More than nine million people in Germany live with type-2 diabetes, according to zdfheute.de.
That figure climbs by roughly 450,000 new diagnoses each year as metabolic dysfunction develops over years before detection. Elevated blood sugar levels often appear well before a formal diagnosis, giving doctors a window to intervene.
Insulin struggles to move glucose from the bloodstream into cells when prediabetes sets in, creating early insulin resistance. The pancreas initially pumps out extra insulin to compensate, but blood sugar climbs past normal thresholds while staying below the diagnostic boundary for diabetes, zdfheute.de reported.
"The values lie above the normal range, but still below the diabetes threshold," said Stefan Kabisch, a physician and metabolism researcher at the Charité – Universitätsmedizin Berlin, zdfheute.de reported.
Prediabetes can either recede, persist unchanged, or advance into full type-2 diabetes. Risk factors include aging, family history, excess abdominal fat, physical inactivity, and poor diet.
Prediabetes rarely triggers noticeable physical symptoms, making routine screening essential for at-risk patients. General practitioners evaluate patients using fasting blood sugar, long-term blood sugar, and occasionally oral glucose tolerance tests, according to zdfheute.de.
Routine check-ups can include a fasting blood sugar test every three years for adults aged 35 and older.
The diagnostic thresholds break down across three standard tests:
| Test Type | Normal Range | Prediabetes Range | Diabetes Range |
|---|---|---|---|
| Fasting Blood Sugar | Under 100 mg/dl | 100 to 125 mg/dl | 126 mg/dl and above |
| Long-Term Blood Sugar (HbA1c) | Under 5.7 percent | 5.7 to 6.4 percent | 6.5 percent and above |
| Oral Glucose Tolerance Test | Under 140 mg/dl | 140 to 199 mg/dl | 200 mg/dl and above |
Lifestyle changes such as increased physical activity, weight loss, and a high-fiber diet help many patients lower their blood sugar and improve insulin sensitivity. However, lifestyle adjustments do not always succeed.
"Lifestyle changes can fail if they are implemented insufficiently, but they can also fail to take effect even with perfect execution," Kabisch told zdfheute.de.
Genetics, along with personal financial and social circumstances, heavily influence whether lifestyle changes reverse prediabetes. Because no medications currently hold formal approval in Germany specifically for prediabetes treatment, researchers are testing alternative approaches. Kabisch is currently investigating the diabetes drug dapagliflozin in the LIFETIME study to see if it normalizes blood sugar by prompting the kidneys to excrete excess glucose through urine, zdfheute.de reported.