Prediabetes is the body’s last clear warning before type 2 diabetes. It’s also one of the most reversible conditions we treat — but only if it’s caught.
The typical scenario is a routine blood test that comes back with an A1C between 5.7% and 6.4%, or a fasting glucose between 6.1 and 6.9 mmol/L (or 100–125 mg/dL). The patient feels fine. They’ve never been told anything was wrong with their blood sugar. And yet, without intervention, somewhere between 15 and 30% of people with prediabetes will progress to full type 2 diabetes within five years.
What prediabetes actually is
In prediabetes, your cells have started to ignore insulin’s signal. Your pancreas compensates by producing more insulin, which keeps blood sugar in a range that looks “normal-ish” — borderline elevated, but not enough to qualify as diabetes.
The compensation works for a while. Eventually, the pancreas can’t keep up, insulin production starts to decline, and blood sugar climbs into the diabetes range.
Why it’s worth taking seriously
Prediabetes isn’t just “almost diabetes.” Even at this stage, the elevated blood sugar and insulin resistance start affecting blood vessels, the kidneys, and other tissues. People with prediabetes already have measurably higher cardiovascular risk than people with normal glucose.
Reversing prediabetes — getting your A1C back below 5.7% — substantially reduces the risk of progression to diabetes and lowers cardiovascular risk over time.
What works for reversal
The Diabetes Prevention Program — one of the largest prevention trials ever conducted — found that modest, sustained lifestyle change reduced progression to diabetes by 58%, more than the leading medication tested in the same study.
The “modest, sustained” part matters. The intervention wasn’t dramatic. It was:
- 5–7% reduction in body weight (about 12–17 pounds for a 200-pound adult)
- 150 minutes per week of moderate-intensity activity
- Reduction in saturated fat and processed carbohydrates
- Increase in fibre, vegetables, and protein
The patients who succeeded weren’t on extreme diets or training for marathons. They made changes they could maintain.
The most powerful thing we can offer a patient with prediabetes is the truth that they’re not broken — and that they have a meaningful window to change the trajectory.
— Dr. Umer Bhatty, Endocrinology
When medication enters the picture
For some patients, lifestyle change alone isn’t enough — especially those with strong family history, polycystic ovary syndrome, or higher A1Cs at baseline. Metformin, the most commonly used diabetes medication, has good evidence in prediabetes and is sometimes added.
This is a discussion to have with your clinician. There’s no single right answer — it depends on your A1C, your other risk factors, what you’ve already tried, and your preferences.
The window matters
Prediabetes is one of those conditions where the time to act is now, not when symptoms appear. Type 2 diabetes typically has no symptoms until it’s well-established. The lab number is the early warning, and it’s been quietly rising for years before it crosses the threshold.
If your last A1C was in the prediabetes range, book a follow-up. The conversation about what to do next is worth more than the prescription, and the changes are easier when started early.
