One in three American adults has prediabetes. Roughly 80% of them don't know it.
Prediabetes is a condition where blood sugar levels are higher than normal — but not yet high enough to be diagnosed as Type 2 diabetes. It's essentially a warning sign. And unlike Type 2 diabetes, it's reversible.
This article is for anyone who's been told their A1C or fasting blood sugar is "a little high" — or who wants to understand their risk before they get that call.
What the Numbers Mean
We diagnose prediabetes using two main tests:
HbA1c (Hemoglobin A1c): This reflects your average blood sugar over the past 2-3 months.
- Normal: Below 5.7%
- Prediabetes: 5.7% – 6.4%
- Diabetes: 6.5% and above
Fasting blood glucose:
- Normal: Below 100 mg/dL
- Prediabetes: 100-125 mg/dL (impaired fasting glucose)
- Diabetes: 126 mg/dL and above
What Causes Prediabetes
Prediabetes develops when your body becomes resistant to insulin — the hormone that allows glucose to enter your cells. Your pancreas compensates by producing more insulin, but eventually, it can't keep up. Blood sugar rises.
Risk factors include:
- Overweight or obesity, especially abdominal fat
- Physical inactivity
- Family history of Type 2 diabetes
- History of gestational diabetes
- Polycystic ovary syndrome (PCOS)
- Age 45+
- Sleep apnea
Race/ethnicity also affects risk — Asian Americans, African Americans, Hispanic Americans, and Native Americans have higher rates of prediabetes and Type 2 diabetes.
The Good News: It's Reversible
Here's what I emphasize to every patient with prediabetes: this is not a life sentence.
The landmark Diabetes Prevention Program (DPP) trial showed that lifestyle intervention — 7% weight loss and 150 minutes of moderate exercise per week — reduced progression to Type 2 diabetes by 58%. In adults over 60, the reduction was 71%.
That's better than metformin, which reduced progression by 31% in the same trial.
What Actually Works
Weight loss — even modest amounts. Losing 5-7% of your body weight significantly improves insulin sensitivity. For a 200-pound person, that's 10-14 pounds. You don't need to reach your "ideal" weight — a moderate, sustainable loss makes a meaningful difference.
Exercise — specifically, both aerobic and resistance training.
- Aim for 150 minutes of moderate aerobic activity per week (brisk walking counts)
- Add 2 sessions of resistance/strength training per week
- Even breaking up prolonged sitting with short walks improves glucose metabolism
Dietary changes — focus on these:
- Reduce refined carbohydrates and added sugars (white bread, white rice, soda, juice, pastries)
- Increase fiber (vegetables, legumes, whole grains, berries)
- Don't skip meals — irregular eating patterns worsen glucose control
- Prioritize protein at each meal to slow glucose absorption
Sleep. Poor sleep significantly worsens insulin resistance. If you're sleeping less than 7 hours or have symptoms of sleep apnea (snoring, excessive daytime sleepiness), address this.
What We Do at ParikhHealth
When I see a patient with prediabetes, we do three things:
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Understand the context. What's driving it? Diet, inactivity, weight, sleep, medications? The intervention matches the cause.
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Set a 3-month plan. Specific, measurable goals. Usually 1-2 dietary changes, a walking or exercise plan, and a follow-up lab at 3 months.
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Consider metformin. For some patients — especially those with A1C above 6.0%, obesity, or a history of gestational diabetes — metformin alongside lifestyle changes is appropriate. We discuss this individually.
If you haven't had your blood sugar checked recently, or if you have risk factors for prediabetes, let's check it at your next visit. Book online at parikhhealth.com or call 408-266-3100.