Prediabetes means your blood sugar is higher than normal, but not yet high enough to be diagnosed as type 2 diabetes. It usually causes no symptoms, which is why most people who have it don't know. The good news is that prediabetes is often reversible, and the evidence for what works is strong.
According to the CDC, about 98 million American adults, more than one in three, have prediabetes, and most of them don't know they have it [1]. If you're a man over 40, carry extra weight around your middle, or have a family history of diabetes, it's worth checking.
What numbers define prediabetes?
Prediabetes is diagnosed with a blood test. The American Diabetes Association uses these ranges [2]:
- A1c (your average blood sugar over about three months): below 5.7% is normal, 5.7% to 6.4% is prediabetes, and 6.5% or higher is diabetes.
- Fasting glucose: below 100 mg/dL is normal, 100 to 125 mg/dL is prediabetes, and 126 mg/dL or higher is diabetes.
- Two-hour glucose tolerance test: below 140 mg/dL is normal, 140 to 199 mg/dL is prediabetes, and 200 mg/dL or higher is diabetes.
A diagnosis of diabetes usually needs two abnormal results. A single result in the prediabetes range is a reason to act, not to panic.
Why prediabetes matters
Prediabetes is not just a waiting room for diabetes. Higher blood sugar and the insulin resistance behind it are linked to heart disease, fatty liver, high blood pressure and, in men, lower testosterone and erectile dysfunction. Catching it early gives you the most room to change course.
What does insulin resistance have to do with it?
Insulin moves sugar from your blood into your cells. When your cells stop responding well to insulin, your pancreas makes more of it to keep blood sugar normal. For years, that extra insulin can hide the problem. Eventually blood sugar starts to rise, first into the prediabetes range, then into diabetes. That's why a doctor may check fasting insulin alongside glucose and A1c: it can show insulin resistance before blood sugar moves.
Can prediabetes be reversed?
Often, yes. The best evidence comes from the Diabetes Prevention Program, a large trial of 3,234 adults with raised blood sugar [3]. People were assigned to an intensive lifestyle program, a diabetes medication, or a placebo, and followed for an average of 2.8 years.
The lifestyle program aimed for modest weight loss and about 150 minutes a week of moderate activity, such as brisk walking. It reduced new cases of type 2 diabetes by 58% compared with placebo. The medication reduced new cases by 31% [3]. In other words, steady changes to weight and activity worked better than the pill.
What actually helps
Based on that evidence, the changes that matter most are:
- Losing a modest amount of weight. You don't need to reach an "ideal" weight to see a benefit.
- Moving most days. Brisk walking counts. Strength training helps your muscles use sugar.
- Cutting back on refined carbohydrates and sugary drinks, and building meals around protein, vegetables and fiber.
- Sleeping enough. Short sleep makes insulin resistance worse.
- Drinking less alcohol, which adds calories and affects liver metabolism.
For some men, a physician may also consider medication, especially when weight or blood sugar doesn't improve with lifestyle changes alone. Weekly medications in the GLP-1 family, for example, lower appetite and improve blood sugar. Treatment is prescribed only if your doctor determines it is medically appropriate.
How often should you be tested?
If you have risk factors, such as being over 35, having overweight, a family history of diabetes or high blood pressure, ask about an A1c or fasting glucose test. If you already have prediabetes, a repeat test at least once a year helps you and your doctor see whether your plan is working.
The bottom line
Prediabetes is common, silent and, for many people, reversible. The key is knowing your numbers and having a plan you can stick to.
At Ora, your doctor checks A1c, fasting glucose and insulin as part of your baseline labs, then builds a plan around your results and follows it with you. Learn more about our medically supervised weight loss or heart and metabolic care.
Sources
- Centers for Disease Control and Prevention. Diabetes: at a glance. cdc.gov
- American Diabetes Association Professional Practice Committee. Diagnosis and classification of diabetes: Standards of Care in Diabetes. Diabetes Care. 2025;48(Suppl 1).
- Diabetes Prevention Program Research Group (Knowler WC, et al.). Reduction in the incidence of type 2 diabetes with lifestyle intervention. N Engl J Med. 2002;346(6):393–403. doi.org/10.1056/NEJMoa012512
