The Warning Before Diabetes
Prediabetes is exactly what it sounds like: a warning stage where your blood sugar levels are higher than normal but not yet high enough to be classified as type 2 diabetes. It affects an estimated 96 million American adults, more than one in three, and according to the Centers for Disease Control and Prevention, more than 80 percent of those with prediabetes do not know they have it.
This is a critical window of opportunity. Prediabetes is reversible. With the right lifestyle changes, many patients can bring their blood sugar back to normal levels and significantly reduce their risk of ever developing type 2 diabetes.
At Zimmer Medical Group, we screen for prediabetes routinely and work with patients to create actionable plans for reversing it.
How Prediabetes Is Diagnosed
Prediabetes is diagnosed through one of three blood tests:
Fasting Blood Glucose
- Normal: Less than 100 mg/dL
- Prediabetes: 100 to 125 mg/dL
- Diabetes: 126 mg/dL or higher on two separate tests
Hemoglobin A1C
- Normal: Below 5.7%
- Prediabetes: 5.7% to 6.4%
- Diabetes: 6.5% or higher
Oral Glucose Tolerance Test (OGTT)
- Normal: Less than 140 mg/dL two hours after a glucose drink
- Prediabetes: 140 to 199 mg/dL
- Diabetes: 200 mg/dL or higher
Your routine blood work typically includes fasting glucose and may include A1C, making prediabetes detection straightforward during annual physicals.
Why Prediabetes Matters
Without intervention, approximately 15 to 30 percent of people with prediabetes will develop type 2 diabetes within five years. But the health risks begin before that threshold is crossed. Prediabetes itself is associated with:
- Increased risk of cardiovascular disease
- Early signs of kidney damage
- Nerve damage (neuropathy)
- Eye changes (retinopathy)
- Increased risk of certain cancers
- Higher rates of non-alcoholic fatty liver disease
The progression from prediabetes to diabetes is not inevitable. Landmark research has proven that lifestyle intervention is remarkably effective at preventing this transition.
The Diabetes Prevention Program: Proof That Reversal Works
The Diabetes Prevention Program (DPP), a landmark clinical trial funded by the National Institutes of Health, demonstrated that participants who achieved modest weight loss through diet and exercise reduced their risk of developing type 2 diabetes by 58 percent. In participants over age 60, the risk reduction was 71 percent.
The lifestyle intervention was more effective than medication (metformin), which reduced risk by 31 percent. Follow-up studies showed that the benefits of lifestyle change persisted for at least 15 years.
The intervention was not extreme. Participants aimed for:
- 7 percent body weight loss (about 14 pounds for a 200-pound person)
- 150 minutes of moderate physical activity per week
- A balanced, reduced-calorie diet
Steps to Reverse Prediabetes
1. Lose a Modest Amount of Weight
You do not need to reach your ideal body weight to reverse prediabetes. Losing just 5 to 7 percent of your current weight produces significant improvements in insulin sensitivity and blood sugar control. For most people, this translates to 10 to 20 pounds.
Focus on gradual, sustainable weight loss of 1 to 2 pounds per week rather than rapid or extreme approaches.
2. Move More
Physical activity directly improves your body's ability to use insulin. The minimum target is 150 minutes per week of moderate-intensity exercise, such as brisk walking, swimming, or cycling. This can be broken into sessions as short as 10 minutes throughout the day.
Resistance training (weight lifting, resistance bands, bodyweight exercises) is also valuable because muscle tissue is a major consumer of glucose, and building muscle mass improves long-term blood sugar regulation.
3. Improve Your Diet
Dietary changes do not need to be drastic to be effective:
- Reduce refined carbohydrates: White bread, white rice, sugary cereals, and pastries cause rapid blood sugar spikes.
- Increase fiber intake: Vegetables, legumes, whole grains, and fruits slow glucose absorption and improve satiety. Aim for 25 to 35 grams of fiber per day.
- Choose healthy fats: Olive oil, nuts, avocado, and fatty fish replace saturated fats and reduce inflammation.
- Limit added sugars: Sugar-sweetened beverages are one of the strongest dietary risk factors for diabetes progression.
- Consider the Mediterranean diet: It has the strongest evidence base for improving metabolic health.
4. Prioritize Sleep
Poor sleep and sleep disorders such as obstructive sleep apnea worsen insulin resistance. Adults should aim for seven to nine hours of quality sleep per night. If you snore loudly, wake frequently, or feel unrefreshed despite adequate sleep time, discuss sleep apnea screening with your doctor.
5. Manage Stress
Chronic stress elevates cortisol, which directly increases blood sugar and promotes abdominal fat storage. Regular exercise, mindfulness practices, social connection, and adequate leisure time all support better stress management and metabolic health.
6. Monitor Your Progress
Regular monitoring provides motivation and allows your healthcare team to adjust your plan:
- Check A1C every three to six months
- Monitor fasting glucose periodically
- Track your weight and physical activity
- Discuss any challenges or questions at follow-up visits
When Medication May Help
For some patients, lifestyle changes alone may not be sufficient, or medical conditions may limit their ability to exercise or modify their diet. In these cases, metformin may be recommended as an adjunct to lifestyle changes. Metformin improves insulin sensitivity and modestly reduces blood sugar levels with a well-established safety profile.
Your doctor will discuss whether medication is appropriate based on your individual risk factors, A1C level, and response to lifestyle modifications.
The Power of Early Action
Prediabetes is one of the most reversible conditions in medicine. The key is catching it early and taking action before it progresses. If you have not had your blood sugar checked recently, or if you have risk factors such as family history of diabetes, excess weight, physical inactivity, or a history of gestational diabetes, schedule a screening.
Concerned about your blood sugar? Contact Zimmer Medical Group to schedule a prediabetes screening and create a personalized prevention plan. The sooner you act, the better your chances of reversing it.
