and it reveals average glycemic control over 3-month period. hba1c less than 5.6% is considered normal. glucose status can also be tested through fasting blood sugar (fbs) and requires a blood sample after a patient has fasted for at least eight hours, so it might not be as convenient. patients who have gotten oral blood samples taken say it feels as if part of a normal procedure, and dentists say it is convenient. in a study that analyzed data from 10,472 adults from 2013 to 2014 and 2015 to 2016, it was revealed that screening for risk of prediabetes in the dental setting has the potential to alert an estimated 22.36 million adults. diabetes may be asymptomatic for a long time, but since it would be wasteful to test every patient at the dental office, utilizing known risk factors may guide who is ideal for testing. since a history is already taken at a dental office, a few additional questions would help guide a dentist on narrowing down who the test is recommended for. for example, people with high bmi are at higher risk for diabetes. a study done by the school of dentistry, diabetes research centre, mazandaran university of medical sciences in sari, iran found a relation between periodontitis and the prediabetic condition, and this could be another tool to help guide who might be recommended to take the test. periodontal disease occurs when a number of anaerobic bacteria living on the tooth surface cause infections, which leads to a potentially sustained immune response. diabetes is a type of condition in which infections are easier to get, and hyperglycemia contributes to the mechanism causing oral complications. prevention the american college of endocrinology (ace) and the american association of clinical endocrinologists (aace) have developed lifestyle intervention guidelines for preventing the onset of type 2 diabetes: healthy diet (a diet with limited refined carbohydrates, added sugars, trans fats, as well as limited intake of sodium and total calories) physical fitness (30–45 minutes of cardiovascular exercise per day, 3–5 days a week) weight loss by as little as 5–10 percent may have a significant impact on overall health management there is evidence that prediabetes is a curable disease state. although some drugs can delay the onset of diabetes, lifestyle modifications play a greater role in the prevention of diabetes. intensive weight loss and lifestyle intervention, if sustained, may improve glucose tolerance substantially and prevent progression from igt to type 2 diabetes. the diabetes prevention program (dpp) study found a 16% reduction in diabetes risk for every kilogram of weight loss. reducing weight by 7% through a low-fat diet and performing 150 minutes of exercise a week is the goal. the ada guidelines recommend modest weight loss (5–10% body weight), moderate-intensity exercise (30 minutes daily), and smoking cessation. there are many dietary approaches that can reduce the risk of progression to diabetes. most involve the reduction of added sugars and fats but there remains a lack of conclusive evidence proving the best approach. for patients with severe risk factors, prescription medication may be appropriate. this may be considered in patients for whom lifestyle therapy has failed, or is not sustainable, and who are at high-risk for developing type 2 diabetes. metformin and acarbose help prevent the development of prediabetes, and also have a good safety profile. evidence also supports thiazolidinediones but there are safety concerns, and data on newer agents such as glp-1 receptor agonists, dpp4 inhibitors or meglitinides are lacking. prognosis the progression to type 2 diabetes mellitus is not inevitable for those with prediabetes. the progression into diabetes mellitus from prediabetes is approximately 25% over three to five years. this increases to 50% risk of progressing to diabetes over 10 years. diabetes is a leading cause of morbidity and mortality. effects of the disease may affect larger blood vessels (e.g., atherosclerosis within the larger arteries of the cardiovascular system) or smaller blood vessels, as seen with damage to the retina of the eye, damage to the kidney, and damage to the nerves. prediabetes is a risk factor for mortality and there is evidence of cardiovascular disease developing prior to a diagnosis of diabetes. epidemiology studies conducted from 1988 to 1994 indicated that of the total population of us in the age group 40–74 years, 34% had ifg, 15% had igt, and 40% had prediabetes (ifg, igt, or both). eighteen million people (6% of the population) had type 2 diabetes in 2002. the incidence of diabetes is growing. in 2014, 29.1 million people or 9% of the us population had diabetes. in 2011–2012, the prevalence of diabetes in the u.s. using hemoglobin a1c, fasting plasma glucose or the two-hour plasma glucose definition was 14% for total diabetes, 9% for diagnosed diabetes, 5% for undiagnosed diabetes and 38% for prediabetes.