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Prediabetes affects more than 1 in 3 American adults, but the good news is that it’s reversible. With the right approach, you can bring your blood sugar back to healthy levels and significantly reduce your risk of developing type 2 diabetes. The key is acting early and choosing treatments that fit your life.
What Is Prediabetes and Why Does It Matter?
Prediabetes means your blood glucose is higher than normal but not high enough for a diabetes diagnosis. You might have no symptoms, but inside your body, insulin resistance is building. Without intervention, up to 70% of people with prediabetes will go on to develop type 2 diabetes within a decade. That’s why starting treatment now is critical.
Lifestyle Changes: The Foundation of Prediabetes Treatment
For most people, lifestyle modifications are the first and most effective step. The landmark Diabetes Prevention Program (DPP) showed that losing 5–7% of body weight and exercising 150 minutes per week cut the risk of progressing to diabetes by 58% (71% for adults over 60). That’s better than any medication.
What to Eat (and What to Limit)
Focus on whole foods that stabilize blood sugar. Swap refined carbs for complex ones: think oats instead of sugary cereal, whole-grain bread instead of white, and quinoa instead of white rice. Vegetables should fill half your plate at every meal. Lean proteins—chicken, fish, tofu, legumes—and healthy fats like avocado, nuts, and olive oil also help. Cut back on sugary drinks, sweets, and refined snacks; one soda can spike your glucose as much as a small meal. A practical goal: reduce added sugar to fewer than 25 grams per day for women and 36 grams for men.
Move Your Body Consistently
Both aerobic exercise and resistance training improve insulin sensitivity. Aim for at least 30 minutes of moderate activity five days a week. Brisk walking, cycling, swimming, or dancing all count. Add two days of strength training—even bodyweight squats and pushups make a difference. One real-world example: a 2019 study found that sedentary adults who started walking 10,000 steps daily lowered their fasting insulin by 16% over three months.
Weight Loss: Even Small Amounts Help
You don’t need to become a fitness model. Losing 5–10% of your body weight (just 10–20 pounds for a 200-pound person) can dramatically improve blood sugar control. For some, combo GLP-1 therapy shows fat loss while preserving lean mass, which may benefit those who struggle with lifestyle changes alone. If you’re considering medical help for weight loss, talk to your doctor about whether these options are right for you.
Medication Options: When Lifestyle Isn’t Enough
If your blood sugar remains elevated after three to six months of lifestyle changes, or if you have other risk factors (like a strong family history or high HbA1c), medication may be needed.
Metformin: The First-Line Drug
Metformin is the most widely prescribed medication for prediabetes. It reduces glucose production in the liver and improves the body’s sensitivity to insulin. Typically taken 500–2000 mg per day, it’s effective and low-cost. Side effects like nausea or diarrhea often subside after a few weeks. A 2021 meta-analysis showed metformin reduced the risk of progressing to diabetes by 31%.
GLP-1 Receptor Agonists: A Promising Option
These injectable drugs (like semaglutide, marketed as Ozempic or Wegovy) not only lower blood sugar but also promote significant weight loss. However, higher doses can bring more benefits and risks—for example, a higher dose of Wegovy ups both weight loss and side effects. These are generally prescribed for people with obesity or when metformin isn’t tolerated. If you’re curious, knowing how to talk to your doctor about GLP-1s can help you have an informed conversation.
Monitoring Your Progress: The HbA1c Test and Beyond
Regular testing is essential to see if your treatment is working. The HbA1c test gives a three-month average of your blood sugar. Experts recommend getting it checked at least twice a year if you have prediabetes. Why you shouldn’t skip your HbA1c test is straightforward: it’s the most reliable way to track your risk and adjust your plan. Also keep an eye on blood pressure—high pressure often accompanies prediabetes. A man’s guide to blood pressure offers practical tips for keeping it under control, applicable to anyone.
Don’t Ignore Related Health Risks
Prediabetes doesn’t exist in a vacuum. It’s linked to other conditions that can worsen outcomes. For instance, non-alcoholic fatty liver disease is common in people with insulin resistance—rising liver disease cases demand immediate attention. Addressing prediabetes often improves liver health, too. Work with your doctor to screen for comorbidities, including high cholesterol, sleep apnea, and hormonal imbalances like PCOS.
The road from prediabetes to diabetes isn’t inevitable. With the right treatment—whether lifestyle-driven, medication-assisted, or both—you can reverse the condition and protect your long-term health. Start with small changes, monitor your progress, and don’t hesitate to enlist professional support. Your future self will thank you.
