Prediabetes means your blood sugar is higher than normal but not yet high enough to be called type 2 diabetes. It is incredibly common, and most people who have it do not know it, because it usually causes no obvious symptoms.
The encouraging part is that prediabetes is a window of opportunity. Research shows that modest, realistic changes can lower your chances of developing type 2 diabetes, and in many cases bring blood sugar back to a normal range.
Key Takeaways
- More than 2 in 5 American adults have prediabetes, and about 8 in 10 of them do not know it.
- Prediabetes is diagnosed with an A1C of 5.7% to 6.4% or a fasting glucose of 100 to 125 mg/dL.
- Most people have no symptoms, so screening based on risk factors is essential.
- Losing 5% to 7% of body weight and getting 150 minutes of activity a week can cut type 2 risk by more than half.
- The CDC-recognized National Diabetes Prevention Program offers structured, proven support.
What Is Prediabetes?
In prediabetes, your body’s cells have started to resist insulin, the hormone that moves sugar from your blood into your cells. Your pancreas makes extra insulin to compensate, but blood sugar still creeps up.
According to the CDC, about 115 million US adults, more than 2 in 5, have prediabetes. Without changes, many will develop type 2 diabetes within several years. Prediabetes is also linked to a higher risk of heart disease and stroke.
Early Signs and Risk Factors
Most people with prediabetes feel completely fine. That is why it is often called a “silent” condition. Some people notice subtle clues, though they are not reliable on their own:
- Darkened, velvety patches of skin, often on the neck, armpits or groin (acanthosis nigricans)
- Small skin tags
- Feeling more tired than usual, especially after meals
- Increased thirst or urination, which may suggest blood sugar is already in the diabetes range
Because symptoms are unreliable, risk factors matter more. You may be at higher risk if you:
- Are 35 or older
- Have overweight or obesity
- Have a parent or sibling with type 2 diabetes
- Are physically active fewer than three times a week
- Had gestational diabetes or gave birth to a baby weighing more than 9 pounds
- Have polycystic ovary syndrome (PCOS), high blood pressure or abnormal cholesterol
The American Diabetes Association recommends that all adults be screened starting at age 35, and earlier for adults with overweight and additional risk factors. If you had gestational diabetes, you need regular screening for life.
Understanding Your Test Results
Prediabetes is diagnosed with the same blood tests used for diabetes. Your doctor may use one or more of these:
| Test | Normal | Prediabetes | Diabetes |
|---|---|---|---|
| A1C | Below 5.7% | 5.7% to 6.4% | 6.5% or higher |
| Fasting plasma glucose | Below 100 mg/dL | 100 to 125 mg/dL | 126 mg/dL or higher |
| 2-hour oral glucose tolerance test | Below 140 mg/dL | 140 to 199 mg/dL | 200 mg/dL or higher |
The A1C reflects your average blood sugar over roughly the past three months, so it gives a bigger picture than a single reading. Our guide to the A1C test explains what can affect that number. Results in the diabetes range are generally confirmed with a repeat test.
The Steps That Turn It Around
The strongest evidence comes from the landmark Diabetes Prevention Program study. Participants who lost a modest amount of weight and became more active reduced their risk of developing type 2 diabetes by 58%, and by 71% among those over 60, according to the NIDDK.
1. Aim for modest weight loss
You do not need to reach an “ideal” weight. Losing 5% to 7% of your body weight makes a real difference. For someone who weighs 200 pounds, that is about 10 to 14 pounds. Slow, steady progress is easier to maintain.
2. Move most days of the week
Aim for at least 150 minutes of moderate activity a week, such as brisk walking, about 30 minutes on five days. Active muscles use glucose and become more sensitive to insulin. Adding strength exercises two days a week helps too. Learn more in our guide to exercise and blood sugar.
3. Reshape your plate
Small changes add up. Fill half your plate with non-starchy vegetables, a quarter with lean protein and a quarter with whole grains or other quality carbohydrates. This simple approach, called the diabetes plate method, works well for prediabetes too.
- Swap sugary drinks for water, unsweetened tea or sparkling water
- Choose whole grains, beans and lentils over refined grains
- Keep portions of sweets and processed snacks small and occasional
4. Protect your sleep and manage stress
Short or poor-quality sleep and ongoing stress can both nudge blood sugar higher. Aim for seven or more hours of sleep, and talk to your doctor if you snore loudly or feel exhausted during the day, as sleep apnea is common and treatable.
5. Do not smoke
Smoking increases insulin resistance and the risk of type 2 diabetes. If you smoke, quitting is one of the best things you can do for your overall health.
Tip: Start with one change you can keep, such as a 10-minute walk after dinner. Short walks after meals can help lower post-meal blood sugar, and small wins build the confidence for bigger ones.
Joining a Diabetes Prevention Program
The CDC’s National Diabetes Prevention Program offers year-long lifestyle change programs led by trained coaches. They are available in person and online, and many are covered by insurance or, for eligible people, Medicare.
Programs focus on practical skills such as healthy eating, being more active, managing stress and staying motivated. Having a group and a coach can make change feel much less lonely.
Will You Need Medication?
Lifestyle changes are the first and most effective step for most people. In some cases, especially for people with higher risk, a doctor may also discuss metformin. This is a decision to make with your healthcare team, based on your health history and preferences.
Whatever your plan, follow-up testing matters. Many people with prediabetes are rechecked at least once a year. You can find more foundational guides in our Diabetes Basics section.
Frequently Asked Questions
Can prediabetes be reversed?
For many people, yes. Weight loss, physical activity and healthy eating can bring blood sugar back into the normal range. Even if it does not fully normalize, these steps can delay or prevent type 2 diabetes.
How often should I be retested?
Many experts recommend testing at least once a year if you have prediabetes, but your doctor will set the schedule that fits your situation.
Does prediabetes always become type 2 diabetes?
No. Not everyone with prediabetes develops type 2 diabetes, and the risk drops substantially with lifestyle changes. Taking action early gives you the best odds.
Can I eat fruit if I have prediabetes?
Yes. Whole fruit provides fiber, vitamins and natural sweetness. Choose whole fruit over juice and pay attention to portion sizes.
This article is for educational purposes only and is not a substitute for professional medical advice. Always talk with your doctor, diabetes educator or pharmacist before changing your treatment.
