Wait... Prediabetes Is Reversible?

Good morning!

About 2 in 5 American adults have prediabetes. Around 90% of people who have it don’t know they do because there are no clear symptoms, no dramatic warning signs, just a blood sugar number sitting in a range that most people never think to check until a doctor mentions it in passing.

The good news? Unlike diabetes, prediabetes isn't a diagnosis you're expected to simply live with. This week, we're breaking down what prediabetes actually is, why it's more reversible than most people assume, and what the evidence says actually moves the needle.

Key Takeaways

• Prediabetes often causes no symptoms, making routine blood work the only way to detect it early.

• Lifestyle changes remain the most effective treatment for preventing and reversing prediabetes.

• Fiber-rich foods, regular exercise, and modest weight loss have the strongest evidence for improving blood sugar control.

CORE

What Is Prediabetes?

Prediabetes is exactly what it sounds like: your blood sugar is higher than normal, but not yet high enough to be considered type 2 diabetes. Think of it as your body's early warning system. Nothing has gone seriously wrong yet, but it's a sign that your body is starting to have trouble keeping blood sugar under control.

Doctors can detect prediabetes with a simple blood test, most commonly an A1c test, which measures your average blood sugar over the past two to three months. An A1c between 5.7% and 6.4% is considered prediabetes. Below that is normal, and above it is type 2 diabetes.

The challenge is that prediabetes is almost completely silent. Unlike many health conditions, it doesn't usually cause pain, fatigue, or any obvious warning signs, which is why the American Diabetes Association recommends regular screening beginning at age 35, or earlier for people with additional risk factors like excess weight, a family history of diabetes, or low physical activity.

If left alone, prediabetes often progresses. Research suggests that 5-10% of people with prediabetes develop type 2 diabetes each year, and over time, the risk continues to climb. Where you start also matters. Someone whose A1c is closer to 6.4% is significantly more likely to progress than someone whose A1c is 5.7%. The earlier prediabetes is identified, the more opportunity there is to change its course.

It's Not A One-way Door

Here's the finding that tends to get buried under the statistics on progression: prediabetes reversal is genuinely common, and more common than most people with a prediabetes diagnosis are told.

A large 2025 analysis, combining data from 19 long-term studies, found that people with prediabetes were actually more likely to return to normal blood sugar than they were to develop type 2 diabetes. The researchers also found that the biggest drivers of those outcomes were lifestyle factors, things people can actually change.

Another study following nearly 28,000 adults with prediabetes reached a similar conclusion. After five years, 36% had returned to normal blood sugar, 41% remained in the prediabetic range, and only 23% progressed to type 2 diabetes.

In fact, the American College of Lifestyle Medicine's first clinical practice guideline on prediabetes concluded that while certain medications can help reverse prediabetes, lifestyle changes remain the most effective and best-supported treatment.

The Two Changes That Matter Most

The landmark Diabetes Prevention Program followed more than 3,200 adults with prediabetes and found that people who lost 7% of their body weight and exercised for at least 150 minutes per week reduced their risk of developing type 2 diabetes by 58% over the next three years.

The exercise doesn't have to be complicated, either. About 30 minutes of moderate activity five days a week is enough… and yes, walking counts (read more on walking here). Exercise plays a major role because your muscles use glucose for fuel. Every time you go for a brisk walk, ride a bike, or lift weights, your muscles pull sugar out of your bloodstream, helping lower blood sugar and making your body more responsive to insulin.

If you're looking to get the biggest return on your time, recent research suggests combining cardio with strength training works better than either one alone. A few walks during the week paired with two strength-training sessions is enough to meaningfully improve blood sugar control.

Those numbers are remarkable. If a new medication reduced diabetes risk by 58%, it would dominate the headlines. In this case, the prescription is simply to move more, lose a little weight, and stay consistent.

What To Eat, And Why It Works

The dietary levers for prediabetes aren't complicated, but they're specific enough that "eat healthier" as advice doesn't quite cut it.

Fiber is the most consistently supported tool. Soluble fiber, found in oats, legumes, apples, and most non-starchy vegetables, slows the digestion and absorption of carbohydrates, which blunts the blood sugar spike that follows a meal. High-fiber diets have been shown to regulate postprandial glucose response and reduce the risk of developing type 2 diabetes. The fiber targets researchers work with are 25 grams per day for women and 38 grams per day for men, numbers most people fall well short of.

Legumes specifically have new trial-level evidence. A 2025 randomized controlled trial published in Nature Communications found that a legume-enriched diet improved metabolic health in people with prediabetes, with improvements mediated through changes in the gut microbiome, providing a mechanistic explanation for why high-legume dietary patterns show up consistently in prediabetes research.

Glycemic index matters, but glycemic load matters more. The glycemic index ranks foods by how quickly they raise blood sugar, but it doesn't account for portion size. A low-GI food eaten in large quantities can produce a high glycemic load, meaning the amount of carbohydrate eaten is as important as its type. Prioritizing non-starchy vegetables, whole grains over refined ones, and pairing carbohydrates with protein and fat at every meal all reduce the glycemic load of a diet without requiring strict elimination of any food group.

ENDNOTE

Final Thoughts

If you haven't checked your blood sugar recently, talk with your doctor about whether screening makes sense for you. And if your numbers are creeping up, remember: your body is giving you a warning light, not a check-engine failure. A few small changes now can go a long way.

Until next week!

Adrian Macdonald | Team Dietitian | The 8% Newsletter Author