Prediabetes: What to Do After Your Diagnosis

What does it mean to have prediabetes?

Prediabetes is diagnosed when blood sugar levels are elevated but not yet high enough to meet the definition of type 2 diabetes. The diagnostic criteria from the American Diabetes Association use any of the following 1Ref 1American Diabetes Association Professional Practice Committee (2024).2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2024.ADA diagnostic thresholds for prediabetes (fasting glucose 100-125, A1c 5.7-6.4%) and criteria for metformin use in prediabetes:

• Fasting glucose: 100–125 mg/dL (diabetes is 126 mg/dL or above)
• A1c: 5.7%–6.4% (diabetes is 6.5% or above)
• 2-hour glucose during an oral glucose tolerance test: 140–199 mg/dL

Prediabetes reflects insulin resistance — the body is still producing insulin, but the cells are not responding to it as effectively. The pancreas works harder to compensate, and over time, if the pattern continues, blood sugar climbs into the diabetes range.

The US Preventive Services Task Force recommends screening for prediabetes and type 2 diabetes in adults aged 35 to 70 who are overweight or obese 2Ref 2US Preventive Services Task Force; Davidson KW, Barry MJ, Mangione CM, et al. (2021).Screening for Prediabetes and Type 2 Diabetes: US Preventive Services Task Force Recommendation Statement.USPSTF recommendation to screen adults aged 35-70 who are overweight or obese.

How serious is prediabetes, and how often does it progress?

Left untreated, prediabetes progresses to type 2 diabetes in a meaningful proportion of people — but the progression is not inevitable, and it is not fast. Many people with prediabetes spend years in that range, and a significant number normalize their blood sugar with sustained lifestyle changes.

Prediabetes is also associated with early cardiovascular risk, so addressing it has benefits beyond just preventing diabetes. The earlier you act, the more time the body has to respond.

What lifestyle changes actually work?

The Diabetes Prevention Program (DPP), a large US randomized controlled trial, found that intensive lifestyle intervention — targeting at least 7% weight loss and 150 minutes of moderate physical activity per week — reduced the development of type 2 diabetes by 58% compared with placebo over about 3 years 3Ref 3Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group (2002).Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.Lifestyle intervention reduced diabetes progression by 58%, metformin by 31%, in the DPP trial. This is a robust, well-replicated finding.

Weight loss is the most powerful lever if you are overweight. Even modest weight reduction — 5 to 10% of body weight — meaningfully improves insulin sensitivity and blood sugar.

Physical activity improves how well muscle cells respond to insulin, independent of weight loss. Both aerobic exercise (walking, cycling, swimming) and resistance training (weights, resistance bands) help. Aiming for 150 minutes per week of moderate activity is a well-supported target 4Ref 4Bull FC, Al-Ansari SS, Biddle S, et al. (2020).World Health Organization 2020 guidelines on physical activity and sedentary behaviour.150 minutes per week of moderate-intensity physical activity as a general health target.

Dietary changes that support these goals: - Reducing refined carbohydrates and sugary beverages, which cause sharp blood sugar spikes - Increasing vegetables, legumes, whole grains, and lean protein — all of which are digested more slowly - Limiting heavily processed foods - Paying attention to portion sizes

There is no single "prediabetes diet." The most effective approach is one you can sustain — whether that is a Mediterranean-style eating pattern, lower-carbohydrate approach, or another evidence-supported framework. A registered dietitian can help individualize this.

Can medication help with prediabetes?

Metformin is the only medication with strong evidence for preventing or delaying diabetes in people with prediabetes. In the DPP trial, metformin reduced progression to diabetes by 31% compared with placebo — meaningful, but less effective than lifestyle change 3Ref 3Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group (2002).Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.Lifestyle intervention reduced diabetes progression by 58%, metformin by 31%, in the DPP trial.

The American Diabetes Association recommends considering metformin for prediabetes, particularly in people with 1Ref 1American Diabetes Association Professional Practice Committee (2024).2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes-2024.ADA diagnostic thresholds for prediabetes (fasting glucose 100-125, A1c 5.7-6.4%) and criteria for metformin use in prediabetes: - BMI 35 or above - Age under 60 - History of gestational diabetes - Those who cannot achieve adequate lifestyle change

Metformin is generally safe, inexpensive, and well-tolerated at the doses used for prediabetes. It does not cause low blood sugar on its own and is taken by mouth, typically once or twice daily with meals.

Newer medications like GLP-1 agonists (such as semaglutide) are being studied in the prediabetes range, but they are not yet standard care for prediabetes in the way they are for diabetes and obesity.

What should I do next?

A prediabetes diagnosis is best treated as a starting point for an honest conversation with your clinician rather than a reason for alarm. Useful next steps:

• Discuss which lifestyle changes are realistic for you — sustainable beats perfect
• Ask about the CDC-recognized National Diabetes Prevention Program — a structured group curriculum delivered in many communities and online that is evidence-based and covered by Medicare and many insurers
• Get repeat labs in 3 to 12 months to track how your blood sugar is responding to changes
• Consider a referral to a registered dietitian for personalized food guidance

A Gale primary care clinician can interpret your lab values, discuss whether metformin is appropriate, help you set realistic goals, and monitor your progress over time.