Prediabetes: what it means and how much of it can be reversed

Being told you have prediabetes can feel like being told you are halfway to a disease. It is better understood as an early warning, arriving at the point where you still have the most room to change the outcome.

What prediabetes means

Prediabetes describes blood sugar that runs above normal but below the level used to diagnose diabetes. Using the SEMDSA 2017 guideline that LifePrint follows, it shows up in one or both of these ways:

• An HbA1c of 6.0 to 6.4%.
• A fasting glucose of 6.1 to 6.9 mmol/L, called impaired fasting glucose.

A glucose tolerance test can also pick up a third form, where sugar stays too high two hours after a sugary drink. A doctor may suggest this test when other results are borderline or disagree.

LifePrint shows these results in a grey zone on your report. They are not an emergency, and they never raise the urgency above routine on their own. But they are worth acting on.

Why it matters

People with prediabetes have a much higher chance of developing type 2 diabetes over the following years than people with normal blood sugar. Not everyone progresses. Some stay at the same level, and some return to normal. Which way it goes depends a lot on what happens next.

Prediabetes is also linked with a higher risk of heart disease and stroke, even before diabetes develops. It often travels with raised blood pressure, high triglycerides, low HDL cholesterol and fatty liver. So it is a prompt to look at your whole metabolic health, not just your sugar.

How much can be reversed

The best evidence comes from large, long-running trials. The best known is the Diabetes Prevention Program in the United States. People with prediabetes who aimed to lose about 7% of their body weight and do around 150 minutes of brisk activity a week cut their risk of developing diabetes by more than half over three years, compared with usual care. Similar results came from studies in Finland and China, and the benefit lasted for years after the programmes ended.

In these studies, many participants did not just avoid diabetes but moved back into the normal range. Returning to normal blood sugar, even for a while, was linked with a lower long-term risk. The earlier the changes start, the better the chance of reversal.

What tends to help

• Modest, steady weight loss if you are carrying extra weight, especially around the waist. Losing 5 to 7% of your body weight is enough to make a measurable difference for many people.
• Regular activity, including walking, and some strength work to build muscle, which uses sugar.
• Fewer sugary drinks and refined starches, and more vegetables, legumes, whole grains and other fibre.
• Enough sleep, since short sleep worsens insulin resistance.
• Stopping smoking, which raises diabetes and heart risk.

In some people, a doctor may also discuss medication. That is a decision to make with a registered healthcare practitioner who knows your full history, not something to start on your own.

How to track progress

HbA1c reflects roughly the last three months, so testing about three to six months after you start making changes shows whether they are working. After that, a yearly check is usually enough if things are stable or improving. Comparing each result with your last one tells you more than any single number. A fall from 6.3% to 6.0% is real progress, even though both sit in the grey zone.

It helps to keep an eye on the other markers that travel with prediabetes too: triglycerides, HDL cholesterol, liver enzymes and, if tested, fasting insulin. These often improve at the same time as blood sugar.

When to see a doctor

If your results fall in the prediabetes range, book a routine visit with a registered healthcare practitioner to discuss your overall risk, your blood pressure and a plan. If either marker reaches the diabetes range, or if you have symptoms such as strong thirst, passing a lot of urine or unexplained weight loss, see a doctor soon. Your LifePrint report will tell you which applies. It is health information, not a diagnosis.