How do you define ‘pre-diabetes’?

health choicesI’m working with a lady at the moment who had a recent HbA1c reading of 41 mmol/mol. Her G.P. says this is fine, and hasn’t arranged any follow up checks or given her any specific dietary advice.

What she is astute enough to know is that 41 mmol/mol might be considered fine in the UK, but that view isn’t shared everywhere. In several other English-speaking countries she would now be diagnosed as ‘pre-diabetic’.

With Type 2 diabetes featuring in her family history my client has decided to act now. She isn’t diabetic, but nor does she want to become diabetic!

The thing I want to explore today is exactly how ‘pre-diabetes’ is defined. The most consistent definition is explained in words, typically as a state in which some signs/symptoms of diabetes are present, crucially impaired glucose tolerance or insulin resistance, but not all. There is no consensus in how you might objectively measure pre-diabetes – it’s a grey area!

More and more HbA1c is being employed as a measure for diagnosis, but different countries fail to agree the thresholds that mean someone has now become pre-diabetic.

In the UK we consider anyone with a HbA1c measure below 42 mmol/mol (7mmol/L or 6%) is normal. Between 42 and 47 indicates pre-diabetes, and 48 or above is actual diabetes.

In the USA the thresholds are decidedly lower. Normal is defined as below 5.7% – equating to 38.8mmol/mol or 6.5 mmol/L. Pre-diabetes starts at this level and has an upper threshold of 6.4% – or 46.4 mmol/mol, or 7.6 mmol/L. Actual diabetes is the USA is diagnosed at a level of 6.5% or above – i.e. above 47.5 mmol/mol or 7.8 mmol/L.

New Zealand defines pre-diabetes between 41 – 49 mmol/mol, and actual diabetes above 50 mmol/mol.

So  EXACTLY when someone is considered OK, or diagnosed as pre-diabetic or actually diabetic is not an exact science it seems. Is it better to be safe than sorry as my new client has concluded? If you think so too then sign up now for a FREE seminar to find out more about how RebalanceDiabetes could help you avoid diabetes in 2015!

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