Can You Reverse Prediabetes?

According to CDC estimates, more than one in three American adults has prediabetes – a health condition marked by blood sugar levels that are higher than average but not yet high enough to be diagnosed as diabetes.

Because prediabetes has no clear symptoms, approximately 80% of patients with the condition may not know they have it and are at higher risk of developing type 2 diabetes in the future.

The good news? You can take steps to reduce your risk of type 2 diabetes and possibly even reverse prediabetes.

Matthew J Lash, MD, family medicine physician with Franciscan Physician Network Greenwood Parke Family Medicine, explains how prediabetes is treated and how to reverse prediabetes.

Key Takeaways: Reversing Prediabetes

• Prediabetes is reversible. Prediabetes is a "warning zone" where blood sugar is high but not yet diabetic; lifestyle changes can return glucose levels to the normal range.
• Losing just 7% of your body weight (about 14 pounds for a 200 lb. person) can reduce the risk of progressing to Type 2 diabetes by nearly 60 percent. With the most reduction around 10% of body weight.
• Aim for 150 minutes of moderate activity per week. A simple habit like taking a 10-minute walk after meals is highly effective at blunting post-meal blood sugar spikes.
• Focus on reducing refined carbohydrates (white bread, pasta, sugar) and increasing fiber and protein to improve insulin sensitivity.

How Is Prediabetes Diagnosed?

Prediabetes is typically diagnosed through two simple blood tests, which can be tested at a primary care physician's office.

The first type of prediabetes screening, known as a fasting blood sugar test, measures the amount of glucose, or sugar, in the blood following an eight- to 12-hour period of fasting. Results of 99 mg/dL or lower are considered normal fasting blood sugar levels. Prediabetes levels fall between 100 and 125 mg/dL, while a result of 126 mg/dL or higher indicates diabetes.

A second prediabetes screening test measures A1C levels in the blood. An A1C test measures your average blood sugar level over the last two to three months. An A1C level below 5.7% is considered normal, whereas results between 5.7% to 6.4% are considered indicators of prediabetes. Meanwhile, A1C readings of 6.5% or above indicate diabetes.

Can Prediabetes Be Treated?

Prediabetes treatments include lifestyle changes and medicine. In fact, positive lifestyle changes - including adding exercise and eating a healthy diet - have been shown to lower the risk of developing Type 2 diabetes following a prediabetes diagnosis by 40-70 percent.

Can You Reverse Prediabetes?

"Only 5-10 percent of patients with prediabetes develop diabetes annually," said Dr. Lash. "So, with early treatment and moderate lifestyle changes, the vast majority of patients can return their blood sugar levels to a normal range and effectively delay or prevent a Type 2 diabetes diagnosis."

What Lifestyle Changes Can Help Reverse Prediabetes?

With early treatment and moderate lifestyle changes, some people with prediabetes can return their blood sugar levels to a normal range, effectively delaying or preventing developing type 2 diabetes. Patients with prediabetes can incorporate exercise and healthier eating habits as a means of lowering their blood sugar levels.  

The American Diabetes Association recommends getting at least 150 minutes of exercise a week - whether by walking or other physical activities - for effective prediabetes management. This could be just 30 minutes of brisk walking 5 times a week. However, an important start is a daily exercise that can be as little at walking 10 minutes or around the block 1 time day with small gradual increases after 1-2 month. “The time of that exercise can also help using a short 10–15-minute walks after you 2 largest (or highest carbs and sugar) meals can make a big difference.  Targeting lunch and dinner with short walks can be easier to start with, especially if your work allows you enough time for a lunch break.”

And, when it comes to diet, balance is key.

"We recommend getting a balanced meal with the right amount of carbs and proteins and a small amount of fat," Dr. Lash said.

He suggests dividing the dinner plate so that one half is filled with non-starchy vegetables, while ¼ is filled with a starch and the final ¼ is filled with lean protein.

Additionally, giving up cigarettes - since smoking has been linked to diabetes risk - can significantly reduce the risk of developing prediabetes.

These lifestyle changes goals are focused on weight reduction. While any amount of weight reduction can help lower risk of developing diabetes. Smaller amounts of weight loss can be helpful as they can stop the weight gain process. With small reductions in weight of even of 1% weight loss noted in the literature to have reductions in progression. The most profound is in the 7-10% range for those with overweight and obesity, with the literature citing a 54 % reduction in progressing to diabetes.

Lifestyle changes are the most effective! Individuals that make these changes in what they do everyday have the longest term and most durable reduction in risk of progressing to diabetes.

What Medications Are Used To Treat Prediabetes?

Certain medications - including metformin or a class of medications known as incretins - may be prescribed to help treat prediabetes. These medications have been used to effectively treat Type 2 diabetes.

Additionally, for those with higher BMIs the newer GLP-1 medicines have been shown to help with weight loss which can then help lower risks of progressing to Diabetes. Additionally other medicines may be used as well for weight loss, while not focused on prediabetes may help. A doctor can talk to you about options, and which are the best for you.

"For patients who have a high body mass index or are unable to get moving physically – or who live in a setting where they don't have control over their food intake – adding medication to lifestyle changes may be key to treating prediabetes effectively," Dr. Lash said.

How Long Does It Take To Reverse Prediabetes?

There is no single timeline for how to reverse prediabetes effectively. For some patients, a return to normal blood sugar levels may come over a few months, while for others, it may take years.

"We repeat the A1C test with our prediabetes patients every three or six months, so we can monitor their progress in getting those A1C levels down," Dr. Lash said.

When Should I Get Screened for Prediabetes?

If you have any of the risk factors for prediabetes – mainly if you are overweight, a current or former smoker or if you're over the age of 45 – you should ask your primary care physician about getting a prediabetes screening test and, if you have prediabetes, discussing how to reverse prediabetes with them.

With screening and appropriate intervention, it's possible to effectively reverse prediabetes and delay or prevent having type 2 diabetes in the future.