Pre-diabetes: Risks & Preventing Type 2 Diabetes

Eight years ago, teacher Rogéria Sousa, 58, went through one of those scares. She was teaching when she started feeling sick and had to be taken to the emergency room. Blood glucose was 230 mg/dL, well above the normal amount of glucose in the blood when not fasting, which is up to 140 mg/dL. It didn’t take long to discover the problem: he had developed diabetes. >

“It was a mixture of feelings. Because when people talked about diabetes, the first thing that came to my mind was amputation of limbs. Then it was a shock, my head went into a knot”, he recalls.>

The teacher was taken by surprise by the diagnosis, especially because she never noticed or was notified by doctors about signs of the disease. “When I found out, I was already diabetic. There was no ‘pre'”, she says. She’s not the only one. Across Brazil, 30 million people live with pre-diabetes, but only one in nine people know they have this condition, according to the Diabetes Atlas of the International Diabetes Federation (IDF). >

“No one sleeps as a non-diabetic and wakes up as a diabetic. So, we have a period and this period will vary from person to person, but when we are diagnosed with diabetes, it means that for about five years before the function of my beta cell, which is the cell that produces insulin, is no longer responding normally”, says endocrinologist Denise Denise Franco, endocrinologist and specialist in technology in the treatment of diabetes, member of the Brazilian Diabetes Society (SBD).>

Denise’s speech took place at a meeting held by the pharmaceutical company Merck Healthcare in São Paulo, on the 6th, to raise awareness about pre-diabetes. At the meeting with the press, professionals in the field showed first-hand the data recently presented at the Congress of the European Association for the Study of Diabetes (EASD) 2025. In addition to the endocrinologist, the conversation was attended by Roberta Brito, medical manager for diabetes and obesity at Merck, and mediated by doctor and presenter Thelma Assis.>

Silently, pre-diabetes precedes type 2 diabetes, which accounts for around 90% of people who have the disease. It consists of a condition in which glucose levels are above normal, but are not yet high enough to characterize diabetes. This is the phase in which the diagnosis can still be reversed, through a change in lifestyle: adopting a healthier diet, exercising regularly and, in some cases, starting to take some medications – all of this, of course, with medical supervision.>

“The patient needs to exercise, needs to eat well, needs to avoid sugars, pasta, fats, control the consumption of alcoholic beverages. But this does not mean that the person with diabetes has lost the meaning of life. No, not at all. A diabetic person can have an absolutely normal life. They just need to control their diabetes effectively”, says endocrinologist Reine Marie Chaves, founding director of the Center for Diabetes and Endocrinology of Bahia (Cedeba). >

Some alarming changes and characteristics of diabetes already begin at this stage, such as changes in the body that lead to cardiovascular events, dysglycemia and oxidative stress, in addition to problems such as cerebrovascular disease, nephropathy and retinopathy.>

Therefore, despite the prefix, it is necessary to keep in mind that pre-diabetes is not “pre-disease”, reinforces Roberta Brito. The term, created in 1997 by the Report of the Expert Committee on the Diagnosis and Classification of Diabetes, was intended to alert doctors and patients and make them change habits to establish control strategies. Over time, however, it ended up becoming a kind of reassuring message, as if there was no need to worry yet. >

“If the ‘pre’ is to prepare someone, I don’t want to prepare myself for having type 2 diabetes. So the name is wrong. There is an important front of medical societies trying to change this, but what is important to show is that this so-called pre-diabetes is already a disease, it is the beginning of Type 2 Diabetes Mellitus. Because it already brings with it a significant increase in [risco de] some types of cancer, by 15%. The cardiovascular risk is 20% – that is, I have a greatly increased chance of having an acute heart attack or stroke – and the risk of kidney problems is 67%”, says the medical manager.>

This year, studies demonstrated for the first time that normalizing blood glucose in patients with prediabetes, achieving remission (normoglycemia), can reduce the risk of cardiovascular death or hospitalization for heart failure by more than 50% and the risk of all-cause mortality by more than 40%.>

Today, to avoid consequences, professor Rogéria Sousa leads her life in the healthiest way possible. Take care of your diet, exercise and live well, even if the disease comes with challenges. If I could go back in time, however, I would do everything to find out in the ‘pre’ and reverse the situation. >

“What kills me, my love, is that beautiful, wonderful pie, looking at me and I can’t eat it”, she says, good-naturedly. “But, when you go to the hospital, when you’re really sick and you see that thread of life slipping away and you hope to get well by doing what the doctors tell you correctly, that’s nothing.” >

Between January and October this year alone, 4,530 people died from diabetes in Bahia, according to information from the State Health Department (Sesab). Currently, Cedeba has more than 100,000 registered patients in all 417 municipalities, 60% of whom are people with diabetes, according to founding director Reine Marie Chaves. >

“Cedeba is a reference center of medium complexity, so it serves patients referred from primary health care. Unfortunately, with the demand from the growing population of diabetes cases, we are unable to serve the entire diabetic population in Bahia. Therefore, in this situation, we train and qualify primary care professionals to care for diabetes and qualify them to respond to this portion of the population that can be controlled only with physical activity, diet and an oral tablet”, explains Reine. When the situation is more complex, patients are referred to remote consultations, via telemedicine.>

In Salvador, according to epidemiological data from the Brazilian Diabetes Society (SBD), the prevalence of diabetes is 7.9%, 0.6% above the national average. >

It is to reverse the situation while there is still time – in cases of type 2 diabetes – and prevent lives from being lost due to this disease that the “Before it turns” movement exists. The initiative is an awareness campaign developed by Merck in partnership with SBD and ADJ Diabetes Brasil. >

The objective is to reach the millions of Brazilians who live with risk factors (obesity and a family history of diabetes, for example), through the provision of free exams and educational activities with health professionals.>

“We need to educate the population and also educate the medical profession. Not every doctor has access to today’s updates. These people are there at the top working X hours a day, what time will they update themselves? I think the cosmetic industry has an obligation to help with this medical education”, argues Roberta Brito. “But the movement has some aspects, and the main target is the population, because we need to empower these people so that they understand what they have to do, before it turns into diabetes.”>

What are the types of diabetes? >

There are different types of diabetes. They are:>

Type 1, which usually appears in childhood or adolescence (but can also be diagnosed in adults). In these cases, the immune system mistakenly attacks the beta cells, so that little or no insulin is released into the body and the glucose stays in the blood instead of being used for energy. >

Type 2 diabetes, developed when the body cannot adequately use the insulin it produces or does not produce enough insulin to control blood glucose levels. About 90% of people with diabetes have Type 2. >

Pre-diabetes, in which glucose levels are above normal, but not yet high enough to characterize type 2 diabetes. It can be reversed through lifestyle changes.>

Gestational diabetes, in turn, is a glycemic change that occurs during pregnancy, a period in which a woman undergoes changes in her hormonal balance to allow the fetus to develop. In this scenario, according to the SBD, there is a risk for both, as it exposes the baby to large amounts of glucose while still in the uterine environment, increasing the risk of excessive growth and, consequently, traumatic births, neonatal hypoglycemia and even obesity and diabetes in adult life.>

Who can develop prediabetes? >

People over 35 years old or under 35 years old, but living with overweight or obesity and one of the following factors:>

– Family history of type 2 diabetes in a first-degree relative;>

– History of cardiovascular disease;>

– Arterial hypertension;>

– High-density lipoprotein (HDL), the “good cholesterol”, below 35 mg/dL;>

– Triglycerides above 250 mg/dL;>

– Polycystic ovary syndrome;>

– Acanthosis nigricans (darker neck region, with a velvety appearance).>

How do I know if I have prediabetes? >

Through the blood glucose test, which can be done in pharmacies. If the result is a blood glucose level between 100 and 126 mg/dL on an empty stomach or between 140 and 199 mg/dL up to two hours after a meal, it is a sign of prediabetes. >

“Normally, an individual begins to become pre-diabetic when they begin to experience weight gain and an increase in abdominal circumference, especially in those people who have a family history of diabetes. And our great concern in diagnosing it effectively is because an individual with pre-diabetes who progresses to diabetes already has a higher risk of developing complications from the disease. And pre-diabetes can be completely asymptomatic”, says endocrinologist Reine Marie Chaves. >

What are the main risk factors and symptoms of diabetes?>

The main risk factors are age over 45 years, family history and overweight and obesity. Endocrinologist Sandra Lopes explains that it is not recommended to wait for symptoms to make a diagnosis. This is because Diabetes Mellitus can be asymptomatic for a long time. Only when blood glucose is significantly increased does the individual feel an increased urge to urinate, lose weight and become very thirsty. >

How should people who were not born with diabetes act to prevent it?>

The most important thing in preventing diabetes is to have a healthy lifestyle, practice physical activity regularly, have a balanced diet and maintain a healthy weight, says doctor Sandra Lopes.>

Are there medications that should be avoided by those with diabetes?>

There are very specific precautions for those with diabetes, and one of them is to avoid certain medications, those that increase blood glucose levels. Some examples are corticosteroids, antipsychotics and antidepressants.>

“There are many people who have joint pain, leg pain, and think they should and can use corticosteroids because they give quick relief from the pain. But the problem is that corticosteroids, for example, make glycemic control much worse and should be avoided because they have diabetes. Therefore, I think my message to the population would be: if you have a diabetic family member, if you are gaining weight, if you have increased waist circumference, that fat located in the abdomen, seek a health professional immediately”, says Reine Marie, director of Cedeba.>