You’ve likely heard of diabetes, a chronic condition that affects how the body regulates blood sugar. But are you familiar with prediabetes?
Prediabetes is a state of elevated blood sugar that falls below the threshold of Type 2 diabetes. It’s becoming increasingly common: More than 1 in 3 US adults has prediabetes, and most aren’t aware of it.
Elevated blood sugar can eventually lead to insulin resistance. Insulin’s job is to help glucose enter muscle and fat cells, where it’s used for energy or stored for later.
If insulin isn’t working effectively or there isn’t enough of it, blood sugar levels rise. Over time, this can damage blood vessels and arteries.
That’s why prediabetes significantly increases the risk for heart attacks and strokes.
Here are some strategies to stop prediabetes in its tracks, including how to use GLP-1 drugs like Ozempic effectively.
What are the symptoms of prediabetes?
The symptoms of diabetes can include frequent urination, excessive thirst or hunger, fatigue, blurred vision, slow-healing sores, numbness or tingling in the hands and feet and unexplained weight loss.
Prediabetes typically has no symptoms, which is why people don’t realize they have it unless they’re tested.
How is prediabetes diagnosed?
During your annual physical, you can ask your provider to include a hemoglobin A1C test in your blood work.
The A1C test reveals your average blood sugar over the past three months. Prediabetes is defined as an A1C between 5.7% and 6.4%. An A1C of 6.5% or higher indicates diabetes.
In most cases, it takes several years for someone to progress from prediabetes to diabetes, though the timeline varies by age.
Adults in their 70s and older are often more likely to remain in the prediabetes range or even return to normal blood sugar levels than to progress to Type 2 diabetes.
Why are the rates of prediabetes increasing?
The risk of developing prediabetes or diabetes is influenced by genetics and environment.
While we can’t change our genetics, we can change environmental factors — such as the foods we eat and our level of physical activity.
One of the biggest risk factors for prediabetes is weight gain. Over the past several decades, rates of obesity have risen dramatically in the US and worldwide. Excess weight drives insulin resistance, which can lead to prediabetes and Type 2 diabetes.
The fastest rise in prediabetes diagnoses has occurred in young adults and adolescents, which is particularly concerning. Earlier onset means longer exposure to diabetes and a higher lifetime risk of cardiovascular complications.
Can prediabetes be reversed with diet?
Yes — prediabetes can often be reversed or prevented from progressing to diabetes.
In fact, a large study found that people with prediabetes who participated in intensive lifestyle interventions — often with support from a dietitian — reduced their risk of developing diabetes by more than 60%.
One important step is limiting simple carbohydrates that rapidly spike blood sugar, such as juices, regular sodas and refined white foods like white bread, white rice and pasta.
Dietary patterns like the Mediterranean diet, which emphasizes plant-focused foods, have been shown to be beneficial. However, the best diet for prediabetes is one that is sustainable in the long term.
Rather than short-term or crash-dieting, lasting changes to eating habits are where we see the most meaningful health benefits.
How can exercise help prediabetes?
Cardiovascular exercise and strength training improve blood sugar control, heart health, muscle strength and mental well-being.
We generally recommend at least 150 minutes of moderate cardio per week (about 30 minutes a day, five days a week). And for strength training, two days per week, using resistance exercises.
You don’t need a gym membership or a personal trainer. Strength training can be done at home using resistance bands or household items like water bottles or canned goods.
How can GLP-1 medications help prediabetes?
Many people who see an obesity specialist have tried multiple diets, only to regain the weight. This isn’t a failure of willpower.
When we lose weight, our body doesn’t recognize that the weight loss was intentional — it responds by increasing hunger and cravings. This biological pushback makes long-term weight maintenance extremely challenging.
GLP-1 medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) can help make lifestyle changes more achievable by lowering the body’s weight “set point.”
These medications simulate a natural hormone that signals fullness, which reduces appetite and food intake, leading to weight loss. They also lower blood sugar, which improves insulin resistance by increasing insulin release after meals.
What should I know before starting a GLP-1 medication?
Before starting a GLP-1 medication, you should be evaluated by a medical provider. This typically includes assessing blood pressure, cholesterol, blood sugar and liver health.
Your provider will help determine the most appropriate treatment. Bariatric surgery remains the most effective tool in our toolbox for addressing obesity.
If a GLP-1 medication is recommended, it’s important to obtain it from a pharmaceutical manufacturer. Compounded formulations are not subject to the same quality oversight and may carry risks related to impurities or dosing variability.
GLP-1 medications have been used for over 20 years, and they represent just the tip of the iceberg in what’s being developed to treat diabetes and obesity.
At NYU Langone Health, we’re excited about these advances and are here to support you at every step of your journey.
Michael A. Weintraub, MD, is a clinical assistant professor in the Department of Medicine, the Holman Division of Endocrinology, Diabetes, and Metabolism at NYU Langone Health. An endocrinologist and obesity medicine specialist at NYU Langone Diabetes & Endocrine Associates, he specializes in managing patients with a wide range of endocrine conditions, including obesity and diabetes.
