How Prediabetes Is Treated

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Prediabetes occurs when blood sugar (glucose) levels are elevated but not high enough to be classified as diabetes. If prediabetes is not treated, it may progress into type 2 diabetes, a chronic condition associated with heart, nerve, eye, kidney, and blood vessel complications.

This article addresses the management of prediabetes, which predominantly involves diet, exercise, and weight loss. It also reviews how a prescription drug called metformin and various complementary therapies may be used to help treat prediabetes.

Couple enjoying a hike to treat prediabetes

kali9 / Getty Images

Lifestyle

To prevent or delay the onset of type 2 diabetes, the American Diabetes Association (ADA) recommends that individuals with prediabetes engage in healthy lifestyle habits, including losing excess weight, eating nutritious meals, and participating in regular physical activity.

Lose Excess Weight

Research suggests that if you are overweight or have obesity, losing weight can potentially prevent type 2 diabetes.

According to a study in the Journal of General Internal Medicine, individuals with prediabetes who lost 5% to 7% of their body weight lowered their risk for type 2 diabetes by 54% within three years. Those who lost 10% or more of their body weight had an 85% reduction in the risk of developing diabetes within three years.

The reason weight loss can reverse prediabetes is that excess weight is associated with low-grade inflammation throughout the body. This inflammation causes insulin resistance, which occurs when your cells become sluggish and stop responding to insulin (a hormone that helps your cells convert food into energy).

As a result of insulin resistance, blood sugar levels rise, potentially damaging vital organs like your kidneys, eyes, nerves, heart, and blood vessels.

Weight loss—ideally through structured intervention programs emphasizing exercise and calorie reduction—can help make your cells more sensitive to insulin.

Eat Nutritious Meals

There is no single best diet for people with prediabetes. Instead, the ADA recommends adopting a meal plan that includes lots of fiber, nonstarchy vegetables (e.g., broccoli or peppers), and whole grains.

The ADA advises limiting added sugars. They also suggest drinking water instead of sugar-sweetened drinks such as regular soda, energy drinks, sweet tea, and sweetened coffee drinks.

The following diets are considered acceptable for prediabetes:

  • Mediterranean diet: This meal plan emphasizes consuming fruits, vegetables, whole grains, olive oil, beans, nuts, and seeds. Low to moderate intake of wine, fish, chicken, and dairy products is allowed.
  • Dietary approaches to stop hypertension (DASH) diet: DASH consists of four to five servings of fruit, four to five servings of vegetables, and two to three servings of low-fat dairy per day. Less than 25% of daily caloric intake can come from fat.
  • Plant-based diets: These diets contain cereals, fruits, vegetables, legumes, and nuts. Depending on the diet, animal-based foods, including meat, dairy products, and eggs, are limited or avoided.

Use a Dietitian

A registered dietitian nutritionist (RDN) or certified diabetes educator (CDE) can help you devise an individualized meal plan based on factors like ideal daily calorie intake, metabolic and weight goals, and personal preference.

Participate in Regular Physical Activity

Regular exercise increases insulin sensitivity (your cells' ability to respond to insulin) in people with prediabetes. It also improves heart, lung, and immune system functioning.

To prevent or manage prediabetes, adults should participate in at least 150 minutes of moderate-intensity aerobic activity per week. This is equivalent to 30 minutes five days a week of brisk walking, water aerobics, or cycling.  

You should also perform muscle-strengthening activities involving major muscle groups (e.g., hips, back, abdomen, chest, shoulders, and arms) two or more days a week.

Talking with a healthcare provider before starting a new exercise program is essential. You may have specific limitations or require additional support if you have other health conditions or complications related to your prediabetes.

Suppose you have nerve damage related to prediabetes—possibly signaled by pain or abnormal sensations in your feet. You may require proper foot care to prevent sores and ulcers from forming.  

Likewise, suppose you have joint pain (perhaps related to your age or weight). In that case, you may need to perform extra stretching and progress more slowly with your activity of choice.

Other Lifestyle Habits

Additional healthy lifestyle habits that may help you or a loved one reverse prediabetes include:

  • Stopping smoking
  • Ensuring adequate sleep (at least seven hours of uninterrupted sleep per night)
  • Minimizing sedentary behaviors (e.g., TV watching or desk work)
  • Managing stress
  • Attending prediabetes educational and support programs to help you maintain healthy lifestyle changes

Prescriptions

Engaging in healthy lifestyle habits remains the crux of the treatment of prediabetes.

In some instances, though, healthcare providers may prescribe a drug called Glucophage (metformin) to help further lower the risk of progressing to type 2 diabetes.

What Is Metformin?

Metformin lowers blood sugar levels by reducing glucose production in the liver and decreasing glucose absorption in the gut. It's approved by the Food and Drug Administration (FDA) to treat type 2 diabetes but is used "off-label" (for a condition not yet approved by the FDA to treat) for prediabetes.

People who seem to benefit the most from metformin include those who have obesity, are less than 60 years of age, or have a history of gestational diabetes (diabetes that develops during pregnancy).

Medications to lower blood pressure and cholesterol may also be prescribed, considering hypertension (high blood pressure) and high cholesterol often coexist with prediabetes.

Complementary and Alternative Medicine (CAM)

Several complementary therapies, including dietary supplements, have been explored for their potential effectiveness in managing prediabetes.

For example, plant sterols and omega-3 fatty acids were found in one study to reduce inflammation, insulin resistance, and glucose metabolism in individuals with prediabetes.

In another study, investigators found that zinc supplementation lowered blood glucose and insulin resistance and reduced progression to diabetes.

Talk With a Healthcare Provider

While dietary supplements are readily available and usually are low cost, the scientific evidence regarding their benefit and safety is limited. Always talk with a healthcare provider before trying any new supplement.

Complementary and alternative practices may help ease stress—and stress has been linked to both prediabetes and type 2 diabetes. Such practices include:

  • Yoga: This practice originated in India and combines exercises called poses with breathing techniques to connect the body, mind, and spirit symbolically.
  • Massage: A certified massage therapist uses their hands to knead and manipulate soft tissues in the body.
  • Acupuncture: Acupuncture is a traditional Chinese healing practice in which very thin needles are placed into the skin, prompting the body to release natural chemicals.

Summary

Prediabetes is a precursor to type 2 diabetes and a host of complications affecting major organs, so treatment is paramount. Lifestyle behaviors, especially losing excess weight, eating a diet rich in fruits and vegetables, and staying physically active, remain at the forefront of treatment for prediabetes.

Metformin—a prescription drug that helps lower blood sugar levels—may also be prescribed for people at high risk.

A Word From Verywell

Prediabetes is a common condition affecting approximately 96 million American adults. Unfortunately, it often goes undiagnosed for years because of subtle or no symptoms.

If you are age 35 or older, ask a healthcare provider to screen you for prediabetes. Children should be screened if they are overweight or have obesity, have entered puberty or are at least 10 years old, and have at least one other risk factor for type 2 diabetes (e.g., a family history).

Frequently Asked Questions

  • Is prediabetes reversible?

    Prediabetes is reversible. This is most effectively achieved through lifestyle behaviors like losing excess weight, eating nutritiously, and exercising.

  • How can you prevent prediabetes from turning into diabetes?

    You can prevent, if not delay, the onset of diabetes by engaging in healthy lifestyle habits. These include eating a diet rich in fruits and vegetables, becoming more physically active, and losing weight if you are overweight or have obesity.

  • Does prediabetes need to be treated?

    If not treated, prediabetes can develop into type 2 diabetes and damage your kidneys, eyes, heart, blood vessels, and nerves. 

13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Sheng Z, Cao JY, Pang YC, et al. Effects of lifestyle modification and anti-diabetic medicine on prediabetes progress: a systematic review and meta-analysisFront Endocrinol (Lausanne). 2019;10:455. doi:10.3389/fendo.2019.00455

  2. Colberg SR, Sigal RJ, Yardley JE et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39(11):2065-2079. doi:10.2337/dc16-1728

  3. Maruthur NM, Ma Y, Delahanty LM, et al. Early response to preventive strategies in the Diabetes Prevention Program. J Gen Intern Med. 2013;28(12):1629-1636. doi:10.1007/s11606-013-2548-4

  4. Miao Z, Alvarez M, Ko A, et al. The causal effect of obesity on prediabetes and insulin resistance reveals the important role of adipose tissue in insulin resistance. PLoS Genet. 2020;16(9):e1009018. doi:10.1371/journal.pgen.1009018

  5. American Diabetes Association. Myths about diabetes.

  6. American Diabetes Association. Standards of medical care in diabetes-2017 abridged for primary care [rovidersClin Diabetes. 2017;35:5–26. doi:10.2337/cd16-0067

  7. Galaviz KI, Narayan KMV, Lobelo F, Weber MB. Lifestyle and the prevention of type 2 diabetes: a status report. Am J Lifestyle Med. 2015;12(1):4-20. doi:10.1177/1559827615619159

  8. Metformin for prediabetes. JAMA. 2017;317(11):1171. doi:10.1001/jama.2016.17844

  9. Wang JF, Zhang HM, Li YY et al. A combination of omega-3 and plant sterols regulate glucose and lipid metabolism in individuals with impaired glucose regulation: a randomized and controlled clinical trial. Lipids Health Dis. 2019;18(1):106. doi:10.1186/s12944-019-1048-x

  10. Ranasinghe P, Wathurapatha WS, Galappatthy P, et al. Zinc supplementation in prediabetes: A randomized double-blind placebo-controlled clinical trial. J Diabetes. 2018;10(5):386-397. doi:10.1111/1753-0407.12621

  11. Li J, Jarczok MN, Loerbroks A, Schöllgen I et al. Work stress is associated with diabetes and prediabetes: cross-sectional results from the MIPH Industrial Cohort Studies. Int J Behav Med. 2013;20(4):495-503. doi:10.1007/s12529-012-9255-0

  12. Centers for Disease Control and Prevention. About prediabetes & type 2 diabetes.

  13. American Diabetes Association. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes—2022Diabetes Care. 2022;45(Supplement 1):S17-S38. doi:10.2337/dc22-S002

By Colleen Doherty, MD
 Colleen Doherty, MD, is a board-certified internist living with multiple sclerosis.