Pre-diabetes: The silent warning before diabetes

Pre-diabetes is increasingly being recognised by health experts as one of the most important early warning stages in the development of type 2 diabetes. Often described as a “silent condition,” pre-diabetes occurs when blood sugar levels are higher than normal but not yet high enough to be classified as diabetes.

Without intervention, many individuals with pre-diabetes will eventually develop type 2 diabetes, along with associated complications such as heart disease, kidney damage and stroke.

According to the World Health Organization, diabetes is one of the fastest-growing non-communicable diseases globally, affecting hundreds of millions of people and contributing to millions of deaths each year. Public health agencies warn that early detection of pre-diabetes is essential in slowing the epidemic.

Across the Caribbean, the issue has become a major public health concern. The Pan American Health Organization reports that non-communicable diseases, including diabetes, account for more than 70 per cent of deaths in many Caribbean countries. Regional governments, including Jamaica, have implemented national strategies focused on prevention, early detection and lifestyle interventions.

Functional medicine physician Dr Orlando Thomas says pre-diabetes is often overlooked because many people feel relatively healthy.

“Pre-diabetes is the stage where the body is already struggling to control blood sugar, but most people have no idea it is happening. This is why screening and awareness are so important,” Dr Thomas said.

Pre-diabetes develops when the body begins to lose its ability to properly regulate blood glucose. This typically occurs due to insulin resistance, a condition where cells stop responding effectively to insulin, the hormone that helps move sugar from the bloodstream into cells for energy.

“When insulin resistance begins, the pancreas works harder and produces more insulin to compensate. Over time the system becomes overwhelmed, blood sugar rises, and that is when pre-diabetes appears,” he said.

EARLY WARNING SIGNS

Health experts emphasise that this stage is critical because lifestyle changes at this point can prevent or significantly delay the progression to type 2 diabetes.

One of the challenges with pre-diabetes is that symptoms are often subtle or absent. However, some early warning signs may include:

• Persistent fatigue

• Increased thirst

• Frequent urination

• Blurred vision

• Increased hunger, particularly after eating

• Slow healing wounds

• Dark patches of skin, particularly around the neck or armpits

Dr Thomas explains that these symptoms are often related to rising insulin levels and the body’s difficulty managing glucose. “When the body is constantly dealing with high blood sugar and high insulin levels, it creates inflammation and metabolic stress. That is when people may begin noticing subtle changes in energy levels and appetite,” Dr Thomas said.

Several factors increase the likelihood of developing pre-diabetes. Age, genetics and lifestyle all play important roles. Common risk factors include:

• Being overweight or obese

• Lack of regular physical activity

• Family history of diabetes

• High blood pressure

• High cholesterol levels

• Diets high in refined carbohydrates and sugary drinks

• History of gestational diabetes during pregnancy

Dr Thomas notes that modern lifestyles have significantly increased metabolic risk. “Highly processed foods, sedentary habits and chronic stress are major drivers of insulin resistance. Many people do not realise how strongly daily lifestyle choices influence metabolic health,” he said.

DIAGNOSTIC TESTS

Medical professionals diagnose pre-diabetes using blood tests that measure glucose levels. Common diagnostic tests include:

• Fasting Blood Glucose Test: Measures blood sugar after at least eight hours without eating.

• Haemoglobin A1C Test: Provides an average of blood sugar levels over the past two to three months.

• Oral Glucose Tolerance Test: Measures how the body processes glucose after consuming a sugary drink.

According to Dr Thomas, early screening can make a significant difference in preventing long-term complications. “If we catch insulin resistance early, lifestyle interventions such as improved nutrition, regular exercise and weight management can dramatically improve metabolic health,” he said.

Public health agencies across the Caribbean continue to emphasise prevention as the most effective strategy for addressing diabetes.

Regional policy initiatives supported by the Pan American Health Organization encourage healthier diets, reduced sugar consumption, increased physical activity and better access to health screening programmes.

Dr Thomas believes pre-diabetes should be viewed as a critical opportunity for change rather than a diagnosis of inevitable disease.

“Pre-diabetes is essentially a warning sign from the body. The encouraging news is that this stage is often reversible. When individuals take steps to improve diet, increase physical activity and manage stress, blood sugar levels can return to a healthy range,” he said.

As diabetes rates continue to rise worldwide, experts say understanding pre-diabetes could play a vital role in reducing the burden of non-communicable diseases.

“The goal is not just to treat diabetes. The goal is to stop it before it begins,” he said.