Management Education Program has been continuously recognized by the American Diabetes Association since 1999 and recently received a received a four-year approval from 2015-2019. Linda is currently the coordinating board chair for the Vermont Association of Diabetes Educators.

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