Prediabetes (Impaired Glucose Regulation)

What is Prediabetes (Impaired Glucose Regulation)?

Prediabetes means your blood sugar levels are higher than normal but not yet high enough to be diagnosed as type 2 diabetes. Your body is struggling to regulate glucose, the sugar your cells use for energy. When you eat, your pancreas releases insulin to help move glucose from your blood into your cells. With prediabetes, your cells become resistant to insulin or your pancreas does not make enough of it.

About 1 in 3 American adults has prediabetes, but more than 80% do not know it. The condition rarely causes obvious symptoms in its early stages. Left unchecked, prediabetes often progresses to type 2 diabetes within 5 to 10 years. The good news is that prediabetes is reversible. Lifestyle changes can bring your blood sugar back to healthy levels and prevent diabetes from developing.

Hemoglobin A1c, or HbA1c, is the primary blood test used to identify prediabetes. It measures your average blood sugar over the past 2 to 3 months. An HbA1c between 5.7% and 6.4% indicates prediabetes. This window gives you a clear opportunity to take action before diabetes sets in.

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Symptoms

Most people with prediabetes have no noticeable symptoms. Your body compensates for rising blood sugar for years before you feel anything different. Some people may notice subtle warning signs as their condition progresses.

Increased thirst or dry mouth
Frequent urination, especially at night
Fatigue or low energy levels
Blurred vision that comes and goes
Slow healing cuts or bruises
Tingling or numbness in hands or feet
Frequent infections or yeast infections
Dark patches of skin on the neck, armpits, or groin

Many people feel completely normal with prediabetes. This is why regular blood testing is so important. Catching elevated blood sugar early gives you the best chance to reverse the condition.

Causes and risk factors

Prediabetes develops when your cells become resistant to insulin, the hormone that regulates blood sugar. Insulin resistance builds up over time due to a combination of genetic factors and lifestyle habits. Excess body weight, especially around the midsection, is the strongest risk factor. Fat tissue releases inflammatory molecules that interfere with how insulin works. Physical inactivity makes the problem worse because your muscles need movement to use glucose efficiently.

Your diet plays a major role too. Eating too many refined carbohydrates and added sugars causes frequent blood sugar spikes. Over time, your pancreas has to work harder to produce enough insulin. Other risk factors include being over age 45, having a family history of diabetes, having polycystic ovary syndrome, a history of gestational diabetes, high blood pressure, low HDL cholesterol, or high triglycerides. Certain ethnic groups, including Black, Hispanic, Native American, Asian American, and Pacific Islander populations, face higher risk.

How it's diagnosed

Prediabetes is diagnosed through blood tests that measure your glucose regulation. The most reliable test is Hemoglobin A1c, which shows your average blood sugar over the past 2 to 3 months. An HbA1c result between 5.7% and 6.4% confirms prediabetes. This test does not require fasting, making it convenient and accurate. Rite Aid includes HbA1c testing in our flagship panel, available at Quest Diagnostics locations nationwide.

Other tests your doctor may use include fasting plasma glucose, which measures blood sugar after an overnight fast, or an oral glucose tolerance test. The HbA1c test is preferred because it reflects long-term glucose control rather than a single moment in time. If your HbA1c falls in the prediabetes range, your doctor will likely recommend retesting every year to monitor your progress.

Treatment options

The foundation of prediabetes treatment is lifestyle modification. Research shows that losing 5% to 7% of your body weight can significantly reduce your risk of developing diabetes.

Follow a diet rich in vegetables, lean proteins, healthy fats, and whole grains
Reduce intake of refined carbohydrates, added sugars, and processed foods
Aim for at least 150 minutes of moderate physical activity per week
Include both aerobic exercise and strength training in your routine
Get 7 to 9 hours of quality sleep each night
Manage stress through mindfulness, meditation, or other relaxation techniques
Quit smoking if you currently use tobacco
Limit alcohol consumption

Some people may benefit from medication such as metformin, especially if lifestyle changes alone are not enough. Your doctor may prescribe metformin if you have additional risk factors or if your blood sugar continues to rise. Regular monitoring with HbA1c tests every 3 to 6 months helps track your progress and adjust your plan as needed.

Frequently asked questions

Yes, prediabetes is often reversible with lifestyle changes. Losing 5% to 7% of your body weight through diet and exercise can bring your blood sugar back to normal levels. Studies show that people who make these changes reduce their risk of developing type 2 diabetes by up to 58%. The earlier you catch prediabetes, the better your chances of reversal.

Adults age 45 and older should get screened every 3 years if results are normal. If you have risk factors like excess weight, family history, or high blood pressure, testing should start earlier and happen more frequently. Once diagnosed with prediabetes, retest your HbA1c every year to monitor your progress. Some doctors recommend testing every 3 to 6 months if you are actively working to reverse the condition.

A normal HbA1c level is below 5.7%. An HbA1c between 5.7% and 6.4% indicates prediabetes. An HbA1c of 6.5% or higher on two separate tests means you have diabetes. The HbA1c test measures your average blood sugar over the past 2 to 3 months, giving a reliable picture of your glucose regulation.

No, prediabetes does not always lead to diabetes. Without lifestyle changes, about 25% of people with prediabetes develop type 2 diabetes within 3 to 5 years. However, losing weight, eating better, and exercising regularly can prevent or delay diabetes indefinitely. Many people bring their blood sugar back to normal and keep it there for years.

Limit refined carbohydrates like white bread, white rice, and pasta made from white flour. Cut back on sugary drinks, candy, baked goods, and processed snacks. Avoid foods high in saturated fats and trans fats. Instead, focus on vegetables, lean proteins, nuts, seeds, legumes, and whole grains that digest slowly and keep blood sugar stable.

Prediabetes itself can increase your risk of heart disease, stroke, and nerve damage. Even blood sugar levels in the prediabetes range put stress on your blood vessels and nerves. The longer you have prediabetes, the higher your risk of complications. Early treatment protects your heart, kidneys, eyes, and circulation.

Yes, although excess weight is the biggest risk factor, thin people can develop prediabetes too. Genetics, lack of physical activity, poor diet, and stress all contribute. Some people have a genetic tendency toward insulin resistance regardless of their weight. Everyone with risk factors should get tested, no matter their size.

Most people can manage prediabetes with lifestyle changes alone. Your doctor may prescribe metformin if you have very high blood sugar in the prediabetes range, a history of gestational diabetes, or are under age 60 with additional risk factors. Medication works best when combined with diet and exercise, not as a replacement for healthy habits.

Exercise makes your cells more sensitive to insulin, which helps lower blood sugar. Physical activity also helps you lose weight and reduces inflammation. Aim for at least 150 minutes per week of moderate activity like brisk walking, swimming, or cycling. Strength training builds muscle, and muscle tissue uses glucose more efficiently than fat.

Insulin resistance is the underlying problem that causes prediabetes. It means your cells do not respond well to insulin, so your pancreas makes more to compensate. Prediabetes is the clinical diagnosis based on blood test results showing elevated blood sugar. Not everyone with insulin resistance has prediabetes yet, but insulin resistance usually comes first.