More Rigid Criteria for Prediabetes May Be in Order in the National Diabetes Prevention Program

To delay or prevent type 2 diabetes, the CDC’s National Diabetes Prevention Program Lifestyle Change Program (National DPP LCP) treats individuals with prediabetes. Prediabetes is a condition where a person's blood glucose is elevated, but not elevated enough to be called diabetes. Prediabetes is often a precursor to type 2 diabetes. The prediabetes criteria used by the National DPP to admit persons into its prevention program are the same criteria used by the American Diabetes Association (ADA) and the CDC. However, those criteria allow individuals into the program who may be at a very low risk of contracting type 2 diabetes. So, looking at the probability of contracting diabetes at different points in the ADA's prediabetes criteria range may be beneficial. And one study has done the analysis.

The ADA uses the following criteria for prediabetes: a fasting plasma glucose (FPG) greater than or equal to 100 mg/dL and less than or equal to 125 mg/dL; an impaired glucose tolerance (IGT) where the glucose is greater than or equal to 140 mg/dL and less than or equal to 200 mg/dL; and an HbA1c greater than or equal to 5.7% and less than or equal to 6.4%.

The study mentioned above was done in Spain. There were 1184 participants in the study. And the participants in the study group satisfied two of the ADA's prediabetes criteria. These criteria were FPG between 100 mg/dL and 125 mg/dL and  HbA1c between 5.7% and 6.4%. The mean follow-up for the group was 4.2 years.

The researchers found that individuals at the lower ends of the prediabetes criteria ranges had a lower probability of advancing to type 2 diabetes. Specifically, the researchers stated that "The lowest incidence rate of diabetes was observed in the prediabetes category for isolated FPG 100–109 mg/dL; and the highest, in individuals with FPG within 110–125 mg/dL plus HbA1c 6.0–6.4%. As for reversion to normoglycemia, the highest rate was in the group with isolated HbA1c 5.7–5.9%, and the lowest in the category with FPG 110–125 mg/dL plus HbA1c 6.0–6.4%."

Therefore, focusing on individuals with prediabetes at the higher levels of blood glucose within the ADA's prediabetes criteria ranges may be a better use of resources.

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Higher Levels of Testosterone May Lower Risk of Diabetes for Prediabetic Individuals

There are a number of known risk factors for prediabetes and diabetes. Prediabetes is one of the risk factors for diabetes. And a low testosterone level may be another risk factor for diabetes in males with prediabetes.

Testosterone is a hormone that is found in men, women and other animals. However, men have more testosterone than women. And the testosterone levels decrease as we age. Furthermore, there are undesirable conditions associated with low testosterone levels making higher levels more desirable. One of the undesirable conditions of low testosterone may be an increased risk for diabetes for males with prediabetes. Indeed, one study has shown that a higher level of testosterone can lower the risk of progression from prediabetes to diabetes for men.

The study was a retrospective study done in Vienna. It consisted of 423 males and 287 females. Both the men and women had prediabetes. The average age of the females in the study was 58.6 years of age. And for males, the average age was 58.4 years.

The researchers concluded that “an increase of testosterone levels in males was related to a more favorable glucose metabolism, including lower HbA1c, lower stimulated glucose levels and higher insulin sensitivity...”

Establishing methods to estimate the risk of prediabetes and diabetes is important in healthcare. The American diabetes Association (ADA) and the Centers for Disease Control and Prevention (CDC) have devised a risk test for prediabetes and diabetes. That test includes questions on age (advancing age raises the risk of diabetes); gestational diabetes, parents or siblings who have had diabetes, high blood pressure, physical activity, being overweight, and gender (males have a higher risk of diabetes than females). Perhaps, low testosterone levels in males with prediabetes could be another risk factor for diabetes.

Low testosterone levels can have undesirable effects in men in general. These effects include a lower sex drive, lower energy, lower self-esteem, weight gain and other conditions. Diabetes is one of the most serious and costly chronic conditions in the U.S. So, more research into the possibility that low levels of testosterone might increase the risk of diabetes for men who have prediabetes may be in order. 

At any rate, health care providers might want to keep in mind that there might be an association between low testosterone and a risk for prediabetes.

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