Prediabetes: What Your Numbers Mean and What Actually Lowers Your Risk

If your last lab report said "prediabetes," you probably have more questions than answers. Is this a diagnosis? Is it serious? Do you need a pill? The short version: prediabetes means your blood sugar runs higher than it should, but not yet high enough to be called diabetes. It is common, it is often silent, and it is one of the most treatable stages in all of metabolic medicine.

We see this result every week. Here is what it means and what the evidence says about lowering your risk.

How prediabetes is diagnosed

Prediabetes is diagnosed with a simple blood test. The American Diabetes Association lists three ways to catch it: a hemoglobin A1c between 5.7% and 6.4%, a fasting blood glucose between 100 and 125 mg/dL, or a blood glucose of 140 to 199 mg/dL two hours after a glucose drink (ADA diagnosis criteria). Any one of these is enough.

A few honest caveats. A single result can bounce around from day to day, so we often repeat a test before drawing conclusions. A1c can also be thrown off by anemia and some inherited blood traits. If your numbers and your symptoms do not line up, we may add a second test. Most people with prediabetes feel completely fine, which is exactly why screening matters.

Why it is worth taking seriously

Prediabetes is a risk marker, not a sentence. Over time, a meaningful share of people with it go on to develop type 2 diabetes, and the longer blood sugar stays elevated, the more strain it puts on your blood vessels, nerves, and kidneys. The good news is that the same window that carries risk also carries opportunity. The National Institute of Diabetes and Digestive and Kidney Diseases notes that weight loss and regular physical activity can prevent or delay type 2 diabetes in people with prediabetes (NIDDK).

What lifestyle change can do

The strongest evidence comes from the Diabetes Prevention Program, a trial of 3,234 adults at high risk. A structured program aiming for at least 7% weight loss and 150 minutes of activity per week cut the incidence of diabetes by 58% compared with placebo (Knowler et al., NEJM 2002). A smaller Finnish trial found a similar 58% reduction with individual counseling on diet and activity (Tuomilehto et al., NEJM 2001).

Ten years on, the protection had faded somewhat but not vanished. Diabetes incidence over the full 10 years was still 34% lower in the original lifestyle group than in the placebo group, even though many people regained some weight (DPP Research Group, Lancet 2009).

In practice, this does not mean a punishing diet. It means a modest, sustainable loss, a pattern of eating you can keep, and movement you will actually do. A 7% loss is about 14 pounds for someone who weighs 200.

Where metformin fits

In the same trial, metformin lowered the risk of diabetes by 31%, which is real but smaller than the lifestyle effect (Knowler et al., NEJM 2002). Follow-up work found it was safe and well tolerated over the long term, though stomach side effects were more common than with placebo (DPP Research Group, Diabetes Care 2012).

We tend to consider metformin when someone is younger, has a higher body weight, has had gestational diabetes, or sees their numbers climbing despite real effort. It is inexpensive and has a long safety record. It is an addition to lifestyle change, not a substitute for it.

Newer medications for people with obesity

For adults who have both prediabetes and obesity, weight loss medication is now a legitimate option. In a three-year trial, Zepbound (tirzepatide), a GIP/GLP-1 medication, was given to 1,032 people with obesity and prediabetes. Weight dropped by roughly 12% to 20% depending on dose, versus 1.3% with placebo. About 1.3% of the tirzepatide groups were diagnosed with type 2 diabetes, compared with 13.3% on placebo (Jastreboff et al., NEJM 2025).

The tradeoffs matter. The trial was funded by the manufacturer. Nausea and other stomach side effects were common, mostly during dose increases. Diabetes rates rose again in some people after treatment stopped. And coverage varies by plan and by indication, so we look at your specific benefits before recommending anything. For many people, lifestyle change plus or minus metformin is the right place to start.

What a good plan looks like

A sensible prediabetes plan is short and specific:

• Confirm the diagnosis and rule out other causes of high A1c.
• Check cholesterol, blood pressure, liver enzymes, and kidney function, since these tend to travel together with blood sugar.
• Pick one or two changes you will keep, such as a daily walk after dinner and swapping sugary drinks for water.
• Decide together whether metformin or another medication belongs in the plan.
• Recheck labs on a schedule, usually about once a year.

All of this works well by video. We order labs near you, review results with you, and adjust as your numbers change.

Next step

If you have a prediabetes result, or you have not had your blood sugar checked in a while, we can help you make sense of it and build a plan you can keep. Learn more about endocrinology care at Stonewood and book a telehealth visit. Most major plans are accepted, including Medicare. Primary care should not be something you buy on top of the coverage you already pay for.