Prediabetes Treatment: What It Is and When It’s Needed

• Prediabetes is a symptomless condition where someone has higher blood glucose or blood sugar levels.
• Most people over 35 should be screened via a blood test for prediabetes every three years. Those with risk factors, like a higher body weight or a family history of diabetes, may be screened more often or earlier than 35. 
• Prediabetes can be treated and even reversed. Prediabetes treatment often includes dietary and lifestyle changes to support overall health, as well as medications or bariatric surgery in some cases. 

Most of us have probably heard about type 2 diabetes, a condition where the body can’t use insulin as intended due to a mix of lifestyle and genetic factors. Prediabetes isn’t talked about as often, even though it’s quite common. More than one in three adults in the US have prediabetes, and the actual numbers may be higher since prediabetes is often symptomless, making it difficult to diagnose.

Prediabetes is marked by higher blood sugar levels and if left unchecked, can turn into a type 2 diabetes diagnosis. It’s a serious condition, but one that can be treated. Ahead, we’ll detail how to know if you have prediabetes and which prediabetes treatment options can help slow or reverse this condition. 

Over 38 million Americans have diabetes, a condition where the body cannot produce or use insulin as intended. There are three types of diabetes: 

• Type 1 diabetes: An autoimmune disease tied to genetics. Type 1 diabetes occurs when beta cells in the pancreas do not make insulin. 
• Type 2 diabetes: Occurs when the body develops insulin resistance, often due to obesity.
• Gestational diabetes: Occurs when the body can’t make the extra insulin required during pregnancy. 

Type 1 and Type 2 diabetes, as well as gestational diabetes cases that are symptomatic, share common symptoms, such as:

• Extreme hunger
• Increased thirst
• Fatigue
• Blurred vision
• Irritability or mood changes
• Headaches
• Increased urination 

When you eat, food breaks down into a sugar that is released into the bloodstream. The pancreas (an internal organ located in the abdomen) creates insulin, a hormone that helps the cells in the body absorb blood sugar, which is then used for energy. If your blood sugar levels are too high over many years, your cells become less responsive to insulin, a condition known as insulin resistance.

In response to insulin resistance, the body produces more insulin, but may be resistant to its effects, eventually causing your blood glucose levels to rise, triggering a condition known as prediabetes.

A prediabetes diagnosis occurs when someone has a higher-than-average blood sugar level, but one that is not high enough to be classified as diabetes. If left untreated, however, prediabetes can turn into type 2 diabetes. 

Prediabetes can also be a risk factor for other medical conditions, such as:

• Metabolic syndrome
• High blood pressure
• Nonalcoholic fatty liver disease
• Kidney failure
• Unhealthy levels of cholesterol
• Obesity or excessive weight gain
• Heart disease

How Common Is Prediabetes?

The Centers for Disease Control and Prevention estimates that more than one-third of Americans have prediabetes or insulin resistance. The likelihood of developing prediabetes increases as we age.

Prediabetes Symptoms

While some people with prediabetes may have symptoms similar to diabetes, most don’t experience any symptoms, and 80% of those with prediabetes don’t know they have it. That makes prediabetes hard to detect unless a primary care provider or another healthcare provider orders blood tests to measure blood sugar levels. 

Prediabetes Causes and Risk Factors

When blood sugar levels are too high for too long, the pancreas’s insulin production can’t keep up, resulting in prediabetes. While scientists are still researching the exact reason why the pancreas stops producing enough insulin in these cases, there are established risk factors for prediabetes.

Common risk factors include:

• A higher-than-average body weight
• Being 35 years or older
• A family history of type 2 diabetes
• Sedentary lifestyle (not being active more than two times a week)
• A history of gestational diabetes
• Having polycystic ovary syndrome (PCOS)
• Giving birth to a baby that weighed over nine pounds
• Excess weight around the abdomen 

Race and ethnicity also play a role. Those who are Black, Latino, American Indian, Indigenous, Pacific Islander, and of certain Asian descent are at higher risk.

The Centers for Disease Control and Prevention has a prediabetes quiz that can assess your risk of developing this condition based on risk factors. This quiz can provide useful information on whether you may benefit from a blood glucose test, but it cannot diagnose diabetes. If what you gather from the test concerns you, it’s important to speak with a provider to determine any lifestyle changes or treatments that may be beneficial to you.

How common is it to get diabetes after a prediabetes diagnosis?

About 70% of people with prediabetes will eventually receive a diabetes diagnosis, but an increased risk doesn’t mean this progression is inevitable. It is possible to reverse prediabetes (which we’ll get into down below). 

Without taking action, prediabetes typically turns into diabetes within five years. A few early signs of prediabetes turning into diabetes include:

• Unexplained weight loss
• Increased urination
• Feeling hungrier or thirstier than usual
• Confused thinking
• Weakness
• Nausea
• Getting more infections, especially yeast or fungal infections 

You can’t physically ​“see” if someone has prediabetes. Instead, a provider must order one or more tests. Usually, these tests are ordered every three years during annual wellness checks, starting when an individual is between the ages of 30 and 45. If someone has one or more risk factors, testing may begin earlier and occur more frequently. 

To diagnose prediabetes, one or more of the following blood tests may be used. Sometimes, a healthcare provider will order two separate tests to confirm results.

A1C Test

This blood test provides a snapshot of the average blood sugar level in the body over the last three months. Test results are reported as a percentage, with a higher percentage indicating higher blood glucose levels. A diagnosis of prediabetes can be made if your hemoglobin A1C falls within the 5.7 to 6.4% range. A hemoglobin A1C of 6.5% or higher indicates type 2 diabetes.

Fasting Blood Sugar Test

This blood test measures blood glucose levels after an eight-hour fast. If the milligrams per deciliter (mg/​dL) in a fasting blood sugar level comes back within the range of 100 to 125, someone may be diagnosed with prediabetes. Levels higher than 125 indicate diabetes, while levels lower than 100 indicate neither.

Glucose Tolerance Test

Sometimes, a provider will order an oral glucose tolerance test. After someone fasts for eight hours, a healthcare provider takes a blood sample. They then provide the individual with a sugary liquid and take another blood sample two hours after they drink it. While effective at diagnosing diabetes and prediabetes, it is more costly and takes longer to complete, which is why it’s the least common of the three. 

Many of the most successful diabetes prevention programs are designed for those with prediabetes. They often focus on diet and lifestyle changes to prevent diabetes, though medications to increase glucose uptake or to facilitate weight loss, as well as bariatric surgery, may also be part of an individual’s treatment plan.

Dietary Changes

A healthy diet can help someone lose excess weight and lower the risk of developing type 2 diabetes. The best diet for treating prediabetes is often high in:

• Whole grains, like quinoa or brown rice
• Lean protein, like chicken, nuts, or chickpeas
• Vegetables and fruit

Many people also find that a low-calorie diet is an effective treatment option as well, so long as the majority of those calories are coming from the above food groups. 

Lifestyle Changes

Lifestyle changes can help reverse or prevent prediabetes. Some of the most effective ones include:

• Learning to manage stress: Stress increases the risk for prediabetes because it releases cortisol into the bloodstream, which can increase blood sugar levels. Engaging in practices like breathwork, meditation, journaling, or even finding a community where you can vent and share your emotions, helps to mitigate stress.
• Quitting smoking: Smoking contributes to insulin resistance, meaning it’s best to quit smoking to reverse or prevent prediabetes. The US government has free resources to help with this, as does the American Diabetes Association.
• Exercising regularly: Regular movement improves blood sugar control, which can prevent or reverse prediabetes. Meeting the CDC’s standards of 150 minutes of sweat-breaking aerobic physical activity (walking, biking, etc.) and two strength training sessions a week has been shown to curb weight gain and decrease the risk of developing type 2 diabetes.
• Engaging in physical activity outside of regular workouts: Like exercise, living a lifestyle full of movement helps with blood glucose control. Choosing to take the stairs over the elevator or parking further out when shopping can increase your everyday activity.

Diet and lifestyle changes can be hard to implement on your own. Many find diabetes support groups to be a useful accountability tool. The American Diabetes Association also hosts more structured lifestyle programs for the clinical management and early treatment of prediabetes, and the US Department of Health and Human Services offers free guides on nutrition and exercise. 

Medications

While nutrition and lifestyle changes may lead to a sustained reduction of prediabetes progression, some people find that medications lower the risk more quickly. Helpful medications in prediabetes and diabetes care vary but may include:

• Insulin medications, such as Metformin, which decrease the amount of glucose someone absorbs from food and support the body’s response to insulin
• Drugs that treat other health problems, like high cholesterol (statins)
• Medications designed to help someone reach a healthy weight and to lower blood sugar levels, such as GLP-1s

Bariatric Surgery

If weight is a significant factor, bariatric surgery may be recommended. This surgery makes your stomach smaller so you feel full sooner, contributing to weight loss and overall dietary/​lifestyle changes. 

A prediabetes diagnosis often means someone has to make some lifestyle changes, which may be overwhelming. Your medical team can provide guidance on what changes will be most effective in your situation. 

There are also some steps you can take to make prediabetes treatment more manageable:

• Start with one or two changes. Once you feel confident in those, integrate a few more.
• Educate yourself on what affects blood sugar levels.
• Lean on your loved ones for support.
• Celebrate progress – and it doesn’t have to be perfect either. Five imperfect but consistent workouts make a bigger difference than one perfect workout.
• Be kind to yourself while making changes.

Many also find it useful to pay attention to their mental health while treating prediabetes. Addressing any emotions that pop up via journaling, therapy, or another modality can prepare you to live with and treat prediabetes. 

If you have prediabetes or are at increased risk for it, see a healthcare provider annually or more often, if the provider recommends more frequent visits. Even if your treatment plan is working, their insight can still prove valuable. 

Questions to ask when seeing a provider include:

• What signs of type 2 diabetes should I look out for?
• Is there anything else I can do to lower my risk of type 2 diabetes?
• What lifestyle changes will have the biggest impact on prediabetes in my case?
• Are there any diabetes prevention programs you can refer me to?
• Should I see any other medical providers? If so, who do you recommend?