What are the risk factors for prediabetes? Can I change any?

Subscribe for the latest articles and newsletter

Prediabetes (also called borderline diabetes) means your blood glucose levels are higher than normal, but not high enough to be called diabetes. Some people are surprised when they are told they have prediabetes, while others have known for a long time that they are at higher risk.

Understanding your personal risk factors is one of the most powerful steps you can take. It explains why prediabetes has developed for you and what changes will have the biggest impact going forward.

If you’re not sure what prediabetes actually is, you may want to read: What is prediabetes?

Non-Modifiable Risk Factors

Some risk factors are out of your control, but still important to know about:

• Age – the risk of prediabetes and type 2 diabetes increases with age, especially after 45.
• Family history – having a parent, brother, or sister with type 2 diabetes increases your risk.
• Ethnic background – some ethnic groups have a higher risk, including people of South Asian, Middle Eastern, African, Pacific Islander, and some Indigenous backgrounds.
• History of gestational diabetes – if you had diabetes during pregnancy, your later risk of prediabetes and type 2 diabetes is higher.

Even though you cannot change these factors, they help your doctor decide how often you should be tested and how proactive your prevention plan needs to be.

Weight, Waist and Body Shape

Carrying extra weight, particularly around the waist, is one of the strongest risk factors for prediabetes because it is closely linked to insulin resistance. This is especially true for:

• Central obesity – a larger waist measurement, even if your overall weight is not very high.
• Rapid weight gain – over a period of months or years.
• YO-YO dieting – repeated cycles of loss and regain can make weight harder to manage and worsen insulin resistance.

You can estimate whether your weight is in a healthy range using the BMI Tool, and learn more about central weight and metabolism here: Our sneaky metabolism at work – what is adaptive thermogenesis?

Lifestyle Factors: Food, Activity and Sleep

Everyday habits have a major impact on your risk of prediabetes and progression to type 2 diabetes.

Dietary Patterns

Higher risk is associated with:

• Frequent intake of sugary drinks and large portions of refined carbohydrates
• Regular fast food and take-away meals
• Large portion sizes and frequent snacking

You don’t need a “special” prediabetes diet, but you may need to gently shift your pattern towards whole foods, more vegetables, and fewer highly processed foods. See: Prediabetes diet: what should I eat?

Physical Activity and Sitting Time

Being inactive is an important risk factor, even if your weight is close to normal. Examples include:

• Sitting at a desk or in front of a screen for most of the day
• Little or no planned exercise
• Driving instead of walking short distances

On the other hand, regular physical activity improves insulin sensitivity and can reduce the risk of progression from prediabetes to diabetes.

Sleep and Shift Work

Poor sleep quality, short sleep, and frequent shift work all increase the risk of insulin resistance and prediabetes. Both “too little” and “too much” sleep have been linked with a higher risk of type 2 diabetes.

You can read more here: Too much or too little sleep and insulin resistance

Medical Conditions and Medications

Certain medical conditions and medicines can increase your risk of prediabetes and progression to type 2 diabetes, including:

• High blood pressure (hypertension)
• Abnormal cholesterol and triglycerides (part of metabolic syndrome)
• Polycystic ovary syndrome (PCOS)
• Non-alcoholic fatty liver disease
• Sleep apnoea

Some medications can also raise blood glucose, particularly higher-dose steroids used for conditions such as asthma, autoimmune disease, or after certain surgeries. If you are on long-term steroid treatment, your doctor may recommend more frequent glucose checks.

Pregnancy-Related Risk Factors

Pregnancy can unmask an underlying tendency to insulin resistance. Your risk of future prediabetes and diabetes is higher if you:

• Had gestational diabetes in a previous pregnancy
• Delivered a very large baby
• Had pregnancy complications related to high blood pressure or abnormal sugars

If any of these apply to you, it’s especially important to have regular follow-up testing after pregnancy. You can read more here: Gestational diabetes risk factors and Key steps to reduce the risk of having gestational diabetes again

How to Check Your Overall Risk

No single factor tells the whole story. Instead, your overall risk comes from a combination of age, weight, waist, family history, blood pressure, cholesterol, and lifestyle.

You can get a quick overview using the Diabetes Risk Calculator. This tool helps you:

• See how your current risk factors add up
• Identify which changes (for example, weight reduction or increased activity) would have the biggest impact

What Should You Do Next?

If you recognise several risk factors in yourself, the next step is not to panic — it’s to act. You can:

• Discuss your risk profile with your doctor and agree on how often to test for prediabetes and diabetes
• Start with one or two realistic lifestyle changes (for example, extra walking or reducing sugary drinks)
• Ask whether other conditions such as blood pressure or cholesterol also need attention

Helpful follow-on articles include:

• Preventing prediabetes and borderline diabetes
• Prediabetes diet: what should I eat?
• How is prediabetes monitored?

Turn Risk Awareness into an Action Plan

If you’d like a guided walkthrough of your risk factors — and a clear explanation of what to do about them — you can join the free, doctor-led online session:

Join the Prediabetes & Insulin Resistance Masterclass →

To receive step-by-step prevention and risk-reduction tips by email: Click here to receive prediabetes risk-reduction emails.