Prediabetes: Can You Reverse It? A Practical Guide
Prediabetes means your blood sugar is higher than normal but not yet high enough to be called diabetes. It is a warning stage, and a valuable one. Unlike diabetes, prediabetes is frequently reversible, and the actions that reverse it also protect your heart and general health.
How common is it
Estimates suggest that around one in three adults in the United States and a similar share in many countries have prediabetes, and most do not know it. Without action, a sizeable proportion, often cited as roughly 5 to 10 per cent a year, go on to develop type 2 diabetes.
How it is diagnosed
Prediabetes usually has no symptoms and is found through blood tests:
- HbA1c of 42 to 47 mmol/mol (6.0 to 6.4 per cent) in many guidelines, or 5.7 to 6.4 per cent in the United States
- Fasting glucose of 5.6 to 6.9 mmol/L (100 to 125 mg/dL)
- Two-hour oral glucose tolerance of 7.8 to 11.0 mmol/L (140 to 199 mg/dL)
Risk factors that should prompt testing include being overweight, particularly around the waist, a parent or sibling with diabetes, polycystic ovary syndrome, a past pregnancy with gestational diabetes, high blood pressure, abnormal cholesterol and South Asian, Black, Hispanic or Indigenous heritage.
Why it matters beyond diabetes
Even at the prediabetic stage, blood vessels begin to be affected. People with prediabetes have a higher risk of heart disease and stroke, and fatty liver disease is very common alongside it. This is why the aim is not just a better glucose number, but an overall healthier metabolism.
The proof that lifestyle works
The landmark Diabetes Prevention Program trial found that intensive lifestyle changes reduced the risk of developing diabetes by 58 per cent over about three years, outperforming metformin, which cut it by 31 per cent. The programme had two main goals: lose 5 to 7 per cent of body weight and do 150 minutes of physical activity a week. For a person weighing 90 kg, that means losing roughly 5 to 6 kg.
Keep reading
The rest of this guide is free. Watch a short ad to unlock it and support independent health writing.
Preparing your ad…
A practical plan
1. Move more, and often. Brisk walking for 30 minutes five days a week is enough. Strength training twice weekly builds muscle, which absorbs glucose. Breaking up long periods of sitting with a few minutes of walking every hour improves post-meal sugar.
2. Shift how you eat.
- Replace sugary drinks with water, tea or sparkling water.
- Swap white bread, white rice and refined cereals for whole grains.
- Fill half your plate with vegetables.
- Add protein and fibre to each meal to slow absorption.
- Reduce ultra-processed snacks and large portions.
- Eat dinner earlier and avoid late-night snacking where you can.
3. Lose a modest amount of weight. You do not need to reach an ideal weight. A loss of 5 to 10 per cent has a large effect on insulin sensitivity.
4. Sleep and stress. Short sleep and chronic stress raise cortisol and appetite hormones, worsening glucose control. Aim for seven to nine hours and treat snoring or suspected sleep apnoea.
5. Stop smoking and moderate alcohol. Both worsen insulin resistance and cardiovascular risk.
Medicines
Metformin can be considered, particularly for younger, more obese people, or those with a history of gestational diabetes or a rising HbA1c despite lifestyle changes. Some newer weight-loss medicines also reduce progression, but lifestyle remains the foundation.
Monitoring
Have your HbA1c or fasting glucose checked at least annually. Many structured prevention programmes provide group coaching, which improves results compared with going it alone. Ask your doctor or health service about referral.
Reversal is possible, not guaranteed
Returning blood sugar to the normal range is common with sustained effort, but the underlying tendency remains. If weight is regained, glucose often rises again. Think of it as ongoing maintenance, not a one-off project.
Key message
Prediabetes is a chance, not a diagnosis of failure. With a few sustainable changes you can lower your risk of diabetes by more than half and improve your heart health along the way.
This article is for general information and is not a substitute for professional medical advice. If you are worried about your health or have symptoms, speak to a doctor or other qualified health professional.