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• Overview
• Symptoms and Causes
• Diagnosis and Tests
• Management and Treatment
• Prevention
• Outlook / Prognosis
• Living With

Overview

What is prediabetes?

Prediabetes is a health condition in which you have higher blood sugar levels than normal but not high enough to be considered diabetes.

People with prediabetes have up to a 50% chance of developing diabetes over the next five to 10 years. But you can take steps to prevent Type 2 diabetes from developing.

Who’s at risk for prediabetes?

If you have risk factors for prediabetes, talk to your healthcare provider about getting your blood sugar checked regularly. These prediabetes checks are essential because prediabetes often has no symptoms. You can have it for years and not know it.

You may also be at higher risk of prediabetes due to:

• Age (being 45 or older).
• Parent or sibling with Type 2 diabetes.
• Ethnicity. Being African-American, Hispanic, Native American, Asian-American race or a Pacific Islander.
• Previous gestational diabetes.
• Polycystic ovary syndrome (PCOS).
• Certain medications, such as steroids, certain antipsychotics and some HIV medications.
• Hormonal conditions, including Cushing’s syndrome and acromegaly.
• Sleep disorders, such as sleep apnea.

Some risk factors for prediabetes can be modified, meaning you can change them. These include:

• Obesity or carrying extra weight.
• Exercising less than three times a week.
• High blood pressure or high cholesterol levels.
• Metabolic syndrome, a combination of high blood pressure, high cholesterol level and large waist measurement.
• Smoking.

What are complications of prediabetes?

Having prediabetes means you are more likely to develop Type 2 diabetes. But it also puts you at increased risk of:

• Heart disease.
• Stroke.

How common is prediabetes?

About 88 million American adults have prediabetes. It affects more than 1 in 3 adults under age 65 and half of people over 65. More than 84% of those with prediabetes don’t even know they have it since prediabetes often has no symptoms.

Symptoms and Causes

What causes prediabetes?

Your pancreas produces a hormone called insulin. Insulin allows blood sugar (glucose) into your cells so your body can use it as energy. In prediabetes, your cells don’t respond to insulin as they should.

In the prediabetes cycle:

1. Cells become insulin resistant. They have a sluggish or low response to insulin.
2. Your pancreas makes more insulin, trying to get the cells to respond.
3. For a while, the extra insulin makes up for the weak response. Blood sugar levels stay normal.
4. Eventually, your pancreas can’t keep up production. Extra glucose stays in your blood instead of entering your cells.
5. Your blood sugar keeps rising. At this point, a blood test may show prediabetes.
6. Without treatment, you can end up with Type 2 diabetes.

What causes insulin resistance?

Researchers don’t understand exactly what causes cells to become insulin resistant. But it’s possible that carrying excess weight and being physically inactive contribute:

• Belly fat can increase inflammation in the body, which may lead to insulin resistance.
• Exercise causes changes in your body that help keep blood sugar levels in balance. Lack of activity makes it difficult to maintain that balance.

What are the symptoms of prediabetes?

Many people have no symptoms of prediabetes, often for years. Prediabetes may be invisible until it develops into Type 2 diabetes.

Some people with prediabetes may experience:

• Darkened skin in the armpit or back and sides of the neck, called acanthosis nigricans.
• Skin tags, small skin growths.
• Eye changes that can lead to diabetes-related retinopathy.

Diagnosis and Tests

How is prediabetes diagnosed?

To test for prediabetes, your healthcare provider will use a blood test. You may have:

• Fasting plasma glucose test, which tests your blood after you have fasted for eight hours (had nothing to eat or drink except water).
• A1C test, which provides your average blood glucose level over the past two to three months.

You would be diagnosed with prediabetes if:

• Your fasting plasma glucose test is 100 to 125 mg/dL (normal is <100; diabetes is 126 or higher).
• Your A1c test is 5.7% to 6.4% mg/dL (normal is < 5.7%); diabetes is 6.5% or higher).

Is there a test for insulin resistance?

Healthcare providers usually don’t test for insulin resistance. The test that exists is complex and used mainly for research.

Management and Treatment

How is prediabetes treated?

The best way to treat diabetes is through healthy lifestyle changes. Eating a nutritious diet and getting regular exercise can help prevent or delay Type 2 diabetes.

Even small changes can significantly lower your risk for developing Type 2 diabetes. The Centers for Disease Control and Prevention recommends:

• Weight loss: Losing 5% to 7% of your body weight can have an impact. For example, a 200-pound person who loses 10 to 14 pounds could see a significant health improvement.
• Regular activity: Aim for 30 minutes a day, five days a week, for a total of 150 minutes a week. Try walking or another activity you enjoy.

Lowering your risk factors for prediabetes can often get your blood sugar levels back to healthy levels. You might:

• Work with a nutritionist or dietitian to plan a healthful diet you can stick with long-term.
• Find ways to reduce or manage stress.
• Quit smoking and limit alcohol.
• Diagnose and treat sleep disorders.
• Manage related disorders, such as high cholesterol and high blood pressure.
• Find support groups where you can meet other people going through the same challenges.

Are there medicines that can treat prediabetes?

Your healthcare provider may prescribe metformin, a diabetes medication. It may help delay diabetes in people with prediabetes.

Prevention

Can I prevent prediabetes?

If diabetes or other metabolic conditions run in your family, talk to your healthcare provider. They can recommend steps to try to prevent prediabetes from developing.

Outlook / Prognosis

What’s the outlook for people with prediabetes?

Prediabetes increases your risk of having diabetes, heart disease and stroke. But you can take steps to lower your risk.

Talk to your healthcare provider about how you can stay healthy, including:

• Getting regular blood sugar tests and other screening tests you may need.
• Working toward a healthy weight.
• Getting regular exercise.
• Taking medications you may need.

Is it possible to reverse prediabetes?

Reversing prediabetes is possible by making lifestyle changes. Many people can prevent or delay Type 2 diabetes by losing weight, increasing physical activity and following a healthy diet. There are many programs available to help people live healthy lives and reverse prediabetes symptoms. To find a plan that works for you, talk to your healthcare provider or find resources through the National Diabetes Prevention Program (see references).

Living With

How can I live with prediabetes?

To manage prediabetes:

• Follow a balanced meal plan.
• Increase your physical activity.
• Take your medicine if necessary, following your provider’s instructions.
• Monitor your blood sugar as your provider instructed.
• Attend your follow-up appointments.
• Monitor your blood pressure. Ideally, blood pressure should be less than 120/80.

Can prediabetes put my vision at risk?

Diabetes — and prediabetes — can increase your risk of vision loss. Prediabetes can cause retinopathy. This change to your eye’s structure can lead to vision loss. See your eye doctor if you notice blurry vision, which can be a sign of retinopathy or another condition.

Even if you have no prediabetes symptoms, get a dilated eye exam every year. And talk to your healthcare provider about getting tested for prediabetes if you are older than 45 and have excess weight.

What else should I ask my healthcare provider?

If you are at risk for diabetes or prediabetes, ask your healthcare provider:

• What is my blood sugar level?
• What steps can I take to lower my blood sugar level?
• How often should I get my blood sugar checked?
• What else can I do to prevent Type 2 diabetes?

A note from Cleveland Clinic

Prediabetes is a common condition. It means your blood sugar levels are high but not high enough to be considered diabetes. You may not have any prediabetes symptoms. It’s important to talk to your healthcare provider about getting regular blood tests, including an A1C test, especially if you’re high risk.

The good news is that you can reverse prediabetes. Losing weight and exercising, along with other lifestyle changes, can bring your blood sugar levels back to a healthy range. Talk to your healthcare provider about how you can prevent or delay Type 2 diabetes.

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Last reviewed by a Cleveland Clinic medical professional on 03/25/2021.

References

• American Diabetes Association. Prediabetes. (https://www.diabetes.org/diabetes-risk/prediabetes) Accessed 3/21/2021.
• American Heart Association. Understand Your Risks for Prediabetes. (https://www.heart.org/en/health-topics/diabetes/understand-your-risk-for-diabetes/understand-your-risks-for-prediabetes) Accessed 3/21/2021.
• Centers for Disease Control and Prevention. Prediabetes — Your Chance to Prevent Type 2 Diabetes. (https://www.cdc.gov/diabetes/basics/prediabetes.html) Accessed 3/18/2021.
• Centers for Disease Control and Prevention. High Blood Pressure Symptoms and Causes. (https://www.cdc.gov/bloodpressure/about.htm) Accessed 3/20/2021.
• Centers for Disease Control and Prevention. National Diabetes Prevention Program. (https://www.cdc.gov/diabetes/prevention/index.html) Accessed 3/18/2021.
• Centers for Disease Control and Prevention. The Surprising Truth About Prediabetes. (https://www.cdc.gov/diabetes/library/features/truth-about-prediabetes.html) Accessed 3/21/2021.
• Centers for Disease Control and Prevention. Type 2 Diabetes. (https://www.cdc.gov/diabetes/basics/type2.html) Accessed 3/21/2021.
• National Institute of Diabetes and Digestive and Kidney Diseases. Insulin Resistance and Prediabetes. (https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/prediabetes-insulin-resistance) Accessed 3/18/2021.

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