Prediabetes Is on the Rise—But It Can Be Reversed
Type 2 diabetes, a condition where the body struggles to use insulin effectively, is becoming more common in the U.S., with over 35 million people affected, many of whom are diagnosed in their youth, even during adolescence. But perhaps the most concerning trend is the rise of prediabetes, the precursor to type 2 diabetes. Prediabetes now impacts an alarming 98 million people—about one in three Americans.
Prediabetes is often seen as a warning sign that insulin levels are rising, signaling that the body is on the path to developing type 2 diabetes. However, it’s still possible to reverse this process and prevent or delay the onset of diabetes by making lifestyle changes such as losing weight, eating healthier, reducing stress, and increasing physical activity. Medications can also play a role.
Reversing prediabetes is critical because, if left unchecked, type 2 diabetes can lead to serious health complications. The condition typically begins with insulin resistance, where cells in the fat, liver, and muscles fail to respond properly to insulin. As the body tries to compensate by producing more insulin, it eventually becomes unable to keep up, causing blood sugar levels to rise. Over time, uncontrolled blood sugar can result in complications such as heart disease, kidney failure, stroke, blindness, and amputations.
What Is Prediabetes?
Prediabetes is often symptom-free, so many people may not realize they have it until more serious complications arise. It can cause long-term damage to blood vessels, nerves, and organs throughout the body. High blood sugar levels contribute to the damage, which can affect nearly every aspect of health.
What Happens When Prediabetes Becomes Type 2 Diabetes?
Unlike type 1 diabetes, in which the body produces little to no insulin, type 2 diabetes is characterized by insulin resistance. In this condition, the body’s cells don’t respond properly to insulin, which means glucose struggles to move from the bloodstream into the cells. As the pancreas works harder to produce more insulin, the body eventually can't keep up, leading to high blood sugar levels—a condition known as hyperglycemia.
Without proper management, hyperglycemia can lead to severe health problems, including heart attacks, stroke, kidney failure, blindness, and the need for amputations. Prediabetes is also dangerous because it often goes hand-in-hand with metabolic syndrome, a cluster of conditions including obesity, high blood pressure, and high cholesterol, which increase the risk of heart disease, stroke, and certain cancers.
In some individuals with prediabetes, damage to the heart, kidneys, and blood vessels may already be underway. Prediabetes has even been linked to "silent" heart attacks, where symptoms are so mild that people may not even realize they occurred.
Are There Symptoms of Prediabetes?
Prediabetes often doesn’t show obvious symptoms, which makes it hard to detect without screening. The symptoms typically associated with type 2 diabetes, such as frequent urination or increased thirst, may not appear until the condition progresses. This means that many people with prediabetes are unaware of their risk.
Key risk factors for prediabetes include:
Obesity: Being overweight significantly raises the risk of insulin resistance and prediabetes. Studies show that people with obesity are up to six times more likely to develop type 2 diabetes than those with a healthy weight.
Age: Being over 45 years old increases the risk.
Physical Inactivity: Exercising less than three times a week increases risk.
Family History: Having a parent or sibling with type 2 diabetes puts you at higher risk.
Gestational Diabetes: Women who have given birth to a baby weighing more than 9 pounds are more likely to develop prediabetes.
Polycystic Ovary Syndrome (PCOS): This hormonal disorder increases the risk of prediabetes.
While these factors raise the likelihood of developing prediabetes, they don’t guarantee it. For example, some people with obesity never develop diabetes, while others who are not overweight may still develop the condition.
Anyone unsure about their risk can take a simple online prediabetes test provided by the CDC.
How Is Prediabetes Diagnosed?
There are several blood tests that can detect prediabetes:
A1C Test: Measures average blood sugar over the past two to three months. A result between 5.7% and 6.4% indicates prediabetes.
Fasting Blood Sugar Test: Measures blood sugar after an overnight fast. A result between 100 and 125 mg/dL indicates prediabetes.
Oral Glucose Tolerance Test: Measures blood sugar before and after drinking a sugary liquid. A result between 140 and 199 mg/dL indicates prediabetes.
When Are People at Higher Risk for Prediabetes?
Certain life stages can increase the risk of developing prediabetes, including:
Puberty: Puberty brings metabolic and hormonal changes that decrease insulin sensitivity, especially in children with obesity.
Pregnancy: Gestational diabetes during pregnancy increases the risk of developing prediabetes or type 2 diabetes later in life.
Menopause: Changes in estrogen levels can lead to weight gain, especially around the abdomen, which is a risk factor for diabetes.
Aging: Older adults may experience joint pain or other physical challenges that reduce their ability to stay active, raising their risk for prediabetes.
Heart disease and the use of medications like steroids, which increase insulin resistance, can also contribute to the development of prediabetes.
Can Children Develop Prediabetes?
Yes, children can develop prediabetes, and its prevalence among adolescents is rising. Around 18% of teens have prediabetes, with those who are overweight or obese at the highest risk. Childhood obesity is a major predictor of future health problems, including type 2 diabetes, heart disease, and kidney disease.
Lifestyle changes are the most effective way to prevent or reverse prediabetes in children, as there are no medications specifically approved for this age group. Family support is key, with small changes like increasing physical activity or improving diet playing an important role in preventing diabetes in children.
How Much Weight Do You Need to Lose to Reverse Prediabetes?
Even a modest weight loss can significantly reduce the risk of developing type 2 diabetes. The CDC’s Diabetes Prevention Program (DPP) found that losing just 5 to 7% of body weight—about 10 to 14 pounds for a 200-pound person—can lower the risk of developing type 2 diabetes by 58%. The DPP offers a structured 16-week lifestyle intervention program followed by a maintenance phase, available through online or in-person support groups.
What If Lifestyle Changes Don’t Lead to Weight Loss?
For those who struggle with lifestyle changes, additional options like weight-loss surgery and medications are available. Medications like metformin, which is commonly used to treat type 2 diabetes, may also be prescribed off-label to help reverse prediabetes. New medications, such as semaglutide (Ozempic™ for diabetes and Wegovy™ for obesity) and tirzepatide (Mounjaro®), are also showing promise in helping people manage both weight and blood sugar levels.
How Can We Reduce the Number of People with Prediabetes?
A major challenge is identifying those with prediabetes, as many people aren’t routinely screened. In 2021, the U.S. Preventive Services Task Force recommended that adults with overweight or obesity be screened for prediabetes starting at age 35, but younger individuals, especially adolescents, are often missed. As studies show, a significant portion of young adults and teens already have prediabetes, making early detection crucial.
Is It Possible to Reverse Prediabetes?
Yes, reversing prediabetes is possible, especially if lifestyle changes are made early. Health experts emphasize the importance of checking blood sugar levels regularly and adopting healthier habits while still young, as glucose tolerance tends to worsen with age. Early intervention is key to avoiding the progression to type 2 diabetes and its associated health risks.
Take control of your health now by understanding your risk factors, making small lifestyle changes, and monitoring your blood sugar regularly. With early intervention, prediabetes can be reversed, reducing the risk of developing type 2 diabetes and improving long-term health outcomes.