Prediabetes
Prediabetes means blood sugar is higher than normal but not yet in the diabetic range, per ADA Standards of Care in Diabetes-2026 criteria. It affects an estimated 96 million American adults -- about 1 in 3 -- per the National Clinical Care Commission Report to Congress, and most don't know they have it.
Symptoms
Prediabetes is typically silent. Warning signs, when they appear, usually signal progression toward overt type 2 diabetes rather than prediabetes itself, which is part of why routine screening is the main way it's found.
Causes and risk
Excess weight, inactivity, family history, and prior gestational diabetes are the main risk factors, closely mirroring type 2 diabetes risk since the two exist on a continuum.
How it is evaluated
Screening follows the same ADA schedule as type 2 diabetes -- starting at 35, or earlier with overweight/obesity plus a risk factor -- with annual monitoring once prediabetes is identified, per ADA prevention guidance.
Treatment
The Diabetes Prevention Program trial found that structured lifestyle change (roughly 7% weight loss and 150 minutes of activity per week) reduces progression to type 2 diabetes by 58%, and metformin reduces it by 31%. The ADA recommends metformin specifically for people under 60 with a BMI of 35 or higher, fasting glucose of 110 or higher, an A1c of 6.0% or higher, or a history of gestational diabetes.
When to seek care
Prediabetes is not an emergency and does not require urgent care on its own. The relevant follow-up is annual monitoring to catch progression to type 2 diabetes early, when it is still most reversible.