Prediabetes treatment

The most important course of treatment for prediabetes is preventing the condition from progressing to type 2 diabetes.

Healthy lifestyle choices can help return blood sugar levels to normal (or prevent it from rising toward the levels seen in type 2 diabetes).

To help prevent prediabetes from progressing to type 2 diabetes, you can:

• Eat a healthy diet: Choose foods low in fat and calories and high in fiber. It’s important to eat plenty of fruits, vegetables, and whole grains.
• Get physical activity: Being physically active makes your body’s insulin work better. Aim to get 30–60 minutes of moderate physical activity on most days of the week.
• Lose excess weight: Losing at least 5–10% of your starting weight³⁵ can help reverse prediabetes and prevent or delay progression to type 2 diabetes. To maintain a healthy weight, focus on permanent changes to your eating and exercise habits.
• Stop smoking
• Take medications as needed: If you’re at high risk for developing type 2 diabetes, your healthcare provider may recommend medications to control cholesterol and high blood pressure.
• Get support and guidance: Programs like the CDC’s National Diabetes Prevention Program³⁶ can help you make healthy lifestyle changes. Such programs can include working with coaches, learning about healthy eating and exercise, managing stress, and sticking to your personal goals.

Prediabetes medication

It's important to talk to your healthcare provider to determine a health plan that works for you.

Prediabetes in adults

Metformin has not been approved by the FDA for prediabetes, but it is a recommended medication to be used off-label for this indication by the American Diabetes Association (ADA).

Metformin is not the first line of therapy, however—while it can be effective, it is not as effective at treating prediabetes as lifestyle changes. Metformin can also be accompanied by adverse gastrointestinal effects.

Prediabetes in children

More studies are needed to determine whether or not metformin should have a role in treating adolescent prediabetes—a few trials have established that it only modestly improves insulin sensitivity and slightly reduces body mass index (BMI).

There is no data showing that metformin affects long-term risks for developing prediabetes or diabetes.

Treatment of prediabetes in children

The prevention and management of prediabetes in children³⁷ follow the same guidelines as they do in adults, such as losing weight, eating a healthy diet, and getting plenty of exercise (generally, around 1 hour a day).

Medication generally isn’t recommended for children with prediabetes.

Prediabetes diet

There are many resources on nutrition³⁸ for people with prediabetes and diabetes. The American Diabetes Association reports “What can I eat?”³⁹ to be the #1 question asked by people after being diagnosed with diabetes.

The ADA emphasizes that your diet and what foods you should or should not eat are up to individual health requirements and preferences. Because all bodies respond differently to various types of foods and diets, no one diet can be prescribed for people with diabetes.

There are, however, some guidelines that can help you manage your blood sugar. The ADA’s 2019 Nutrition Consensus Report⁴⁰ provides some tips for determining the right diet for you. The report recommends getting a referral to a registered dietician nutritionist (RDN) who can help you determine what eating plan makes the most sense for you and your treatment goals.

An easy way for people with diabetes and prediabetes to reduce the risk for cardiovascular disease and kidney disease is to swap unhealthy foods for more nutritious, less fattening options: for example, replacing foods high in saturated fat such as butter and fatty beef with foods rich in unsaturated fats such as olive oil and fish.

While many different diets can help you manage your prediabetes, it is important for everyone to minimize added sugars and refined grains, and include lots of non-starchy vegetables and whole, minimally processed foods.