Prediabetes: What It Means and Whether It Can Be Reversed

What is actually happening in prediabetes?

Your body regulates blood sugar through insulin, a hormone made by the pancreas. When you eat, blood sugar rises and insulin helps move that sugar into cells to be used as energy. In prediabetes, the body's cells don't respond to insulin as efficiently as they should — a state called insulin resistance. The pancreas compensates by producing more insulin, but over time it struggles to keep up. Blood sugar begins to run chronically higher than normal, though not yet at the level that meets diagnostic criteria for type 2 diabetes.

The prediabetes range is defined by 1Ref 1American Diabetes Association Professional Practice Committee (2024).Standards of Care in Diabetes—2024.Diagnostic criteria for prediabetes and diabetes; lifestyle change as first-line treatment; CDC National Diabetes Prevention Program; metformin use in high-risk prediabetes: - Fasting blood glucose: 100–125 mg/dL - A1C (a three-month average): 5.7–6.4%

Numbers above those thresholds — fasting glucose at or above 126 mg/dL, or A1C at or above 6.5% — meet criteria for type 2 diabetes on repeat testing.

Can prediabetes actually be reversed?

Yes — for many people, genuinely so. "Reversed" or "remission" in this context means blood sugar returns to a normal range without medication. This is meaningfully possible, especially in the earlier stages and when changes happen before insulin-producing cells have been substantially stressed.

The evidence is strongest for 1Ref 1American Diabetes Association Professional Practice Committee (2024).Standards of Care in Diabetes—2024.Diagnostic criteria for prediabetes and diabetes; lifestyle change as first-line treatment; CDC National Diabetes Prevention Program; metformin use in high-risk prediabetes2Ref 2Bull FC, Al-Ansari SS, Biddle S, et al. (2020).World Health Organization 2020 guidelines on physical activity and sedentary behaviour.Regular aerobic and strength training activity improving insulin sensitivity as part of metabolic health management:

• Modest sustained weight loss — even losing a modest percentage of body weight if overweight can measurably improve insulin sensitivity
• Regular physical activity — both aerobic exercise and strength training improve how cells respond to insulin 2Ref 2Bull FC, Al-Ansari SS, Biddle S, et al. (2020).World Health Organization 2020 guidelines on physical activity and sedentary behaviour.Regular aerobic and strength training activity improving insulin sensitivity as part of metabolic health management
• Eating patterns that reduce blood sugar spikes — fewer ultra-processed foods, refined carbohydrates, and sugary drinks; more fiber, vegetables, legumes, and whole grains

These changes don't need to be extreme. They need to be sustainable. Structured programs — such as the CDC-recognized National Diabetes Prevention Program — provide coaching, accountability, and skills, and are covered by many insurance plans 1Ref 1American Diabetes Association Professional Practice Committee (2024).Standards of Care in Diabetes—2024.Diagnostic criteria for prediabetes and diabetes; lifestyle change as first-line treatment; CDC National Diabetes Prevention Program; metformin use in high-risk prediabetes.

What role does medication play?

Lifestyle change is the first-line approach for prediabetes and has a stronger track record than medication alone in preventing progression to type 2 diabetes 1Ref 1American Diabetes Association Professional Practice Committee (2024).Standards of Care in Diabetes—2024.Diagnostic criteria for prediabetes and diabetes; lifestyle change as first-line treatment; CDC National Diabetes Prevention Program; metformin use in high-risk prediabetes. That said, a clinician may discuss medication for people at highest risk — for example, those with a very high A1C within the prediabetes range, obesity, a strong family history, or a history of gestational diabetes.

Metformin is the medication most commonly used when medication is indicated for prediabetes 3Ref 3MedlinePlus / U.S. National Library of Medicine (2024).Metformin: MedlinePlus Drug Information.Metformin as the medication most commonly used when pharmacotherapy is indicated for prediabetes or type 2 diabetes. The decision to add medication is individualized and does not replace lifestyle changes — both together often work better than either alone.

What happens if prediabetes is not addressed?

Not everyone with prediabetes progresses to type 2 diabetes — some people's blood sugar stays stable for years. But the risk of progression is real, and type 2 diabetes carries significant long-term complications including nerve damage, kidney disease, eye disease, and cardiovascular disease 1Ref 1American Diabetes Association Professional Practice Committee (2024).Standards of Care in Diabetes—2024.Diagnostic criteria for prediabetes and diabetes; lifestyle change as first-line treatment; CDC National Diabetes Prevention Program; metformin use in high-risk prediabetes.

Prediabetes itself is associated with elevated cardiovascular risk — it matters not only because of where it can lead, but for its current impact on the heart and blood vessels. Knowing you have it is useful precisely because this is the window where the most can be done.

Monitoring and follow-up

A clinician will typically recheck blood sugar at regular intervals — often every three to six months while changes are being made, then annually once things are stable. Tracking blood sugar trends alongside weight, activity, and eating habits provides concrete data for both you and your clinician.

Screening for prediabetes and type 2 diabetes is recommended for overweight or obese adults aged 35 to 70 4Ref 4US Preventive Services Task Force (2021).Screening for Prediabetes and Type 2 Diabetes: US Preventive Services Task Force Recommendation Statement.Screening for prediabetes and type 2 diabetes recommended for overweight or obese adults aged 35 to 70. If you have risk factors — family history, gestational diabetes history, sedentary lifestyle — earlier or more frequent screening may be appropriate.