Nearly 38% of the U.S. adult population has prediabetes.¹ Of the 96 million U.S. adults with prediabetes, more than 80% are unaware that have an increased risk for type 2 diabetes and other long-term medical conditions associated with it.²

So, how do you know if you are at risk or have prediabetes? That’s the tricky part. Prediabetes doesn’t always produce symptoms and you can remain symptom-free for years. The problem is that  nearly every organ system in your body is incrementally harmed by having higher than healthy blood glucose levels. But, there is hope! By making lifestyle changes that lead to overall better health, you can reverse prediabetes and live a longer, healthier life. 

What is Prediabetes?

Think of prediabetes like the check engine light that comes on in the dashboard of your car. When the engine is running smoothly, the light stays off. But when the car’s control system recognizes that there is something wrong with the engine, the light comes on. The light is a warning sign that something is off – maybe it's a worn spark plug, a loose gas cap, or a faulty oxygen sensor. Either way, it's a sign that the engine isn’t running as optimally. 

Like the check engine light, prediabetes is a warning sign that you are at an increased risk for diabetes and other long-term medical conditions. Prediabetes is when your blood glucose is higher than it should be, but not high enough to meet the criteria for type 2 diabetes.

The American Diabetes Association's expert panel estimates that up to 70% of people with prediabetes will develop type 2 diabetes.³ The progression from normal glucose tolerance to diabetes is a continuous process that can be stopped.⁴ Thankfully, you can reverse this trend.

In healthy people, fasting blood sugar is strictly regulated by insulin and glucagon. After a meal, beta cells in the pancreas release insulin to move glucose from the blood into muscle and liver cells. This lowers the amount of glucose in the blood. Prediabetes is an indication that this regulation is faulty (remember, there’s something wrong with the engine). 

Prediabetes is linked to insulin resistance, a condition that results in excessive glucose in the bloodstream. Excess sugar in the bloodstream damages the inner lining of your blood vessels, increasing your risk for cardiovascular disease, high blood pressure, nerve damage, vision problems, and abnormal triglycerides.³ Prediabetes shares risk factors with metabolic syndrome, a group of conditions that further raise your risk for serious chronic diseases. This is why tracking your blood glucose via a continuous glucose monitor (CGM) is a vital tool to help you reverse prediabetes. 

Risk factors for type 2 diabetes that you have no control over include: 

Age (45+)

Some people lose their ability to regulate their blood sugar as they get older. Increased body fat and decreased physical activity are major risk factors for developing prediabetes as you get older. While roughly 37% of U.S. adults have prediabetes, the figure rises to 51% of U.S. adults aged 65 and older.⁵ Growing older increases your risk for insulin resistance, prediabetes, and type 2 diabetes, and having diabetes speeds up the aging process.⁶ In a study evaluating diabetes risk profiles, researchers found that unhealthy sleep was associated with increased diabetes risk for older adults. Surprisingly, obesity and abnormal lipid levels did not increase diabetes risk in adults over age 75.⁷ 

Family history or a first-degree relative with type 2 diabetes/Ethnicity

Family history is an important risk factor for diabetes. A family history of diabetes can increase your risk of developing it by two to six times. The higher incidence of type 2 diabetes in certain populations suggests a strong genetic component.⁸ Populations with the highest risk of prediabetes include non-Hispanic black people (21.8%), non-Hispanic Asian people (20.6%), and Hispanic people (22.6%), when compared with non-Hispanic white people (11.3%).⁹ 

The rise of diabetes around the world is related to the rise of its two biggest risk factors: being overweight or obese and a lack of physical activity.¹⁰ Modifiable risk factors for type 2 diabetes that you can change include the following: 

Obesity

Obesity is the strongest modifiable risk factor for prediabetes and type 2 diabetes.¹¹ As shown in a 2020 study, participants who had obesity were eight times more likely to develop type 2 diabetes than participants at a healthy weight, despite having a low genetic risk and favorable lifestyle habits. Participants who were overweight had a 2.4-fold higher risk than individuals at a healthy body weight.¹² Obesity is strongly linked to a higher risk of diabetes in adults under the age of 75, even in people who otherwise choose to live a healthy lifestyle.⁷

Sedentary lifestyle

Most people spend between half and three-quarters of their day sitting. And as most of us know, sitting for a long time is hazardous for our health. It increases your risk of type 2 diabetes by negatively impacting lipid and glucose metabolism. Based on an analysis of 10 scientific studies, researchers found that there is a 112% greater relative risk for type 2 diabetes in people with sedentary lifestyles.¹³ 

Smoking

People who smoke are 30% to 40% more likely to develop type 2 diabetes than people who don't.¹⁴ Smoking increases inflammation, which is a risk factor for insulin resistance and prediabetes. Nicotine and other chemicals in cigarette smoke change glucose homeostasis, which makes it harder for the body to use glucose and respond to insulin. Smoking may also impair beta-cell function in the pancreas, which are the cells that store and secrete insulin.¹⁵

Although cigarette smokers may be less sensitive to insulin while smoking, insulin sensitivity increases within one to two weeks after they stop.¹⁶ Smoking cessation can help reduce your risk of developing prediabetes.¹⁵

Other risk factors for prediabetes include: 

PCOS

Polycystic ovary syndrome (PCOS) is associated with insulin resistance, infertility, obesity, abnormal lipid levels, and high blood pressure.¹⁷  It is a common disorder that affects between 6% and 12% of women.¹⁸ A PCOS diagnosis depends on having at least two of the following:

• Increased androgens
• Irregular menstrual cycles
• Polycystic ovaries

Steroids, antipsychotic medications, and HIV medications  

Medications can change your metabolism and make it more difficult to manage your blood sugar. For example, glucocorticoids increase insulin resistance and glucose production in the liver, both of which increase blood glucose levels. Review your medication list with your doctor to see if any of them may increase your risk of prediabetes. 

Hypertension

Many people with high blood pressure (hypertension) also have high blood sugar. Both conditions are associated with inflammation, obesity, increased triglycerides, metabolic disease, and increased insulin levels.¹⁹ Both high blood pressure and prediabetes can be present for years without symptoms, which is why it’s important to monitor your blood pressure and blood sugar.

Dyslipidemia

Over 38% of Americans have high cholesterol. Total cholesterol includes LDL cholesterol, triglycerides, and HDL cholesterol.²⁰ Increases in LDL cholesterol (bad cholesterol) and triglycerides increase fatty deposits on the walls of your blood vessels, increasing your blood pressure.  Increases in LDL cholesterol and triglycerides are linked to other risk factors for type 2 diabetes and cardiovascular diseases. Researchers found that people with prediabetes also had unhealthy increases in LDL cholesterol and triglycerides.²¹ 

These prediabetes risk factors can have a cumulative effect on your diabetes risk. Individuals who have obesity, have a high genetic risk for type 2 diabetes, and make unhealthy lifestyle choices have a 14.5 times higher risk of developing type 2 diabetes than people who do not.¹² 

Warning Signs and Symptoms of Prediabetes

The warning signs and symptoms of prediabetes can be very subtle and they aren’t always specific. If you do notice any new or worsening symptoms, it is important to make an appointment with your doctor to check your risks for prediabetes and to determine whether another condition may be causing your symptoms. 

Potential warning signs of prediabetes: 

• Excessive thirst and hunger
• Blurred vision
• Tiredness and fatigue
• Increased urination
• Slow healing wounds
• Increased numbers of infections
• Numbness in the feet and hands

When your blood sugar is too high, it exceeds your kidney's capacity to filter it out of urine and return it to the body, so more sugar is lost in your urine. Your body needs to dilute this sugar, so it increases water loss in urine as well. As you produce more urine loaded with excess glucose, you are more likely to become dehydrated and hungry, which triggers your body to drink more fluids and eat more.

Increased blood sugar damages the inner lining of small blood vessels throughout the body, resulting in decreased blood flow to the skin. This can lead to things like poor healing and increased skin infections. High blood sugar in the body creates an environment that bacteria thrive in, and it impacts how well immune cells can fight infection.²²