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Prediabetes affects roughly 98 million American adults. Unmanaged, it can develop into Type 2 diabetes, increasing the risk of complications, including heart disease. Prevention and management include lifestyle modifications and drugs like Metformin or GLP-1 agonists such as Ozempic and Mounajro.

Last Modified: July 2, 2024
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What Is Prediabetes?

Prediabetes is a health condition marked by higher-than-normal blood sugar levels that are not high enough to warrant a Type 2 diabetes diagnosis.

“It’s like a warning sign that you’re on the path to developing type 2 diabetes, which is a more serious condition,” Dr. Soma Mandal, a board-certified internist and women’s health specialist at Summit Health in New Providence, N.J., told Drugwatch.

Prediabetes affects nearly one-third of American adults, many of whom are unaware of the risk. Doctors often consider prediabetes to be a warning sign of developing Type 2 diabetes, because it indicates the pancreas’ inability to produce sufficient insulin to manage blood glucose levels.

“Having been diagnosed with gestational diabetes during my first pregnancy, placed me at higher risk for developing diabetes,” Kimberley Wiemann, a registered dietician nutritionist in Westbury, New York, told Drugwatch. Wieman focuses on the treatment of prediabetes in her practice.

Diagnosing Prediabetes

Doctors use blood tests to measure blood sugar levels and screen for prediabetes. A range of 100-125 mg/dL indicates prediabetes, while levels above 126 mg/dL indicate diabetes. It’s important to monitor these levels as many patients show no symptoms.

Testing for Prediabetes
  • A1C test results of 5.7% to 6.4%
  • Fasting plasma glucose test levels of 100-125 mg/dL
  • Two-hour oral glucose tolerance test levels of 140 to 199 mg/dL

Adhering to a routine screening program can help people identify changes in blood glucose levels, monitor the progress of prevention strategies and receive appropriate medical care for their condition. The American Diabetes Association recommends that patients with prediabetes receive regular blood screening at least every two years.

The Role of Medication in Prediabetes Treatment

Certain drugs can play an important role in prediabetes treatments. This is especially true for patients with obesity, which contributes to their insulin resistance.

Prediabetes Medications
  • Metformin
  • Acarbose
  • GLP-1 receptor agonists
  • Thiazolidinediones

Clinical trials have explored the use of various drugs to prevent this progression. The landmark Diabetes Prevention Program (DPP) demonstrated in 2002 that metformin could reduce the risk of developing Type 2 diabetes by 31% in individuals with prediabetes.

GLP-1 agonists like semaglutide, found in Wegovy and Ozempic, show promise in treating prediabetes and aiding weight loss with lower blood sugar levels. Patients should use them with a balanced, reduced-calorie diet and increased exercise.

Acarbose reduces the rate at which your body absorbs carbohydrates and has been shown to reduce the chances of developing diabetes if you have prediabetes. Thiazolidinediones enhance the uptake of insulin in muscles and fat, but side effects such as heart failure and weight gain restrict their use.

Only a medical provider can provide a diagnosis of prediabetes or Type 2 diabetes. Therefore, individuals at high risk for the condition or who suspect they have prediabetes should consult their health care provider for regular blood sugar level screenings.

Causes of Prediabetes

An abnormal insulin response that reduces the body’s ability to regulate blood sugar causes prediabetes. Because genetics can play a role in its development, doctors recommend that people with a family history of diabetes should get regular checkups and blood tests to screen for the condition.

Doctors are an excellent resource for answering questions and providing health information about prediabetes.

Risk Factors

Both environmental and genetic risk factors for prediabetes exist. New research shows a strong genetic component to developing the condition, and patients with a family history of diabetes or prediabetes are more likely to develop it than others. It is also more prevalent in people from certain ethnic backgrounds, such as African Americans, Native Americans, South Asians and Hispanics. However, many patients with insulin resistance have more than one risk factor.

Environmental Risk Factors for Prediabetes
Many people develop insulin resistance with age, and around 50% of adults older than 65 have prediabetes.
Eating a diet high in sugar or simple carbohydrates increases the risk of developing insulin resistance.
Infrequent Exercise
A sedentary lifestyle that includes minimal physical activities that provide a safe and healthy workout increases the risk of developing prediabetes.
Smokers are at greater risk of developing prediabetes or Type 2 diabetes.

Medical history can play a role in the development of prediabetes. People with a history of gestational diabetes, high blood pressure, high triglycerides, low HDL, obesity and polycystic ovary syndrome are more likely to develop insulin resistance. Although patients cannot eliminate all risk factors, they can manage many by implementing a comprehensive prevention strategy with their medical providers.

“If you are at a high risk for developing diabetes, it is important to take action as soon as possible to try to prevent the onset of prediabetes,” Wiemann said. “People should focus on avoiding processed foods and foods high in added sugars as much as possible.”

Common Symptoms of Prediabetes

Prediabetes symptoms are subtle and many patients never exhibit them. Those who do often report symptoms similar to those associated with Type 2 diabetes. When symptoms manifest, this often indicates that the prediabetes is progressing to Type 2 diabetes.

Common Prediabetes Symptoms
  • Blurry vision
  • Darkened skin on the groin, neck and underarm areas
  • Fatigue
  • Increase appetite and thirst
  • Recurrent infections
  • Sweating
  • Weakness

Because symptoms are typically mild or nonexistent, regular blood sugar testing is the most effective way to monitor prediabetes. It is especially important in high-risk populations, such as individuals with a family history of diabetes.

Health Consequences of Untreated Prediabetes

Untreated prediabetes can have serious health consequences. Patients are at increased risk of developing Type 2 diabetes, heart disease and stroke. Untreated prediabetes may also contribute to irreversible kidney and blood vessel damage.

Patients should seek medical care for the condition to limit these consequences. Prediabetes treatments can help counter insulin resistance and reduce the incidence of diabetes.

Preventing Type 2 Diabetes

Patients can often prevent Type 2 diabetes with lifestyle modifications and careful monitoring with medical interventions. Implementing these strategies may help patients with prediabetes symptoms or an increased risk of prediabetes to maintain proper blood glucose levels.

Lifestyle Modifications

Lifestyle modifications are effective prediabetes treatments that can significantly reduce individual risk of developing Type 2 diabetes. When implemented, they can mitigate many of the environmental factors that contribute to increasing insulin resistance.
“Prediabetes is typically managed through lifestyle modifications rather than medication,” Mandal said. “These changes can include a healthy diet, regular physical activity and maintaining a healthy weight.”

Dietary changes, including reduced sugar and refined carbohydrate intake, are crucial to reducing blood sugar levels and slowing insulin resistance. They may also help patients maintain a healthy weight, reducing the risk of developing diabetes.

“Pairing carbohydrate sources with proteins or fats can also help to slow digestion and slow the absorption of sugars into the bloodstream, thus helping to avoid spikes in blood sugar levels,” Weimann said.

Regular exercise is another important lifestyle behavior for preventing Type 2 diabetes. The American Heart Association recommends that adults exercise at least 150 minutes each week. Walking, cycling, swimming and other cardiovascular activities contribute to this threshold and improve blood sugar management.

“Even incorporating walking after dinner can help,” Weimann said. “Exercise helps the body move the sugars from the bloodstream into the cells for energy — so, movement after meals may be a great way to help prevent prediabetes onset.”

Managing stress also helps improve overall health and keeps blood glucose levels in check. Hormones released during high-stress events can increase blood sugar levels and may contribute to insulin resistance. Patients should speak to their health care providers about how to use stress management techniques as effective prediabetes treatments.

Editor Lindsay Donaldson contributed to this article.

Please seek the advice of a medical professional before making health care decisions.