GoodRx Guide
Prediabetes: Your GoodRx Guide
Comprehensive information for you or a loved one — including treatment options and discounts on popular medications.
Definition
Prediabetes is a condition that describes abnormal blood sugar levels. It is diagnosed when someone’s blood sugar levels are higher than they should be, but do not qualify for a diagnosis of type 2 diabetes. It can be thought of as a precursor to diabetes. It is also known as “impaired glucose tolerance” and “impaired fasting glucose,” but these terms are less common.
So why does prediabetes matter? Because people with prediabetes are at high risk for developing type 2 diabetes. Prediabetes also raises your risk of heart disease and stroke. But when diagnosed and treated early, people with prediabetes can reverse the condition, and slow or even stop the development of type 2 diabetes.
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Causes
Prediabetes is caused by the same problems with insulin that can eventually lead to type 2 diabetes.
The body needs insulin to remove glucose from the blood so that the body can use it for energy. If there is not enough insulin, glucose remains in the blood and cannot be used by the rest of the body. Diabetes develops for two reasons:
There is not enough insulin naturally produced by the body.
The body is insulin-resistant, meaning it doesn’t use insulin properly.
Like type 2 diabetes, prediabetes can occur at any age, but it more often develops later in life. There is a genetic link, but other factors play a very important role:
Diet
Lack of exercise
Screening
Prediabetes doesn’t have symptoms, so diagnosis relies on screening blood tests.
You should be screened for prediabetes if you:
Are 45 years or older
Have a body mass index (BMI) of 25 or higher
Have high blood pressure
Exercise fewer than 3 times per week
Have a parent or sibling with type 2 diabetes
Are African American, Hispanic/Latino American, American Indian, Asian American, or Pacific Islander
For women specifically, there are additional reasons to be screened:
You have polycystic ovary syndrome.
You had diabetes during pregnancy.
You gave birth to a baby that weighed more than 9 lb.
This online test from the Centers for Disease Control and Prevention (CDC) will help you get a better idea of your prediabetes risk.
Diagnosis
There are several blood tests that are used to diagnose prediabetes. These are the same tests used to diagnose type 2 diabetes. The results (and degree to which they are abnormal) determine whether you have normal blood sugar regulation, prediabetes, or diabetes.
These tests are:
Fasting blood glucose: This tests your blood sugar level when you have been fasting for 8 hours. A normal result is less than 100 mg/dl. Prediabetes is diagnosed if the result is 100 mg/dl to 125 mg/dl.
Oral glucose tolerance test: This tests your blood sugar 2 hours after you are given a specific amount of sugar. A normal result is less than 140 mg/dl. Prediabetes is diagnosed if the value is 140 mg/dl to 199 mg/dl.
Hemoglobin A1C: This test gives a picture of your average blood sugar over the past 2 to 3 months. It can be taken at any time, and does not require fasting or a recent meal. A normal result is less than 5.7%. Prediabetes is diagnosed if the result is 5.7% to 6.4%.
Treatment
Treatment for prediabetes is all about lifestyle changes. People with prediabetes are encouraged to make changes to their diet and exercise routine, which can completely reverse the condition and prevent progression to type 2 diabetes. About one-third of people who make these changes successfully reverse their condition.
These lifestyle changes include:
A healthy diet: There is no specific diet plan recommended to people with prediabetes. Any diet that reduces the number of calories, carbohydrates, and fat is effective.
Physical activity: This is also flexible, and can be as simple as going for a walk every day. The ADA recommends aiming for 150 minutes of exercise per week.
Weight loss: Research has shown that you need to lose 7% of your body weight to have a meaningful impact on your blood glucose levels.
Treatment always starts with a steady diet and exercise routine. But if your blood glucose levels remain elevated after these changes, your provider may consider prescribing a medication called metformin. Metformin is a common oral medication prescribed to people with diabetes, but research has shown it can also help reverse prediabetes.
Common concerns
Most of the time, yes. There are some rare exceptions, like when people develop diabetes from other medical conditions or medication. But most people who develop type 2 diabetes likely had prediabetes first. This is why screening for prediabetes is so important. It catches the condition early, and can prevent progression to type 2 diabetes.
Yes. More children are developing type 2 diabetes now, which is linked to an unhealthy diet, not getting enough exercise, and being overweight. Girls are more likely than boys to develop prediabetes and type 2 diabetes. Screening for prediabetes in children can help prevent them from developing type 2 diabetes.
Children who are overweight should be screened for prediabetes if they have on of the following risk factors:
They have a family history of type 2 diabetes.
They are black, Asian, Hispanic/Latino, Native American, or Pacific Islander.
They had a low weight at birth.
They were born to a mother with diabetes, or a mother who had diabetes during pregnancy.
Screening should happen when the child turns 10 or passes puberty (whichever happens first). This is when most cases of type 2 diabetes in children are diagnosed.
Metabolic syndrome is a collection of signs that suggest your metabolism is abnormal. It is a syndrome that identifies people at risk for conditions like diabetes. An elevated blood sugar — in the prediabetes range — is part of this syndrome. If you are diagnosed with prediabetes, you will be screened for other signs of metabolic syndrome. This includes measuring your blood pressure, cholesterol levels, and waist size.
A healthy diet is an important part of treating, and reversing, prediabetes. There are many ways to adopt healthy eating habits that will help lower your blood sugar levels. Dietary changes can sometimes feel overwhelming, so starting with small changes and slowly changing your diet over time can sometimes be the best approach.
This can start with eliminating one or two foods that may be elevating your blood sugar. If you have been diagnosed with prediabetes, some foods to limit or avoid all together are:
Beverages with added sugar (soda, juice, flavored coffee drinks)
Foods with added sugars, particularly those with high-fructose corn syrup (these can hide anywhere, from cereal and breads to salad dressing and ketchup)
Foods with trans fat, which are added to a lot of processed foods (look for the ‘partially hydrogenated’ in the oils listed on the ingredient list)
Even some fruits can have high amounts of sugar and should be eaten in moderation (dried fruits, bananas, pears, cherries, and grapes are some examples)
Taking the time to read ingredient lists and nutrition labels to understand how much sugar is in common foods is a good place to start and can have a big impact on your blood sugar levels.
References
American Diabetes Association. (2019). Diabetes overview: Diagnosis.
American Diabetes Association. (2021). Weekly exercise targets.
Centers for Disease Control and Prevention. (2018). Prevalence of prediabetes.
Centers for Disease Control and Prevention. (2019). About diabetes.
Centers for Disease Control and Prevention. (2019). Could you have prediabetes? Take the test.
Centers for Disease Control and Prevention. (2019). Diabetes risk factors.
Centers for Disease Control and Prevention. (2021). About prediabetes & type 2 diabetes.
Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. New England Journal of Medicine.
Kowall B., et al. (2012). Impact of weight and weight change on normalization of prediabetes and on persistence of normal glucose tolerance in an older population: the KORA S4/F4 study. International Journal of Obesity.
Lyssenko, V., et al. (2008). Clinical risk factors, DNA variants, and the development of type 2 diabetes. New England Journal of Medicine.
National Heart, Lung, and Blood Institute. (2019). Calculate your body mass index.
Paprott R., et al. (2018). Determinants of change in glycemic status in individuals with prediabetes: results from a nationwide cohort study in Germany. Journal of Diabetes Research.
