Insulin Resistance and Prediabetes - What is insulin?
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Insulin Resistance
and Prediabetes
National Diabetes Information Clearinghouse
What is insulin?
Insulin is a hormone made in the pancreas,
an organ located behind the stomach. The
pancreas contains clusters of cells called
Liver
islets. Beta cells within the islets make Pancreatic
islet
insulin and release it into the blood.
Insulin plays a major role in metabolism—
the way the body uses digested food for
energy. The digestive tract breaks down
carbohydrates—sugars and starches found
in many foods—into glucose. Glucose is a
form of sugar that enters the bloodstream. Pancreas
With the help of insulin, cells throughout the Beta cell
body absorb glucose and use it for energy.
The pancreas contains clusters of cells called islets.
Insulin’s Role in Blood Glucose Beta cells within the islets make insulin and release it
into the blood.
Control
When blood glucose levels rise after a meal,
the pancreas releases insulin into the blood. What is insulin resistance?
Insulin and glucose then travel in the blood Insulin resistance is a condition in which
to cells throughout the body. the body produces insulin but does not use
• Insulin helps muscle, fat, and liver cells it effectively. When people have insulin
absorb glucose from the bloodstream, resistance, glucose builds up in the blood
lowering blood glucose levels. instead of being absorbed by the cells,
leading to type 2 diabetes or prediabetes.
• Insulin stimulates the liver and muscle
tissue to store excess glucose. The Most people with insulin resistance don’t
stored form of glucose is called know they have it for many years—until they
glycogen. develop type 2 diabetes, a serious, lifelong
disease. The good news is that if people
• Insulin also lowers blood glucose levels learn they have insulin resistance early on,
by reducing glucose production in the they can often prevent or delay diabetes by
liver. making changes to their lifestyle.
In a healthy person, these functions allow
blood glucose and insulin levels to remain in
the normal range.Insulin resistance can lead to a variety of What causes insulin
serious health disorders. The section “What
is metabolic syndrome?” provides more
resistance?
information about other health disorders Although the exact causes of insulin
linked to insulin resistance. resistance are not completely understood,
scientists think the major contributors to
insulin resistance are excess weight and
What happens with insulin physical inactivity.
resistance?
In insulin resistance, muscle, fat, and liver Excess Weight
cells do not respond properly to insulin and Some experts believe obesity, especially
thus cannot easily absorb glucose from the excess fat around the waist, is a primary
bloodstream. As a result, the body needs cause of insulin resistance. Scientists used
higher levels of insulin to help glucose enter to think that fat tissue functioned solely
cells. as energy storage. However, studies have
shown that belly fat produces hormones
The beta cells in the pancreas try to keep
and other substances that can cause serious
up with this increased demand for insulin
health problems such as insulin resistance,
by producing more. As long as the beta
high blood pressure, imbalanced cholesterol,
cells are able to produce enough insulin
and cardiovascular disease (CVD).
to overcome the insulin resistance, blood
glucose levels stay in the healthy range. Belly fat plays a part in developing chronic,
or long-lasting, inflammation in the body.
Over time, insulin resistance can lead to
Chronic inflammation can damage the body
type 2 diabetes and prediabetes because
over time, without any signs or symptoms.
the beta cells fail to keep up with the
Scientists have found that complex
body’s increased need for insulin. Without
interactions in fat tissue draw immune cells
enough insulin, excess glucose builds up
to the area and trigger low-level chronic
in the bloodstream, leading to diabetes,
inflammation. This inflammation can
prediabetes, and other serious health
contribute to the development of insulin
disorders.
resistance, type 2 diabetes, and CVD.
Studies show that losing the weight can
reduce insulin resistance and prevent or
delay type 2 diabetes.
2 Insulin Resistance and PrediabetesPhysical Inactivity
Many studies have shown that physical Does sleep matter?
inactivity is associated with insulin Yes. Studies show that untreated sleep
resistance, often leading to type 2 diabetes. problems, especially sleep apnea, can
In the body, more glucose is used by muscle increase the risk of obesity, insulin
than other tissues. Normally, active muscles resistance, and type 2 diabetes. Night
burn their stored glucose for energy and shift workers may also be at increased
refill their reserves with glucose taken from risk for these problems. Sleep apnea is
the bloodstream, keeping blood glucose a common disorder in which a person’s
levels in balance. breathing is interrupted during sleep.
Studies show that after exercising, muscles People may often move out of deep
become more sensitive to insulin, reversing sleep and into light sleep when their
insulin resistance and lowering blood breathing pauses or becomes shallow.
glucose levels. Exercise also helps muscles This results in poor sleep quality that
absorb more glucose without the need for causes problem sleepiness, or excessive
insulin. The more muscle a body has, the tiredness, during the day.
more glucose it can burn to control blood Many people aren’t aware of their
glucose levels. symptoms and aren’t diagnosed. People
Other Causes who think they might have sleep
problems should talk with their health
Other causes of insulin resistance may care provider.
include ethnicity; certain diseases;
hormones; steroid use; some medications; More information about sleep problems
older age; sleep problems, especially sleep is available from the National Heart,
apnea; and cigarette smoking. Lung, and Blood Institute at
www.nhlbi.nih.gov/health/public/sleep.
3 Insulin Resistance and PrediabetesWhat is prediabetes? type 2 diabetes, it often sets the stage for
the disease by placing a high demand on the
Prediabetes is a condition in which blood
insulin-producing beta cells. In prediabetes,
glucose or A1C levels—which reflect average
the beta cells can no longer produce enough
blood glucose levels—are higher than
insulin to overcome insulin resistance,
normal but not high enough for a diagnosis
causing blood glucose levels to rise above
of diabetes. Prediabetes is becoming more
the normal range.
common in the United States. The U.S.
Department of Health and Human Services Once a person has prediabetes, continued
estimates that at least 86 million U.S. adults loss of beta cell function usually leads to
ages 20 or older had prediabetes in 2012.1 type 2 diabetes. People with type 2 diabetes
People with prediabetes are at increased have high blood glucose. Over time, high
risk of developing type 2 diabetes and CVD, blood glucose damages nerves and blood
which can lead to heart attack or stroke. vessels, leading to complications such as
heart disease, stroke, blindness, kidney
How does insulin resistance failure, and lower-limb amputations.
relate to type 2 diabetes and Studies have shown that most people with
prediabetes develop type 2 diabetes within
prediabetes? 10 years, unless they change their lifestyle.
Insulin resistance increases the risk of Lifestyle changes include losing 5 to 7 percent
developing type 2 diabetes and prediabetes. of their body weight—10 to 14 pounds for
Prediabetes usually occurs in people who people who weigh 200 pounds—by making
already have insulin resistance. Although changes in their diet and level of physical
insulin resistance alone does not cause activity.
Diabetes
Prediabetes Caution: Take steps to prevent type 2 diabetes now.
Normal
1National diabetes statistics report, 2014. Centers for
Disease Control and Prevention website. www.cdc.gov/
diabeteS/pubs/statsreport14 htm. Updated June 13, 2014.
Accessed June 16, 2014.
4 Insulin Resistance and PrediabetesWhat are the symptoms • having a family background that is
African American, Alaska Native,
of insulin resistance and American Indian, Asian American,
prediabetes? Hispanic/Latino, or Pacific Islander
Insulin resistance and prediabetes usually American
have no symptoms. People may have one • giving birth to a baby weighing more
or both conditions for several years without than 9 pounds
knowing they have them. Even without
symptoms, health care providers can • being diagnosed with gestational
identify people at high risk by their physical diabetes—diabetes that develops only
characteristics, also known as risk factors. during pregnancy
The section “Who should be tested for • having high blood pressure—
prediabetes?” lists these risk factors. 140/90 mmHg or above—or being
People with a severe form of insulin treated for high blood pressure
resistance may have dark patches of skin, • HDL cholesterol level below 35 mg/dL
usually on the back of the neck. Sometimes or a triglyceride level above 250 mg/dL
people have a dark ring around their neck. • having polycystic ovary syndrome
Dark patches may also appear on elbows, (PCOS)
knees, knuckles, and armpits. This condition
is called acanthosis nigricans. • having prediabetes, impaired fasting
glucose (IFG), or impaired glucose
tolerance (IGT) on an earlier testing
Who should be tested for
prediabetes? • having other conditions associated with
insulin resistance, such as obesity or
The American Diabetes Association acanthosis nigricans
(ADA) recommends that testing to detect
prediabetes be considered in adults who are • having CVD
overweight or obese and have one or more If test results are normal, testing should
additional risk factors for diabetes. The be repeated at least every 3 years. Testing
section “Body Mass Index (BMI)” explains is important for early diagnosis. Catching
how to determine if a person is overweight prediabetes early gives people time to
or obese. However, not everyone who is change their lifestyle and prevent type 2
overweight will get type 2 diabetes. People diabetes and CVD. Health care providers
without these risk factors should begin may recommend more frequent testing
testing at age 45. depending on initial results and risk status.
Risk factors for prediabetes—in addition to
being overweight or obese or being age 45 or
older—include the following:
• being physically inactive
• having a parent or sibling with diabetes
5 Insulin Resistance and PrediabetesIn addition to weight, the location of excess Body Mass Index (BMI)
fat on the body can be important. A waist
Body mass index is a measurement of
measurement of 40 inches or more for men
body weight relative to height. Adults ages
and 35 inches or more for women is linked
20 or older can follow the steps below using
to insulin resistance and increases a person’s
the BMI chart to find out whether they are
risk for type 2 diabetes. This is true even if a
normal weight, overweight, or obese:
person’s BMI falls within the normal range.
• People should find their height in the
left-hand column.
How to Measure the Waist • They should move across the row to the
To measure the waist, a person should number closest to their weight.
• place a tape measure around the • Then, they should check the number at
bare abdomen just above the hip the top of that column.
bone The number at the top of the column is the
• make sure the tape is snug but isn’t BMI. The words above the BMI number
digging into the skin and is parallel indicate whether that person is normal
to the floor weight, overweight, or obese. People who are
overweight or obese should consider talking
• relax, exhale, and measure
with a health care provider or registered
dietitian about ways to lose weight to reduce
the risk of diabetes.
The BMI chart has certain limitations. The
chart may overestimate body fat in athletes
and others who have a muscular build and
underestimate body fat in older adults
and others who have lost muscle. BMI for
children and teens must be determined
based on age and sex in addition to height
and weight.
Source: Adapted from www.cdc.gov.
6 Insulin Resistance and PrediabetesInformation about BMI in children and The NIH also has a free smartphone app
teens, including a BMI calculator, is for calculating BMI. People can search
available from the Centers for Disease “My BMI Calculator” on their phone to
Control and Prevention (CDC) at find the app. The app also provides links to
www.cdc.gov/nccdphp/dnpa/bmi. The CDC information about steps people can take to
website also has a BMI calculator for bring their BMI into a healthy range.
adults. A BMI calculator from the National
See the “BMI Chart” on page 16.
Institutes of Health (NIH) is available at
www.nhlbi.nih.gov/health/educational/lose_wt/
BMI/bmicalc.htm.
What is metabolic syndrome? • higher than normal blood glucose
levels—fasting blood glucose level
Metabolic syndrome, also called insulin
of 100 mg/dL or above, or taking
resistance syndrome, is a group of
medication for elevated blood glucose
traits and medical conditions linked to
overweight and obesity that puts people In addition to type 2 diabetes, metabolic
at risk for both CVD and type 2 diabetes. syndrome has been linked to the following
Metabolic syndrome is defined* as the health disorders:
presence of any three of the following2: • obesity
• large waist size—waist measurement • CVD
of 40 inches or more for men and
35 inches or more for women • PCOS
• high triglycerides in the blood— • nonalcoholic fatty liver disease
triglyceride level of 150 milligrams • chronic kidney disease
per deciliter (mg/dL) or above,
or taking medication for elevated However, not everyone with these disorders
triglyceride level has insulin resistance, and some people may
have insulin resistance without getting these
• abnormal levels of cholesterol in the disorders.
blood—HDL, or good, cholesterol
level below 40 mg/dL for men and People who are obese or who have
below 50 mg/dL for women, or taking metabolic syndrome, insulin resistance,
medication for low HDL type 2 diabetes, or prediabetes often also
have low-level inflammation throughout
• high blood pressure—blood pressure the body and blood clotting defects that
level of 130/85 or above, or taking increase the risk of developing blood
medication for elevated blood pressure clots in the arteries. These conditions
*Similar definitions have been developed by the
contribute to increased risk for CVD.
World Health Organization and the American
Association of Clinical Endocrinologists.
2Alberti KG, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: a joint interim statement of
the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and
Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and
International Association for the Study of Obesity. Circulation. 2009;120:1640–1645.
7 Insulin Resistance and PrediabetesHow are insulin resistance A1C test. Sometimes called hemoglobin
A1c, HbA1c, or glycohemoglobin test, this
and prediabetes diagnosed? test reflects average blood glucose levels
Health care providers use blood tests to over the past 3 months. This test is the
determine whether a person has prediabetes, most reliable test for prediabetes, but it is
but they do not usually test specifically for not as sensitive as the other tests. In some
insulin resistance. Insulin resistance can be individuals, it may miss prediabetes that
assessed by measuring the level of insulin in could be caught by glucose tests.
the blood.
Although some health care providers can
However, the test that most accurately quickly measure A1C in their office, that
measures insulin resistance, called the type of measurement—called a point-of-care
euglycemic clamp, is too costly and test—is not considered reliable for diagnosis.
complicated to be used in most health care For diagnosis of prediabetes, the A1C test
providers’ offices. The clamp is a research should be analyzed in a laboratory using a
tool used by scientists to learn more about method that is certified by the NGSP.
glucose metabolism. Research has shown
that if blood tests indicate prediabetes, The A1C test can be unreliable for
insulin resistance most likely is present. diagnosing prediabetes in people with
certain conditions that are known to
Blood Tests for Prediabetes interfere with the results. Interference
All blood tests involve drawing blood at a should be suspected when A1C results
health care provider’s office or commercial seem very different from the results of
facility and sending the sample to a lab for a blood glucose test. People of African,
analysis. Lab analysis of blood is needed to Mediterranean, or Southeast Asian descent,
ensure test results are accurate. Glucose or people with family members with sickle
measuring devices used in a health care cell anemia or a thalassemia, are particularly
provider’s office, such as finger-stick devices, at risk of interference. People in these
are not accurate enough for diagnosis but groups may have a less common type of
may be used as a quick indicator of high hemoglobin, known as a hemoglobin variant,
blood glucose. that can interfere with some A1C tests.
Prediabetes can be detected with one of the An A1C of 5.7 to 6.4 percent indicates
following blood tests: prediabetes.
• the A1C test More information about the A1C test
is available from the National Diabetes
• the fasting plasma glucose (FPG) test Information Clearinghouse (NDIC) fact
• the oral glucose tolerance test (OGTT) sheet The A1C Test and Diabetes at
www.diabetes.niddk.nih.gov.
8 Insulin Resistance and PrediabetesFasting plasma glucose test. This test OGTT. This test measures blood glucose
measures blood glucose in people who have after people have not eaten for at least
not eaten anything for at least 8 hours. 8 hours and 2 hours after they drink a sweet
This test is most reliable when done in the liquid provided by a health care provider or
morning. Prediabetes found with this test is laboratory. Prediabetes found with this test
called IFG. is called IGT.
Fasting glucose levels of 100 to 125 mg/dL A blood glucose level between 140 and
indicate prediabetes. 199 mg/dL indicates prediabetes.
The following table lists the blood test levels
for a diagnosis of prediabetes.
Blood Test Levels for Diagnosis of Diabetes and Prediabetes
Fasting Plasma Oral Glucose
A1C
Glucose Tolerance Test
(percent)
(mg/dL) (mg/dL)
Diabetes 6.5 or above 126 or above 200 or above
Prediabetes 5.7 to 6.4 100 to 125 140 to 199
Normal About 5 99 or below 139 or below
Definitions: mg = milligram, dL = deciliter
For all three tests, within the prediabetes range, the higher the test result, the greater the risk of diabetes.
Source: Adapted from American Diabetes Association. Standards of medical care in diabetes—2012. Diabetes
Care. 2012;35(Supp 1):S12, table 2.
9 Insulin Resistance and PrediabetesUnderstanding Test Results people one test will indicate a diagnosis of
prediabetes or diabetes when another test
A blood test indicating prediabetes means
does not. People with differing test results
that insulin resistance has progressed to the
may be in an early stage of the disease,
point where the beta cells in the pancreas
where blood glucose levels have not risen
can no longer compensate and a person’s
high enough to show on every test.
blood glucose levels are rising toward type 2
diabetes. The higher the test results, the Health care providers repeat laboratory tests
greater the risk of type 2 diabetes. The level to confirm test results. Diabetes develops
of risk also depends on an individual’s other over time, so even with variations in test
risk factors, which are listed in the section results, health care providers can tell when
“Who should be tested for prediabetes?” overall blood glucose levels are becoming
too high.
Test numbers. For example, people with an
A1C below 5.7 percent may still be at risk
for diabetes if they have a family history of Can insulin resistance and
type 2 diabetes or have gained excess weight prediabetes be reversed?
around the waist. People with an A1C above Yes. Physical activity and weight loss help
6.0 percent should be considered at very the body respond better to insulin. The
high risk of developing diabetes. A level Diabetes Prevention Program (DPP) was
of 6.5 percent or above means a person has a federally funded study of 3,234 people at
diabetes. high risk for diabetes.
Follow up. People whose test results The DPP and other large studies proved that
indicate they have prediabetes may be people with prediabetes can often prevent
retested in 1 year and should consider or delay diabetes if they lose a modest
making lifestyle changes to reduce their risk amount of weight by cutting fat and calorie
of developing type 2 diabetes. intake and increasing physical activity—for
Varying results. Although all these tests example, walking 30 minutes a day, 5 days a
can be used to test for prediabetes, in some week.
10 Insulin Resistance and PrediabetesPeople at High Risk for Diabetes People in the lifestyle change group showed
DPP study participants were overweight and the best outcomes. However people
had prediabetes. Many had family members who took metformin also benefited. The
with type 2 diabetes. Prediabetes, obesity, results showed that by losing an average
and a family history of diabetes are strong of 15 pounds in the first year of the study,
risk factors for type 2 diabetes. About half people in the lifestyle change group reduced
of the DPP participants were from minority their risk of developing type 2 diabetes by
groups with high rates of diabetes, including 58 percent over 3 years.
African Americans, Alaska Natives, Lifestyle change was even more effective
American Indians, Asian Americans, in those ages 60 and older. People in this
Hispanics/Latinos, and Pacific Islander group reduced their risk by 71 percent.
Americans.
People in the metformin group also benefited,
DPP participants also included others at reducing their risk by 31 percent. More
high risk for developing type 2 diabetes, information about the DPP, funded under
such as women with a history of gestational NIH clinical trial number NCT00004992, is
diabetes and people ages 60 and older. available at www.bsc.gwu.edu/dpp.
Approaches to Preventing
Diabetes
The DPP tested three approaches to
preventing diabetes:
• Making lifestyle changes. People in
the lifestyle change group exercised,
usually by walking 5 days a week for
about 30 minutes a day, and lowered
their intake of fat and calories.
• Taking the diabetes medication
metformin. Those who took metformin
also received information about
physical activity and diet.
• Receiving education about diabetes.
The third group only received
information about physical activity and
diet and took a placebo—a pill without
medication in it.
11 Insulin Resistance and PrediabetesLasting Results For more information about the risk of
The Diabetes Prevention Program Outcomes developing diabetes; the DPP, funded under
Study (DPPOS) has shown that the benefits NIH clinical trial number NCT00004992;
of weight loss and metformin last for at least and the DPPOS, funded under NIH
10 years. The DPPOS has continued to clinical trial number NCT00038727,
follow most DPP participants since the DPP see the following NDIC publications at
ended in 2001. The DPPOS showed that www.diabetes.niddk.nih.gov:
10 years after enrolling in the DPP • Diabetes Prevention Program
• people in the lifestyle change group • Am I at risk for type 2 diabetes? Taking
reduced their risk for developing Steps to Lower Your Risk of Getting
diabetes by 34 percent Diabetes
• those in the lifestyle change group
ages 60 or older had even greater What steps can help reverse
benefit, reducing their risk of insulin resistance and
developing diabetes by 49 percent
prediabetes?
• participants in the lifestyle change By losing weight and being more physically
group also had fewer heart and blood active, people can reverse insulin resistance
vessel disease risk factors, including and prediabetes, thus preventing or delaying
lower blood pressure and triglyceride type 2 diabetes. People can decrease their
levels, even though they took fewer risk by
medications to control their heart
disease risk • eating a healthy diet and reaching and
maintaining a healthy weight
• those in the metformin group reduced
their risk of developing diabetes by • increasing physical activity
18 percent • not smoking
Even though controlling weight with lifestyle • taking medication
changes is challenging, it produces long-
term health rewards by lowering the risk
for type 2 diabetes, lowering blood glucose
levels, and reducing other heart disease risk
factors.
12 Insulin Resistance and PrediabetesEating, Diet, and Nutrition Dietary Supplements
Adopting healthy eating habits can help Vitamin D studies show a link between
people lose a modest amount of weight people’s ability to maintain healthy blood
and reverse insulin resistance. Experts glucose levels and having enough vitamin
encourage people to slowly adopt healthy D in their blood. However, studies to
eating habits that they can maintain, rather determine the proper vitamin D levels for
than trying extreme weight-loss solutions. preventing diabetes are ongoing; no special
People may need to get help from a dietitian recommendations have been made about
or join a weight-loss program for support. vitamin D levels or supplements for people
with prediabetes.
In general, people should lose weight by
choosing healthy foods, controlling portions, Currently, the Institute of Medicine
eating less fat, and increasing physical (IOM), the agency that recommends
activity. People are better able to lose supplementation levels based on current
weight and keep it off when they learn how science, provides the following guidelines for
to adapt their favorite foods to a healthy daily vitamin D intake:
eating plan.
• People ages 1 to 70 years may require
The DASH (Dietary Approaches to Stop 600 International Units (IUs).
Hypertension) eating plan, developed by
• People ages 71 and older may require
the NIH, has been shown to be effective in
as much as 800 IUs.
decreasing insulin resistance when combined
with weight loss and physical activity. The IOM also recommended that no more
More information on DASH is available than 4,000 IUs of vitamin D be taken per day.
at www.nhlbi.nih.gov/health/health-topics/ To help ensure coordinated and safe care,
topics/dash. people should discuss use of complementary
The U.S. Dietary Guidelines for Americans and alternative medicine practices, including
also offers healthy eating advice and tools the use of dietary supplements, with their
for changing eating habits at health care provider.
www.choosemyplate.gov. More information about using dietary
supplements to help with diabetes is
available from the NDIC at
www.diabetes.niddk.nih.gov/dm/pubs/
alternativetherapies/index.aspx.
13 Insulin Resistance and PrediabetesPhysical Activity Not Smoking
Regular physical activity tackles several risk Those who smoke should quit. A health
factors at once. Regular physical activity care provider can help people find ways to
helps the body use insulin properly. quit smoking. Studies show that people who
get help have a better chance of quitting.
Regular physical activity also helps a person
• lose weight
• control blood glucose levels For more information about how
to reverse insulin resistance and
• control blood pressure prediabetes with diet and increased
• control cholesterol levels physical activity, see the following
National Diabetes Education Program
People in the DPP who were physically publications at www.yourdiabetesinfo.org:
active for 30 minutes a day, 5 days a week,
reduced their risk of type 2 diabetes. Many • Get Real! You Don’t Have to Knock
chose brisk walking as their physical activity. Yourself Out to Prevent Diabetes!
Most people should aim for at least • More Than 50 Ways to Prevent
30 minutes of exercise most days of the Diabetes
week. For best results, people should do • Small Steps. Big Rewards. Your
both aerobic activities, which use large Game Plan to Prevent Type 2
muscle groups and make the heart beat Diabetes.
faster, and muscle strengthening activities.
Aerobic activities include brisk walking,
climbing stairs, swimming, dancing, and
other activities that increase the heart rate.
Muscle strengthening activities include
lifting weights and doing sit-ups or push-ups.
People who haven’t been physically active
recently should talk with their health care
provider about which activities are best for
them and have a checkup before starting an
exercise program.
14 Insulin Resistance and PrediabetesMedication Several medications have been shown
The medication metformin is recommended to reduce type 2 diabetes risk to varying
for treatment of some individuals at very degrees, but the only medication
high risk of developing type 2 diabetes. In recommended by the ADA for type 2
the DPP, metformin was shown to be most diabetes prevention is metformin. Other
effective in preventing or delaying the medications that have delayed diabetes
development of type 2 diabetes in younger, have side effects or haven’t shown long-
heavier people with prediabetes. In general, lasting benefits. No medication, including
metformin is recommend for those who are metformin, is approved by the U.S. Food
younger than age 60 and have and Drug Administration to treat insulin
resistance or prediabetes or to prevent
• combined IGT and IFG type 2 diabetes.
• A1C above 6 percent
• low HDL cholesterol
• elevated triglycerides
• a parent or sibling with diabetes
• a BMI of at least 35
Metformin also lowers the risk of diabetes in
women who have had gestational diabetes.
People at high risk should ask their health
care provider if they should take metformin
to prevent type 2 diabetes.
15 Insulin Resistance and PrediabetesBody Mass Index Table
Normal Overweight Obese Extreme Obesity
BMI 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54
Height Body Weight
(inches) (pounds)
58 91 96 100 105 110 115 119 124 129 134 138 143 148 153 158 162 167 172 177 181 186 191 196 201 205 210 215 220 224 229 234 239 244 248 253 258
59 94 99 104 109 114 119 124 128 133 138 143 148 153 158 163 168 173 178 183 188 193 198 203 208 212 217 222 227 232 237 242 247 252 257 262 267
60 97 102 107 112 118 123 128 133 138 143 148 153 158 163 168 174 179 184 189 194 199 204 209 215 220 225 230 235 240 245 250 255 261 266 271 276
61 100 106 111 116 122 127 132 137 143 148 153 158 164 169 174 180 185 190 195 201 206 211 217 222 227 232 238 243 248 254 259 264 269 275 280 285
62 104 109 115 120 126 131 136 142 147 153 158 164 169 175 180 186 191 196 202 207 213 218 224 229 235 240 246 251 256 262 267 273 278 284 289 295
16 Insulin Resistance and Prediabetes
63 107 113 118 124 130 135 141 146 152 158 163 169 175 180 186 191 197 203 208 214 220 225 231 237 242 248 254 259 265 270 278 282 287 293 299 304
64 110 116 122 128 134 140 145 151 157 163 169 174 180 186 192 197 204 209 215 221 227 232 238 244 250 256 262 267 273 279 285 291 296 302 308 314
65 114 120 126 132 138 144 150 156 162 168 174 180 186 192 198 204 210 216 222 228 234 240 246 252 258 264 270 276 282 288 294 300 306 312 318 324
66 118 124 130 136 142 148 155 161 167 173 179 186 192 198 204 210 216 223 229 235 241 247 253 260 266 272 278 284 291 297 303 309 315 322 328 334
67 121 127 134 140 146 153 159 166 172 178 185 191 198 204 211 217 223 230 236 242 249 255 261 268 274 280 287 293 299 306 312 319 325 331 338 344
68 125 131 138 144 151 158 164 171 177 184 190 197 203 210 216 223 230 236 243 249 256 262 269 276 282 289 295 302 308 315 322 328 335 341 348 354
69 128 135 142 149 155 162 169 176 182 189 196 203 209 216 223 230 236 243 250 257 263 270 277 284 291 297 304 311 318 324 331 338 345 351 358 365
70 132 139 146 153 160 167 174 181 188 195 202 209 216 222 229 236 243 250 257 264 271 278 285 292 299 306 313 320 327 334 341 348 355 362 369 376
71 136 143 150 157 165 172 179 186 193 200 208 215 222 229 236 243 250 257 265 272 279 286 293 301 308 315 322 329 338 343 351 358 365 372 379 386
72 140 147 154 162 169 177 184 191 199 206 213 221 228 235 242 250 258 265 272 279 287 294 302 309 316 324 331 338 346 353 361 368 375 383 390 397
73 144 151 159 166 174 182 189 197 204 212 219 227 235 242 250 257 265 272 280 288 295 302 310 318 325 333 340 348 355 363 371 378 386 393 401 408
74 148 155 163 171 179 186 194 202 210 218 225 233 241 249 256 264 272 280 287 295 303 311 319 326 334 342 350 358 365 373 381 389 396 404 412 420
75 152 160 168 176 184 192 200 208 216 224 232 240 248 256 264 272 279 287 295 303 311 319 327 335 343 351 359 367 375 383 391 399 407 415 423 431
76 156 164 172 180 189 197 205 213 221 230 238 246 254 263 271 279 287 295 304 312 320 328 336 344 353 361 369 377 385 394 402 410 418 426 435 443
Source: Adapted from Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report. National Institutes of Health, 1998.Points to Remember • By losing weight and being more
physically active, people can reverse
• Insulin is a hormone that helps cells
insulin resistance and prediabetes, thus
throughout the body absorb glucose
preventing or delaying type 2 diabetes.
and use it for energy. Insulin resistance
is a condition in which the body • People with insulin resistance and
produces insulin but does not use it prediabetes can decrease their risk for
effectively. diabetes by eating a healthy diet and
reaching and maintaining a healthy
• Insulin resistance increases the risk
weight, increasing physical activity, not
of developing type 2 diabetes and
smoking, and taking medication.
prediabetes.
• The DPP showed the diabetes
• The major contributors to insulin
medication metformin to be most
resistance are excess weight, especially
effective in preventing or delaying
around the waist, and physical
the development of type 2 diabetes
inactivity.
in younger and heavier people with
• Prediabetes is a condition in which prediabetes and women who have had
blood glucose or A1C levels—which gestational diabetes.
reflect average blood glucose levels—
are higher than normal but not high
enough for a diagnosis of diabetes.
• The Diabetes Prevention Program
(DPP) study and its follow-up study,
the Diabetes Prevention Program
Outcomes Study (DPPOS), confirmed
that people with prediabetes can often
prevent or delay diabetes if they lose
a modest amount of weight by cutting
fat and calorie intake and increasing
physical activity.
17 Insulin Resistance and PrediabetesHope through Research For More Information
The National Institute of Diabetes and American Association of Diabetes Educators
Digestive and Kidney Diseases (NIDDK) 200 West Madison Street, Suite 800
conducts and supports research in insulin Chicago, IL 60606
resistance, diabetes, glucose metabolism, Phone: 1–800–338–3633
and related conditions. Clinical trials Internet: www.diabeteseducator.org
related to diabetes include
American Diabetes Association
• Genetic Studies of Insulin and 1701 North Beauregard Street
Diabetes, funded by the NIDDK Alexandria, VA 22311
under NIH clinical trial number Phone: 1–800–DIABETES
NCT00001987 (1–800–342–2383)
Email: askADA@diabetes.org
• Diabetes and Heart Disease Risk
Internet: www.diabetes.org
in Blacks, funded by the NIDDK
under NIH clinical trial number National Heart, Lung, and Blood Institute
NCT00001853 Health Information Center
Attn: Website
Clinical trials are research studies involving
P.O. Box 30105
people. Clinical trials look at safe and
Bethesda, MD 20824–0105
effective new ways to prevent, detect, or
Phone: 301–592–8573
treat disease. Researchers also use clinical
Telecommunications Relay Services: 7–1–1
trials to look at other aspects of care, such
Fax: 301–592–8563
as improving the quality of life for people
Email: nhlbiinfo@nhlbi.nih.gov
with chronic illnesses. To learn more about
Internet: www.nhlbi.nih.gov
clinical trials, why they matter, and how to
participate, visit the NIH Clinical Research
Trials and You website at www.nih.gov/health/ Acknowledgments
clinicaltrials. For information about current Publications produced by the Clearinghouse
studies, visit www.ClinicalTrials.gov. are carefully reviewed by both NIDDK
For more information about the NIDDK’s scientists and outside experts. This
research on diabetes and related topics, see publication was originally reviewed
www.diabetes.niddk.nih.gov/diabetesresearch/ by George A. Bray, M.D., Pennington
dm_research.aspx. Biomedical Research Center, Louisiana
State University, and Richard F. Hamman,
M.D., Dr.P.H., Department of Preventive
Medicine and Biometrics, University of
Colorado Health Sciences Center.
18 Insulin Resistance and PrediabetesYou may also find additional information about this National Diabetes Education
topic by visiting MedlinePlus at www.medlineplus.gov.
This publication may contain information about
Program
medications and, when taken as prescribed, 1 Diabetes Way
the conditions they treat. When prepared, this Bethesda, MD 20814–9692
publication included the most current information
available. For updates or for questions about Phone: 1–888–693–NDEP
any medications, contact the U.S. Food and Drug (1–888–693–6337)
Administration toll-free at 1–888–INFO–FDA
(1–888–463–6332) or visit www.fda.gov. Consult your
TTY: 1–866–569–1162
health care provider for more information. Fax: 703–738–4929
Email: ndep@mail.nih.gov
Internet: www.ndep.nih.gov
www.yourdiabetesinfo.org
The U.S. Government does not endorse or favor any
specific commercial product or company. Trade, The National Diabetes Education Program
proprietary, or company names appearing in this
document are used only because they are considered
is a federally funded program sponsored by
necessary in the context of the information provided. the U.S. Department of Health and Human
If a product is not mentioned, the omission does not Services’ National Institutes of Health
mean or imply that the product is unsatisfactory.
and the Centers for Disease Control and
Prevention and includes over 200 partners at
the federal, state, and local levels, working
together to reduce the morbidity and
mortality associated with diabetes.
19 Insulin Resistance and PrediabetesNational Diabetes
Information Clearinghouse
1 Information Way
Bethesda, MD 20892–3560
Phone: 1–800–860–8747
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: ndic@info.niddk.nih.gov
Internet: www.diabetes.niddk.nih.gov
The National Diabetes Information
Clearinghouse (NDIC) is a service of the
National Institute of Diabetes and Digestive
and Kidney Diseases (NIDDK). The
NIDDK is part of the National Institutes
of Health of the U.S. Department of
Health and Human Services. Established
in 1978, the Clearinghouse provides
information about diabetes to people
with diabetes and to their families, health
care professionals, and the public. The
NDIC answers inquiries, develops and
distributes publications, and works closely
with professional and patient organizations
and Government agencies to coordinate
resources about diabetes.
This publication is not copyrighted. The Clearinghouse
encourages users of this publication to duplicate and
distribute as many copies as desired.
This publication is available at
www.diabetes.niddk.nih.gov.
NIH Publication No. 14–4893
June 2014
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