Prediabetes is on the rise — are you at risk?

Prediabetes is like an early-warning system — one that (ironically) doesn’t come with flashing lights and blaring sirens. Without any obvious symptoms, many who have prediabetes don’t even know it. And yet, getting alerted that your blood sugar is higher than it should be can help you make certain lifestyle changes and delay the onset of diabetes. Learn more about prediabetes, who is most at risk, and what can be done next to get blood sugar back to where it should be.

Prediabetes is a condition in which your blood sugar is higher than normal, but not so high that it meets the criteria for diabetes. This elevated blood sugar, along with other metabolic changes, is likely to have an impact on your heart, blood vessels, and other organs in and of itself, but the main concern is that it means you’re on a path toward developing type 2 diabetes— which comes with a wide range of potentially serious complications, from nerve damage to vision and heart disease to kidney failure.

Scary? Yes. Inevitable? Not at all. Estimates vary, but as many as two-thirds of people with prediabetes never go on to have type 2 diabetes, and up to one third see their blood sugar actually reverse and go back to normal over time. That’s because prediabetes is treatable — and even reversible — with upgrades to your diet, activity level, and body composition. “A diagnosis of prediabetes is a chance for people to make the changes needed to help prevent diagnosis of diabetes,” says Dr. Jennifer Cheng, D.O., chief of endocrinology at Hackensack Meridian Jersey Shore University Medical Center.

In that sense, getting the warning call of prediabetes is a good thing. “The earlier the diagnosis is, the better the health outcomes, as this allows us to develop treatment strategies,” says Dr. Jorge Moreno, M.D., assistant professor of medicine at Yale School of Medicine.

The truth is that most people with prediabetes don’t notice any outward signs. “There are millions of people who have prediabetes and do not realize they have it,” says Cheng. “It’s typically found incidentally when they get lab work done.” The small portion who do experience symptoms might report:

• Fatigue or weakness

• Lightheadedness

• Taking longer to recover from illness

• Cuts and bruises healing more slowly

Symptoms like increased thirst or needing to urinate more often may signal that prediabetes has progressed into diabetes itself, and you should notify your doctor.

The main culprit behind prediabetes is something called insulin resistance. Whenever you eat, the carbohydrates in the food break down into sugar that enters your blood stream. Your pancreas then secretes a hormone called insulin that helps move the sugar (a.k.a. glucose) from your blood into the cells of your muscles and organs.

Insulin resistance means the cells don’t respond properly to insulin, and the sugar can’t get where it needs to go. Instead, it builds up in the blood, and blood sugar starts to climb. If you think this sounds a lot like type 2 diabetes, you’d be right. It’s the same mechanism, just at different levels of severity. “Prediabetes and diabetes are on a spectrum, and blood work can give doctors an indication of how well insulin is working, if an adequate amount is being secreted by the pancreas, and if the body is becoming resistant to insulin,” says Moreno. It’s not fully clear why insulin resistance develops in some people, but lifestyle factors like diet, exercise, and high body fat appear to play a role.

The single most important risk factor for prediabetes (and type 2 diabetes) is having excess body fat. This fatty tissue, especially around the waist, interferes with the ability of the hormone insulin to pull sugar from the blood into the body’s cells. “The more fat you have, the more resistant cells become to insulin,” says Cheng. If you have a body mass index (BMI) over 25 — which is considered overweight — or your waist measures over 35 inches for women or over 40 inches for men, you have a greater chance of developing prediabetes.

Additional risk factors for prediabetes include:

• Age (over 35)

• Having a parent or sibling with diabetes

• A history of gestational diabetes

• Having given birth to a baby over 9 pounds

• Being African American, Alaska Native, Asian American, Hispanic American, Native American, or Pacific Islander

• Sedentary lifestyle

• Smoking

• Some medical conditions including high blood pressure, polycystic ovary syndrome (PCOS), and obstructive sleep apnea

The American Diabetes Association recommends the average person get screened for prediabetes every three years starting at age 35 — even if you don’t have any risk factors for diabetes. If you do have some risk factors, your doctor may start testing you earlier. “People who have obesity or meet overweight criteria (BMI over 25) are at higher risk and should get lab work done if they have at least one additional risk factor for prediabetes,” says Moreno.

During a screening, your doctor will order one of the following tests:

• Fasting plasma glucose test: You’ll stop eating or drinking anything other than water for 8 to 12 hours (usually overnight) before your blood test. A result between 100 and 125 mg/dL qualifies as prediabetes.

• Hemoglobin A1C test: The A1C is a measure of your average blood sugar levels over the last two to three months; you can have your blood drawn at any time for this test and you don’t need to fast beforehand. A result between 5.7% and 6.4% indicates prediabetes.

• Oral glucose tolerance test: After fasting, a healthcare provider will draw your blood before and two hours after you drink a sweet drink containing 75 grams of glucose. Prediabetes is diagnosed if your result on the second blood test is between 140 and 199 mg/dL.

A fourth type of test, called a random plasma glucose test (which simply measures your non-fasting blood sugar at any point in time), is usually only done if you have symptoms of type 2 diabetes. A result between 140 and 199 mg/dL could point to prediabetes. The test should be repeated to confirm. And in fact, that’s true for any of the blood sugar tests, since results can vary slightly from day to day or even from test to test with the same blood sample.

If your test results show you have prediabetes, you should get tested once a year to check whether it has progressed to type 2 diabetes.

Along with other associated metabolic changes, prediabetes increases your chance of developing heart disease and stroke. But it’s what can happen if left untreated that is more serious. If your prediabetes progresses into type 2 diabetes, it raises the risk of additional health problems, including:

• Alzheimer’s disease

• Blindness

• Depression

• Gastroparesis, which can cause nausea, heartburn, and bloating

• Gum disease and cavities

• Hearing loss

• Kidney failure

• Liver disease

• Nerve damage that can lead to leg or foot amputation

The good news about prediabetes is that it is entirely reversible. Not only can you delay or avoid the onset of type 2 diabetes, but you can make moves to bring your blood sugar back to fully healthy levels. “The main treatments for prediabetes are lifestyle modifications — that means a healthier diet, increased physical activity, and losing weight to help prevent progression of the disease and get blood sugar back to normal,” says Cheng. “Those lifestyle changes can reduce the risk of developing diabetes by over 58 percent.”

Changing your everyday habits can be challenging, of course, but even incremental shifts go a long way. Here’s where to start:

If you’re overweight, dropping 7 percent of your body weight is enough to move the needle on prediabetes. But every little bit can help improve glycemic control: For every kilogram (2.2 pounds) that you lose, you lower your risk of ultimately getting type 2 diabetes by 16 percent, according to studies of the CDC’s intensive lifestyle-change plan called the National Diabetes Prevention Program. Want a plan to follow? The WeightWatchers Points Program, which is recognized by the CDC as a Diabetes Prevention Program, is proven to help with weight loss and can help lower glucose levels in those with prediabetes.

Eating patterns focused on choosing whole grains, vegetables, fruits, nuts, and legumes over refined grains and processed foods are linked with a lower risk of type 2 diabetes. There’s not just one “anti-diabetes diet” for everyone: Low-carb, vegetarian, plant-based, intermittent fasting, DASH (Dietary Approaches to Stop Hypertension), and Mediterranean-style eating habits have all proven beneficial. The WeightWatchers Points Program can take the guesswork out of what to eat, helping you prioritize foods that are high in fiber and low in added sugar.

Brisk walking (or an equivalent moderately intense activity) for at least 150 minutes a week is the goal for slowing the progression of prediabetes to diabetes. Strength training activities can make up half of your 150 minutes. Simply getting up and moving around if you’ve been sitting for a while helps too. “Increasing activity level is very important because as you build more muscle, more glucose is absorbed from the blood stream, which helps decrease your blood glucose levels,” says Moreno.

There’s a growing consensus that how much and how well you sleep is crucial when managing prediabetes. Aim for at least 7 hours a night — getting less than 6 hours of sleep per night ups the risk of progressing to type 2 diabetes by 50 percent. Keeping a night-owl schedule (even while logging enough hours overall) also boosts your risk.

The American Diabetes Association recommends people at high risk for type 2 diabetes consider taking metformin, a medication long used to help manage blood sugar in people who already have diabetes. For people with a BMI over 35 and those who’ve had gestational diabetes, it can be as effective as an intensive diet and exercise program in warding off diabetes, according to research. What about Ozempic and the other big diabetes-slash-weight loss medications of the moment? “GLP-1s are not currently approved for diabetes prevention, but studies have shown they are effective in reducing diabetes progression,” says Moreno. These medications help the pancreas make more insulin and keep the liver from producing too much sugar.

Prediabetes might sound scary, but it’s really a helpful heads-up that your blood sugar is trending high, and that it’s time to course-correct. Most people don’t notice symptoms, so routine screening is important, especially if you have risk factors like excess weight or a family history of diabetes. Luckily, making key shifts — including eating well, moving more, sleeping better, and losing even a modest amount of weight — can lower your blood sugar and dramatically cut your risk of your condition progressing to type 2 diabetes. Remember: Prediabetes is reversible, and you have the power to alter its trajectory.