What Is Prediabetes, and Can It Be Reversed?

You had a blood sugar test and the doctor said “prediabetes.” Some people are frightened by the word and some do not take it seriously. Neither helps. In this article we explain simply what this condition is and what reliable sources say about it.

What is prediabetes?

The CDC writes that prediabetes means blood sugar is higher than normal but not yet high enough to diagnose type 2 diabetes. Most people go through this stage before diabetes. It usually has no noticeable symptoms, and a person can have it for years without knowing. For this reason the CDC and the American Diabetes Association write that in the United States about eight out of every ten people who have prediabetes do not know it.

NIDDK gives these numbers:

• A1C: 5.7 to 6.4 percent is prediabetes. (Below 5.7 is normal, 6.5 or higher is diabetes.)
• Fasting blood sugar: 100 to 125 milligrams per deciliter (mg/dL). (Up to 99 is normal, 126 or higher is diabetes.)
• Glucose tolerance test, two hours after the sugar drink: 140 to 199. (Below 140 is normal, 200 or higher is diabetes.)

NIDDK writes that people who have prediabetes should be tested for diabetes again every year. Diagnosis is not possible with a home device.

Who is at higher risk?

The CDC and NIDDK write: a close family member with type 2, age over 45 (NIDDK advises routine testing from age 35 if you have risk factors), overweight or obesity, previous gestational diabetes and high blood pressure. The NHS says that in certain ethnic groups, such as South Asian, the risk rises from a younger age.

Can it be reversed?

Three sources describe the situation this way:

• CDC: Prediabetes can be reversed with lifestyle change: a small amount of weight loss, healthier food and more activity.
• American Diabetes Association: For some people, early treatment and moderate lifestyle changes bring blood sugar back into the normal range and can delay or prevent diabetes. The same source says prediabetes does not mean you will definitely get diabetes.
• NIDDK does not use the word “reversible.” It writes that the risk of type 2 diabetes can be lowered with weight loss, more activity and a low-calorie eating plan, and that type 2 diabetes can “be delayed or even prevented.”

So the honest summary is this: reversal or delay is possible, but the result differs for each person. We do not promise results.

What lowers the risk?

NIDDK lists these:

• A small amount of weight loss: 5 to 7 percent of starting weight may delay or prevent type 2 diabetes. For someone who weighs 200 pounds (about 90 kg), that is 10 to 14 pounds.
• Activity: at least 30 minutes, 5 days a week. If you have been inactive for a while, start slowly.
• Food: a low-calorie plan, smaller portions, lower-fat food, and water instead of sweet drinks.
• Medicine: ask the doctor whether metformin is right for you. NIDDK names it for delaying or preventing type 2 diabetes. Starting a medicine is the doctor’s decision.

The CDC writes that once the doctor confirms prediabetes, you can join the “National Diabetes Prevention Program.” In this program you work with a trained coach on nutrition, activity, stress management and staying motivated. The American Diabetes Association writes that such a program “can cut the risk of developing it in half.” Here we only say that such programs appear in the sources. Availability in Iran has to be asked about.

The NHS also writes that lifestyle change lowers the risk and that the UK has a prevention program.

When should I be tested again?

NIDDK says every year for someone who has prediabetes. If the result was normal, every three years. If you develop symptoms of diabetes, do not wait until next year: a lot of thirst, a lot of urination, tiredness, unexplained weight loss (NHS).

If the doctor says I have prediabetes

• Ask for the exact number and the date of the test and keep them.
• Ask what matters most for you: weight, food, activity, or checking blood pressure and blood lipids.
• Ask when the next test is.
• Instead of giving up everything, start one change and keep it.
• If you develop warning signs of diabetes, see the guide “When should I call right away?”

The page “Diabetes and Prediabetes” describes the symptoms and treatment of diabetes in more detail.