The numbers are staggering: 96 million American adults—more than 1 in 3—have prediabetes. More than 8 in 10 don't know they have it.
The good news? Prediabetes doesn't have to become type 2 diabetes. The 2025 ADA guidelines confirm what research has shown for years: with the right lifestyle changes, you can reduce your risk of developing type 2 diabetes by 58% (or 71% if you're over 60).
Here's everything you need to know about preventing diabetes based on the latest evidence.
What Is Prediabetes?
Prediabetes means your blood sugar levels are higher than normal but not high enough to be diagnosed as type 2 diabetes. It's your body's warning system—a chance to make changes before permanent damage occurs.
How Prediabetes Is Diagnosed
| Test | Prediabetes Range | Diabetes Range |
|---|---|---|
| A1C | 5.7% - 6.4% | ≥ 6.5% |
| Fasting Plasma Glucose | 100 - 125 mg/dL | ≥ 126 mg/dL |
| 2-hour OGTT | 140 - 199 mg/dL | ≥ 200 mg/dL |
Important: You don't need to have abnormal results on all three tests. Any one abnormal test is sufficient for diagnosis.
Who Should Be Screened?
The 2025 standards recommend screening for prediabetes in adults who:
- Are overweight or obese (BMI ≥ 25 kg/m², or ≥ 23 kg/m² for Asian Americans)
- Have a first-degree relative with diabetes
- Are physically inactive
- Have polycystic ovary syndrome (PCOS)
- Have a history of gestational diabetes
- Have hypertension (≥ 130/80 mmHg)
- Have HDL < 35 mg/dL or triglycerides > 250 mg/dL
- Have A1C ≥ 5.7%
- Have signs of insulin resistance
The Diabetes Prevention Program (DPP): The Gold Standard
In 2002, the landmark Diabetes Prevention Program trial proved that lifestyle intervention could prevent or delay type 2 diabetes better than medication. The results have held up for more than 20 years.
The Original DPP Results
| Intervention | Risk Reduction | 3-Year Diabetes Risk |
|---|---|---|
| Intensive lifestyle | 58% reduction | 14% |
| Metformin | 31% reduction | 22% |
| Placebo | — | 29% |
For participants aged 60+, lifestyle intervention reduced risk by 71%.
What Was the Lifestyle Intervention?
The DPP lifestyle program had specific goals:
- Achieve and maintain 7% weight loss
- Accumulate at least 150 minutes/week of moderate-intensity physical activity
- Reduce dietary fat to less than 25% of calories
- Follow a structured curriculum (16 sessions over 24 weeks, then monthly maintenance)
The key: participants didn't do it alone. They had:
- A lifestyle coach (trained in behavioral strategies)
- Group support meetings
- Regular follow-up and accountability
- Tools for self-monitoring (food logs, activity tracking)
The 2025 Recommendations: What Should Happen When You're Diagnosed with Prediabetes
According to the 2025 ADA standards:
1. Lifestyle Modification as First-Line
Referral to a CDC-recognized Diabetes Prevention Program is the recommended first step for all patients with prediabetes.
These programs:
- Follow the evidence-based DPP curriculum
- Are led by trained lifestyle coaches
- Provide year-long support
- Are often covered by insurance
2. Metformin Consideration
Consider metformin for prediabetes patients with:
- BMI ≥ 35 kg/m²
- Age < 60 years
- Women with prior gestational diabetes
- Rising A1C despite lifestyle changes
Note: Metformin is not FDA-approved for prediabetes, but is widely recommended based on evidence.
3. Annual Monitoring
Test for progression to diabetes at least annually:
- A1C test
- Fasting plasma glucose
- Consider OGTT if A1C and fasting glucose are discordant
4. Cardiovascular Risk Assessment
Prediabetes increases cardiovascular risk. Assess:
- Blood pressure
- Lipid profile
- Smoking status
- Family history of premature CVD
Nutrition Strategies for Diabetes Prevention
1. Weight Loss: The Most Powerful Intervention
The evidence is clear: weight loss is the single most effective strategy for preventing diabetes.
- 5% weight loss: Meaningful reduction in diabetes risk
- 7% weight loss: The DPP target—achieved 58% risk reduction
- 10-15% weight loss: Even greater protection, possible remission of prediabetes
2. Dietary Patterns That Work
The 2025 guidelines recommend several evidence-based eating patterns:
| Dietary Pattern | Key Features | Evidence |
|---|---|---|
| Mediterranean | Olive oil, nuts, fish, vegetables, whole grains | 30% risk reduction in PREDIMED trial |
| DASH diet | Low sodium, fruits, vegetables, low-fat dairy | Effective for blood pressure and insulin sensitivity |
| Plant-based | Emphasis on whole plant foods, minimal animal products | 34% lower risk in Adventist studies |
| Low-carbohydrate | < 130 g/day carbs, emphasis on quality | Effective for weight loss and A1C reduction |
The common thread: All these patterns share:
- Minimal ultra-processed foods
- Abundant vegetables and fruits
- Whole grains over refined
- Healthy fats (nuts, olive oil, avocado)
- Limited added sugars and refined grains
3. Specific Foods to Include
- Non-starchy vegetables: Broccoli, leafy greens, peppers, cauliflower (unlimited)
- Berries: Blueberries, strawberries, raspberries (lower sugar fruit)
- Legumes: Beans, lentils, chickpeas (fiber and protein)
- Nuts and seeds: Almonds, walnuts, chia seeds, flaxseeds
- Whole grains: Oats, quinoa, brown rice, whole grain bread
- Fatty fish: Salmon, sardines, mackerel (omega-3s)
- Greek yogurt: Probiotics + protein
4. Foods to Limit or Avoid
- Sugar-sweetened beverages: The single strongest dietary risk factor for diabetes
- Processed meats: Bacon, sausage, hot dogs
- Refined carbohydrates: White bread, white rice, sugary cereals
- Trans fats: Partially hydrogenated oils
- Ultra-processed foods: Packaged snacks, fast food
Physical Activity: Moving More Matters
The 2025 Physical Activity Recommendations for Prediabetes
| Type of Activity | Target | Examples |
|---|---|---|
| Aerobic | 150 min/week moderate OR 75 min/week vigorous | Brisk walking, swimming, cycling |
| Resistance training | 2-3 sessions/week | Weight machines, free weights, resistance bands |
| Reduce sitting | Break up prolonged sitting every 30 minutes | Stand, walk, stretch |
| Daily movement | 7,000-10,000 steps/day | Walking throughout the day |
Why Exercise Works for Diabetes Prevention
- Increases insulin sensitivity—muscles use glucose more efficiently for 24-72 hours after exercise
- Builds muscle mass—more muscle means more glucose disposal capacity
- Reduces visceral fat—the metabolically active fat around organs
- Improves mitochondrial function—better energy metabolism at the cellular level
Exercise Tips That Work
- Start small: If you're sedentary, even 10 minutes of walking helps
- Find what you enjoy: You're more likely to stick with it
- Schedule it: Treat exercise like a non-negotiable appointment
- Track your progress: Use a fitness tracker or app
- Build in variety: Mix cardio, strength, and flexibility work
Sleep, Stress, and Other Lifestyle Factors
Sleep Duration and Quality
Both short sleep (< 6 hours) and long sleep (> 9 hours) are associated with increased diabetes risk.
Strategies for better sleep:
- Aim for 7-8 hours nightly
- Maintain consistent sleep/wake times
- Create a dark, cool bedroom environment
- Avoid screens for 1 hour before bed
- Limit caffeine after 2 PM
- Avoid large meals close to bedtime
Stress Management
Chronic stress elevates cortisol, which increases blood sugar and promotes abdominal fat deposition.
Evidence-based stress reduction techniques:
- Mindfulness meditation (10-15 minutes daily)
- Progressive muscle relaxation
- Deep breathing exercises
- Regular physical activity
- Social connection and support
- Cognitive behavioral therapy for chronic stress
Smoking Cessation
Smokers have a 30-40% higher risk of developing type 2 diabetes compared to never-smokers. Quitting smoking:
- Reduces cardiovascular risk (which is already elevated in prediabetes)
- Improves insulin sensitivity over time
- May cause temporary weight gain—plan for this
Tracking Your Progress
What should you monitor if you have prediabetes?
At Home
- Weight: Weekly weigh-ins, same time of day
- Activity: Steps per day, exercise minutes
- Food intake: Consider a food diary for insight into patterns
- Sleep: Duration and quality
At the Doctor's Office (Annually or Semi-Annually)
- A1C: Monitor for improvement or progression
- Fasting glucose: Additional data point
- Lipid panel: Assess cardiovascular risk
- Blood pressure: Monitor for hypertension
- Liver enzymes: NAFLD often accompanies prediabetes
What Success Looks Like
| Improvement Target | What It Indicates |
|---|---|
| A1C decrease of 0.5%+ | Meaningful reduction in diabetes risk |
| Return to normal A1C (< 5.7%) | Prediabetes reversal possible |
| 5-7% weight loss | Significant risk reduction achieved |
| 150+ minutes activity weekly | Meeting minimum exercise goal |
| Normal fasting glucose (< 100 mg/dL) | Improved insulin sensitivity |
Can Prediabetes Be Reversed?
Yes. Research shows that with sustained lifestyle changes, many people can return their A1C to the normal range (< 5.7%).
Factors that increase likelihood of reversal:
- Shorter duration of prediabetes
- Higher starting A1C (more room for improvement)
- Greater weight loss achieved
- Consistent physical activity
- Ongoing support and accountability
Important: Even if A1C returns to normal, continue healthy habits. The underlying predisposition remains.
Key Takeaways
- Prediabetes is extremely common—96 million Americans have it, but most don't know
- Lifestyle change is the most effective treatment—58% risk reduction proven
- Weight loss of 7% is the target—but any loss helps
- The Diabetes Prevention Program works—find a CDC-recognized program near you
- Annual monitoring is essential—track A1C to catch progression early
- Reversal is possible—with sustained effort, prediabetes can return to normal
FAQ Section
How do I know if I have prediabetes?
Ask your doctor for an A1C test, which measures your average blood sugar over the past 3 months. An A1C of 5.7-6.4% indicates prediabetes. You can also be diagnosed with a fasting glucose test (100-125 mg/dL) or an oral glucose tolerance test (140-199 mg/dL).
Can prediabetes go away on its own?
No. Prediabetes rarely resolves without intervention. However, with lifestyle changes (especially weight loss and regular physical activity), prediabetes can revert to normal blood sugar levels. Without intervention, prediabetes typically progresses to type 2 diabetes within 3-10 years.
Is metformin recommended for prediabetes?
The 2025 ADA guidelines suggest considering metformin for prediabetes patients with:
- BMI ≥ 35 kg/m²
- Age < 60 years
- History of gestational diabetes
- Rising A1C despite lifestyle efforts
Lifestyle change remains first-line treatment, with metformin as an additional tool for high-risk individuals.
How much weight do I need to lose to prevent diabetes?
The Diabetes Prevention Program showed that 7% weight loss reduced diabetes risk by 58%. For a 200-pound person, that's 14 pounds. However, any weight loss is beneficial—research shows that even 3-5% weight loss improves insulin sensitivity and reduces risk.
What foods should I avoid if I have prediabetes?
The most important foods to limit or avoid:
- Sugar-sweetened beverages (soda, juice, sweet tea)
- Refined grains (white bread, white rice, sugary cereals)
- Processed meats (bacon, sausage, hot dogs)
- Ultra-processed foods (fast food, packaged snacks)
- Trans fats (partially hydrogenated oils)
Focus on whole foods: vegetables, fruits, legumes, nuts, whole grains, and lean proteins.
Start Your Prevention Journey Today
Knowledge is power, but tracking is transformation.
- Track your A1C trends over time
- Monitor your weight and activity
- Store lab results in one place
- Set and achieve prevention goals
Your future self will thank you for starting today.
Sources:
- American Diabetes Association. Standards of Care in Diabetes—2025. Diabetes Care 2025; 48(Suppl 1)
- Diabetes Prevention Program Research Group. N Engl J Med 2002; 346:393-403
- CDC National Diabetes Prevention Program
- ADA Prediabetes Resources