What Is Prediabetes?
Prediabetes means your blood sugar is higher than normal but not high enough yet to be diagnosed as type 2 diabetes. It’s diagnosed with a simple blood test — A1C, fasting glucose, or an oral glucose tolerance test — and it usually causes no symptoms at all, which is why an estimated 115.2 million American adults have it, and 8 in 10 don’t know. The good news: prediabetes is reversible. Modest weight loss and regular activity can cut your risk of progressing to type 2 diabetes by more than half. Below: the real symptoms to watch for, who’s at risk, and exactly what prevention looks like.
How Prediabetes Is Diagnosed
Prediabetes isn’t something you can feel your way to a diagnosis on — it’s confirmed with a blood test ordered by a doctor. The American Diabetes Association’s criteria, as summarized by NIDDK, use one of three tests:
| Test | Normal | Prediabetes | Diabetes |
|---|---|---|---|
| A1C | Below 5.7% | 5.7%–6.4% | 6.5% or higher |
| Fasting Plasma Glucose | Below 100 mg/dL | 100–125 mg/dL | 126 mg/dL or higher |
| Oral Glucose Tolerance Test (2-hr) | Below 140 mg/dL | 140–199 mg/dL | 200 mg/dL or higher |
A single test can sometimes miss it — some people have a normal fasting glucose but an A1C in the prediabetes range, or vice versa — which is one reason regular checkups matter more than any single number.
How Common Is Prediabetes?
Prediabetes is far more common than most people realize. According to the CDC, 115.2 million American adults — more than 2 in 5 — have prediabetes, and roughly 8 in 10 of them don’t know it, largely because it rarely causes noticeable symptoms. Prevalence rises sharply with age: it affects about 36% of adults 18–44, nearly 49% of adults 45–64, and just over 52% of adults 65 and older.
Prediabetes Symptoms: What to Actually Watch For
Most people with prediabetes have no symptoms at all — that’s the central, most important fact about it. It’s typically found through routine bloodwork rather than because someone felt sick. That said, a few signs are worth knowing:
- Darkened patches of skin (acanthosis nigricans), often on the neck, armpits, or groin — a visible sign of insulin resistance.
- Increased thirst or more frequent urination — more typical of full diabetes, but can appear as blood sugar climbs.
- Fatigue that doesn’t have an obvious cause.
Because symptoms are unreliable, the CDC and ADA recommend testing based on risk factors and age rather than waiting for symptoms to appear.
Who’s at Risk for Prediabetes?
Certain factors raise the odds significantly:
- Being overweight or having obesity
- Age 45 or older
- A parent or sibling with type 2 diabetes
- Physical inactivity (less than 3 times a week)
- A history of gestational diabetes or giving birth to a baby over 9 lbs
- Polycystic ovary syndrome (PCOS)
- Being Black, Hispanic, American Indian, Asian American, or Pacific Islander — groups with higher prevalence rates
“Controlling weight is a key factor. For people with prediabetes, even a 5% weight loss can be a powerful preventive measure.”
— Dr. Trachtenbarg, in an interview with UnityPoint Health
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Why Prediabetes Matters
Left unaddressed, prediabetes raises the risk of eventually developing type 2 diabetes, and research summarized by NIDDK-affiliated researchers links it to roughly a 50% higher risk of cardiovascular disease as well. That’s the case for taking it seriously even though it isn’t a diabetes diagnosis itself — it’s a warning sign, and one you can act on.
How to Prevent Prediabetes From Becoming Type 2 Diabetes
This is the most encouraging part: prediabetes is one of the few pre-disease states with strong evidence behind exactly how to reverse its trajectory. The landmark Diabetes Prevention Program (DPP) trial found that a structured lifestyle change — 5–7% weight loss plus 150 minutes per week of moderate physical activity (about 30 minutes, 5 days a week) — cut the risk of progressing to type 2 diabetes by 58% in adults, and by 71% in adults 60 and older.
- Lose a modest amount of weight. For someone at 200 lbs, that’s just 10–14 lbs — not a dramatic transformation.
- Move for 150 minutes a week. Brisk walking counts; it doesn’t need to be intense.
- Consider a CDC-recognized lifestyle change program. The National Diabetes Prevention Program offers structured, often insurance-covered coaching based on the original DPP trial.
- Ask about metformin. NIDDK notes it’s an option some doctors consider for adults under 60 with prediabetes plus additional risk factors like a BMI of 30+ or an A1C above 6%.
- Get retested periodically. Doctors typically recheck blood sugar every 1–2 years once prediabetes is identified.
Frequently Asked Questions
Can prediabetes be reversed?
Yes, for many people. Weight loss and regular activity can bring blood sugar back into the normal range, though ongoing checkups are still worthwhile since risk doesn’t disappear entirely.
Does prediabetes always turn into type 2 diabetes?
No. It raises the risk substantially, but it’s not inevitable — lifestyle changes meaningfully lower the odds, as shown in large clinical trials like the DPP.
What foods should I avoid with prediabetes?
There’s no single forbidden food list — the general pattern that helps is reducing refined carbohydrates and sugary drinks, and building meals around vegetables, whole grains, and lean protein. A registered dietitian can tailor this to your situation.
Should I get tested for prediabetes if I have no symptoms?
Yes, if you have risk factors like age 45+, excess weight, or a family history — since most people with prediabetes have no symptoms, risk-based screening is how it’s usually caught.
Bottom Line
Prediabetes affects more than 2 in 5 American adults, and most don’t know they have it because it rarely causes symptoms. A simple blood test can catch it, and unlike many health conditions, there’s strong evidence for exactly what to do about it: modest weight loss and regular activity can cut your risk of progressing to type 2 diabetes by more than half. If you have risk factors, ask your doctor about getting tested.
Disclaimer: This article is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician before starting any new health routine.
