The Silent Threat Sneaking Up on 1 in 3 Americans—And Why You Should Get Tested

Prediabetes affects more than 1 in 3 US adults, yet most don't realize they have it because there are typically no symptoms. This silent condition—where blood sugar levels are elevated but not yet high enough to be classified as Type 2 diabetes—significantly increases your risk for heart attacks and strokes. The good news: prediabetes can often be reversed or prevented from progressing to diabetes through lifestyle changes and, in some cases, medication.

What Is Prediabetes and Why Should You Care?

Prediabetes is a state of elevated blood sugar that falls below the threshold of Type 2 diabetes. Your body uses a hormone called insulin to help glucose enter muscle and fat cells, where it's used for energy or stored for later. When insulin isn't working effectively or there isn't enough of it, blood sugar levels rise. Over time, this damages blood vessels and arteries, which is why prediabetes significantly increases your cardiovascular risk.

The concerning part? The fastest rise in prediabetes diagnoses has occurred in young adults and adolescents. Earlier onset means longer exposure to elevated blood sugar and a higher lifetime risk of cardiovascular complications.

How Do You Know If You Have Prediabetes?

Unlike Type 2 diabetes, prediabetes typically has no symptoms, which is why most people don't realize they have it unless they're tested. During your annual physical, ask your healthcare provider to include a hemoglobin A1C test in your blood work. This test reveals your average blood sugar over the past three months.

Here's how to interpret your results:

• A1C Between 5.7% and 6.4%: You have prediabetes and should take action to prevent progression to Type 2 diabetes.
• A1C of 6.5% or Higher: You have been diagnosed with Type 2 diabetes and need medical management.
• A1C Below 5.7%: Your blood sugar levels are in the normal range.

In most cases, it takes several years for someone to progress from prediabetes to diabetes, though the timeline varies by age. Adults in their 70s and older are often more likely to remain in the prediabetes range or even return to normal blood sugar levels than to progress to Type 2 diabetes.

Can You Reverse Prediabetes Through Diet and Exercise?

Yes—prediabetes can often be reversed or prevented from progressing to diabetes. A large study found that people with prediabetes who participated in intensive lifestyle interventions, often with support from a dietitian, reduced their risk of developing diabetes by more than 60%.

The key is making sustainable changes rather than relying on short-term crash diets. One important step is limiting simple carbohydrates that rapidly spike blood sugar, such as juices, regular sodas, and refined white foods like white bread, white rice, and pasta. Dietary patterns like the Mediterranean diet, which emphasizes plant-focused foods, have been shown to be beneficial. However, the best diet for prediabetes is one that is sustainable in the long term.

Exercise is equally important. Cardiovascular exercise and strength training improve blood sugar control, heart health, muscle strength, and mental well-being. "We generally recommend at least 150 minutes of moderate cardio per week (about 30 minutes a day, five days a week). And for strength training, two days per week, using resistance exercises," explains Dr. Michael Weintraub, a clinical assistant professor in the Department of Medicine at NYU Langone Health. You don't need a gym membership or a personal trainer—strength training can be done at home using resistance bands or household items like water bottles or canned goods.

What Role Can GLP-1 Medications Play?

For people who have struggled with weight loss through diet and exercise alone, glucagon-like peptide-1 (GLP-1) medications like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) offer another option. Many people who see an obesity specialist have tried multiple diets, only to regain the weight. This isn't a failure of willpower—when we lose weight, our body doesn't recognize that the weight loss was intentional and responds by increasing hunger and cravings.

GLP-1 medications can help make lifestyle changes more achievable by lowering the body's weight "set point." These medications simulate a natural hormone that signals fullness, which reduces appetite and food intake, leading to weight loss. They also lower blood sugar, which improves insulin resistance by increasing insulin release after meals.

Before starting a GLP-1 medication, you should be evaluated by a medical provider. This typically includes assessing blood pressure, cholesterol, blood sugar, and liver health. Your provider will help determine the most appropriate treatment. It's also important to obtain GLP-1 medications from a pharmaceutical manufacturer rather than compounded formulations, which are not subject to the same quality oversight and may carry risks related to impurities or dosing variability.

Why Are Prediabetes Rates Rising?

The risk of developing prediabetes or diabetes is influenced by genetics and environment. While we can't change our genetics, we can change environmental factors such as the foods we eat and our level of physical activity. One of the biggest risk factors for prediabetes is weight gain. Over the past several decades, rates of obesity have risen dramatically in the US and worldwide. Excess weight drives insulin resistance, which can lead to prediabetes and Type 2 diabetes.

The bottom line: prediabetes is a wake-up call, not a death sentence. Getting tested during your annual physical is the first step toward protecting your cardiovascular health and preventing a condition that affects more than 100 million Americans.