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Prediabetes is a condition in which blood glucose (blood sugar) levels are higher than normal but not yet high enough to be diagnosed as type 2 diabetes. It is a warning sign that the body is struggling to keep blood sugar in a healthy range, and it signals an elevated risk of developing type 2 diabetes, heart disease, and stroke.
Prediabetes is extremely common. According to the Centers for Disease Control and Prevention (CDC), about 115.2 million American adults—more than 1 in 3—have prediabetes, and roughly 8 in 10 of them do not know it. The encouraging news is that prediabetes can often be reversed or delayed: research shows that modest weight loss and increased activity can cut the risk of progressing to type 2 diabetes roughly in half.
This article is for general education only and is not medical advice. Talk with a licensed clinician about your individual risk and testing.
Prediabetes develops mainly because of insulin resistance. Insulin is a hormone that helps glucose move from the bloodstream into your cells for energy. In insulin resistance, the muscle, fat, and liver cells stop responding well to insulin. The pancreas compensates by making more insulin, but over time it may not keep up, so glucose builds up in the blood.
The exact triggers are not fully understood, but excess body fat (especially around the abdomen) and physical inactivity are strongly linked to insulin resistance. Genetics also play a role.
You are more likely to have prediabetes if you:
Most people with prediabetes have no symptoms at all, which is why so many cases go undiagnosed. Prediabetes is sometimes called a "silent" condition.
When signs do appear, they may include increased thirst, more frequent urination, fatigue, or blurred vision. Some people develop acanthosis nigricans—patches of darkened, velvety skin on the neck, armpits, or groin—which can be a marker of insulin resistance. Because symptoms are unreliable, blood testing is the only way to know for sure.
Prediabetes is diagnosed with a simple blood test. Clinicians use any of three tests, and the diagnostic ranges are well established:
These tests do not always agree, so a clinician may repeat or combine tests to confirm the result.
Who should be screened? The U.S. Preventive Services Task Force recommends screening adults ages 35 to 70 who have overweight or obesity. People with additional risk factors—such as a family history of diabetes or prior gestational diabetes—may be tested earlier or more often.
The goal of managing prediabetes is to bring blood sugar back toward normal and lower the risk of type 2 diabetes. The strongest evidence supports lifestyle change, with medication reserved for higher-risk individuals. Decisions about your care should be made with a licensed clinician.
The landmark NIH-funded Diabetes Prevention Program (DPP) randomized trial found that an intensive lifestyle program reduced the roughly 3-year risk of developing type 2 diabetes by 58%, and by 71% in adults age 60 and older—more than the medication group achieved. The program centered on:
The CDC-recognized National Diabetes Prevention Program offers this structured, year-long curriculum with a trained coach, in person or online.
There is no drug FDA-approved specifically for prediabetes. Metformin, an FDA-approved type 2 diabetes medication, is sometimes used off-label for prevention; in the DPP it lowered risk by 31% (and was less effective in older adults and those with a lower body mass index). The American Diabetes Association suggests it may be considered for higher-risk people, such as adults aged 25-59 with a BMI of 35 or higher, higher fasting glucose or A1C, or a history of gestational diabetes. Treating related conditions—high blood pressure and abnormal cholesterol—also lowers cardiovascular risk. Any medication decision should be individualized with a clinician.
See a healthcare professional if you have risk factors for prediabetes, are 35 or older with overweight, or have a family history of type 2 diabetes—even if you feel fine. A simple blood test can identify prediabetes early, when lifestyle changes are most effective.
Seek prompt care if you develop classic high-blood-sugar symptoms such as excessive thirst, frequent urination, unexplained weight loss, blurred vision, or persistent fatigue, which may indicate progression to diabetes. If you have already been diagnosed with prediabetes, follow up regularly—often every 1 to 3 years, or as your clinician advises—so changes can be caught early.
There is no FDA-approved medication specifically labeled to "treat prediabetes." The most evidence-based intervention is a structured lifestyle change program: in the NIH-funded Diabetes Prevention Program (DPP) randomized trial, intensive lifestyle change (modest weight loss of 5-7% plus about 150 minutes of activity per week) cut the roughly 3-year risk of developing type 2 diabetes by 58% (71% in adults age 60 and older). The CDC-recognized National Diabetes Prevention Program delivers this curriculum nationwide. Metformin, an FDA-approved diabetes drug, is sometimes prescribed off-label for prevention in higher-risk people; in the DPP it reduced risk by 31%. The American Diabetes Association suggests metformin may be considered especially in adults at high risk, such as those aged 25-59 with a BMI of 35 or higher, higher fasting glucose or A1C, or a history of gestational diabetes. Any medication decision should be made with a licensed clinician. This information is educational and is not medical advice.
This page is for general information and is not medical advice. Always consult a qualified clinician about diagnosis and treatment. Individual results vary.