Prediabetes means blood sugar is above normal but below the type 2 diabetes range, usually an A1C of 5.7 to 6.4 percent. Lifestyle change is the proven first step, and GLP-1 trials show added benefit in people who also have obesity.
Prediabetes means your blood sugar is higher than normal but not yet high enough to be diagnosed as type 2 diabetes. It is usually identified by an A1C of 5.7 to 6.4 percent, a fasting glucose of 100 to 125 mg/dL, or a 2-hour glucose tolerance result of 140 to 199 mg/dL. The well-established first step is modest weight loss and regular activity. GLP-1 medications are not FDA-approved to treat prediabetes itself, but in people who also have obesity, trials show they can lower the chance of progressing to type 2 diabetes while they are being taken.
Insulin is the hormone that lets sugar from your blood move into cells for energy. The CDC explains that in prediabetes, cells stop responding normally to insulin, so the pancreas makes more to compensate. Over time the pancreas can fall behind, and blood sugar rises. This pattern is called insulin resistance.
Prediabetes is common and often invisible. The CDC reports that more than 2 in 5 American adults have it, and NIDDK estimated that about 97.6 million US adults had prediabetes in 2021. You can have it for years without clear symptoms, which is why testing matters.
The CDC lists risk factors that include having overweight, being 45 or older, having a parent or sibling with type 2 diabetes, being physically active fewer than 3 times a week, a history of gestational diabetes, and polycystic ovary syndrome. NIDDK adds a large waist size, smoking, sleep apnea and certain long-term medicines such as glucocorticoids.
NIDDK describes three tests used to identify prediabetes:
| Test | What it measures | Prediabetes range |
|---|---|---|
| A1C | Average blood sugar over the past 3 months | 5.7 to 6.4 percent |
| Fasting plasma glucose (FPG) | Blood sugar at the time of the test, after fasting | 100 to 125 mg/dL |
| Oral glucose tolerance test (OGTT) | Blood sugar 2 hours after a sugary drink | 140 to 199 mg/dL |
A few practical notes from NIDDK:
NIDDK also notes that people with prediabetes should be tested for type 2 diabetes every year, and that people without prediabetes who have risk factors may be retested every few years.
Prediabetes is not a diagnosis of diabetes, and NIDDK notes that not everyone with prediabetes goes on to develop type 2 diabetes. But the CDC describes it as a serious health condition that raises the risk of type 2 diabetes, heart disease and stroke. NIDDK adds that people with insulin resistance and prediabetes can also develop high blood pressure, metabolic syndrome and fatty liver disease.
The encouraging part is that prediabetes is one of the most studied "early warning" conditions in medicine, and the evidence for prevention is strong.
The Diabetes Prevention Program, published in the New England Journal of Medicine in 2002, randomly assigned 3,234 adults with elevated blood sugar to placebo, metformin or an intensive lifestyle program. The lifestyle goals were at least 7 percent weight loss and at least 150 minutes of physical activity per week.
Over an average of 2.8 years, new cases of diabetes occurred at these rates per 100 person-years:
That means the lifestyle program reduced the incidence of diabetes by 58 percent and metformin by 31 percent, compared with placebo. NIDDK reports that follow-up research found people can prevent or delay type 2 diabetes for at least 15 years with lifestyle changes or metformin.
The CDC translates the target into everyday terms: weight loss of about 5 to 7 percent of body weight, which is around 10 to 14 pounds for a 200-pound person, plus about 30 minutes of brisk walking 5 days a week. The CDC-led National Diabetes Prevention Program reports that participants can lower their risk of type 2 diabetes by 58 percent, or 71 percent for people over 60.
GLP-1 medications lower blood sugar and reduce appetite, so it is natural to ask whether they help with prediabetes. Two sets of trial data speak to this, both in people who also had overweight or obesity.
A 2022 analysis in Diabetes Care looked at participants with prediabetes across the STEP trials. In STEP 1, after 68 weeks, 84.1 percent of participants with prediabetes at the start had normal blood sugar on semaglutide, compared with 47.8 percent on placebo. Most of these analyses were post hoc, and the authors noted there was no off-treatment period, so the study could not show whether the improvement would last after stopping.
A 2025 report in the New England Journal of Medicine followed 1,032 participants with both obesity and prediabetes for 176 weeks. Average weight change was -12.3 to -19.7 percent with tirzepatide, depending on dose, versus -1.3 percent with placebo. Type 2 diabetes was diagnosed in 1.3 percent of participants on tirzepatide compared with 13.3 percent on placebo. After 17 weeks off treatment, those figures were 2.4 percent and 13.7 percent.
These are averages from controlled trials; individual results vary.
Yes, blood sugar can return to the normal range. In the STEP 1 analysis, nearly half of placebo participants receiving lifestyle counseling reached normal blood sugar, and more did with semaglutide. NIDDK notes that weight loss of 5 to 7 percent helped reduce the chance of developing diabetes in people at high risk.
There is no single best test for everyone. A1C shows your average blood sugar over the past 3 months but may miss prediabetes in people with certain health conditions, and the OGTT is less convenient and costs more. Your clinician will choose based on your situation.
Not necessarily. The Diabetes Prevention Program showed that a structured lifestyle program was more effective than metformin at preventing diabetes. Medication may be discussed when prediabetes occurs alongside obesity or other conditions, and that decision belongs with a licensed provider.
That is not well established. The tirzepatide study found that diabetes diagnoses rose somewhat during 17 weeks off treatment, and the semaglutide analysis could not assess what happens after stopping. Planning for long-term habits is wise either way.
If your A1C or fasting glucose falls in the prediabetes range, a licensed provider can confirm the result, look at your other risk factors and help you decide on next steps. Bring recent lab reports and a list of your medications. You can use our BMI calculator as one starting point and read about nutrition on a GLP-1 program. This article is educational and does not determine eligibility for any treatment.
Written by the NewDay Wellness editorial team from the sources above and checked against them before publication, and medically reviewed by Dr. Sean Arora and Dr. Shannon Arora of Arora Health & Aesthetics; see our editorial standards. This article is educational and does not diagnose conditions, establish eligibility for any medication, or replace care from a licensed provider. Compounded medications are not FDA-approved.
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