How is prediabetes treated?

Prediabetes treatment is all about turning a warning light into an opportunity. At this stage, blood glucose levels are higher than normal, but long-term damage can still be prevented — and in many people, glucose levels can return to the normal range.

This article explains how prediabetes is treated, from lifestyle changes and weight loss through to medications like metformin. You’ll see which steps you can start today and when to discuss medication with your doctor.

What Are the Goals of Treating Prediabetes?

The main aims of treatment are to:

• Prevent or delay type 2 diabetes
• Improve insulin sensitivity and reduce insulin resistance
• Lower the risk of heart disease, stroke, and other complications
• Improve energy, sleep, and overall wellbeing

Large trials such as the Diabetes Prevention Program have shown that structured lifestyle changes can reduce the risk of developing type 2 diabetes by around 50% or more. Similar findings are reported by organisations like the NIDDK and CDC.

Lifestyle Changes: The Foundation of Treatment

Regardless of whether you use medication, lifestyle is the cornerstone of treatment. Key elements include:

• Healthy eating – focusing on vegetables, wholegrains, lean protein, and healthy fats
• Regular physical activity – aiming for at least 150 minutes of moderate exercise per week
• Reducing sitting time – breaking up long periods of sitting with short movement breaks
• Gradual, sustainable changes – small steps that you can keep doing long term

For practical tips on what to eat, see: Prediabetes Diet: What Should I Eat?

Weight Loss and Insulin Resistance

Carrying extra weight around the middle is strongly linked to insulin resistance. Losing even 5–7% of your body weight can significantly improve insulin sensitivity and lower your risk of diabetes.

Helpful steps include:

• Reducing portion sizes
• Choosing water or unsweetened drinks instead of sugary beverages
• Adding more high-fibre foods to help you feel full for longer
• Tracking your weight and waist measurement every few weeks

You can estimate whether your weight is in a healthy range using the BMI Tool.

Physical Activity

Exercise helps muscles take up glucose without needing as much insulin. Start where you are:

• Begin with short walks and build up gradually
• Include activities you enjoy — dancing, swimming, cycling, gardening
• Add some strength or resistance exercises 2–3 times per week

For busy people, “exercise snacking” — small bouts of movement throughout the day — can be a powerful strategy. You might like: Exercise snacking: an easy way to lose weight

Medications in Prediabetes

Lifestyle changes are always first-line, but some people also benefit from medication, particularly if they:

• Are younger with very high risk
• Have a strong family history of type 2 diabetes
• Have rising blood sugars despite lifestyle changes
• Had gestational diabetes in a previous pregnancy

Metformin

Metformin is the most commonly used medicine in prediabetes. It works mainly by:

• Reducing the amount of glucose released by the liver
• Improving how sensitive your body is to insulin

Metformin is usually well tolerated but can cause stomach upset in some people. It should only be started after discussion with your doctor. You can learn more here: Starting on metformin – what you really need to know

Other Medications

In selected high-risk cases, other medications such as SGLT2 inhibitors or GLP-1 receptor agonists may eventually be considered, mainly in people who already have type 2 diabetes. For prediabetes, the evidence is still evolving, and lifestyle remains the primary approach.

Don’t Forget Sleep, Stress, and Smoking

Poor sleep, chronic stress, and smoking all worsen insulin resistance:

• Sleep – short or disrupted sleep increases hunger hormones and makes lifestyle change harder
• Stress – stress hormones raise blood glucose and can trigger comfort eating
• Smoking – increases insulin resistance and cardiovascular risk

You can read more about sleep and insulin resistance here: Sleep habits and insulin resistance

What Should You Do Next?

If you’ve been told you have prediabetes, try to see this as a “turning point” rather than a failure. You have a window of opportunity to protect your future health.

Helpful next articles:

• What are the symptoms of prediabetes?
• Preventing prediabetes from progressing
• How is prediabetes monitored?

Join the Prediabetes & Insulin Resistance Masterclass

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