Prediabetes is a condition with higher-than-normal blood sugar levels. You may not feel sick or have any symptoms, but having prediabetes puts you at higher risk for developing type 2 diabetes within a few years. About 5 to 10% of people with prediabetes develop diabetes each year, and 90% of people with prediabetes will develop diabetes within the next 20 years.
Prediabetes treatments can lower your risk for diabetes and complications of diabetes. Lifestyle modifications, such as losing extra weight and increasing physical activity, are the most effective approaches for most people.
Certain medications can also help delay the onset of type 2 diabetes or prevent it altogether. Metformin is the most common blood sugar-lowering medication for prediabetes, but there are others. These prescription medications are only for some patients with prediabetes, and they work best when you also adapt a healthy lifestyle.
Prediabetes Treatment Approaches: Lifestyle and Medication
Prediabetes treatment has three main components.
Lifestyle modification to make healthy behavior choices in daily life.
Prediabetes medication(s) to control blood sugar and/or increase insulin sensitivity.
Screening and any necessary treatment for high blood pressure and high cholesterol.
Lifestyle Modification: The American Diabetes Association (ADA) recommends that people with prediabetes take part in a lifestyle intervention program. This can be a Centers for Disease Control and Prevention (CDC)-Recognized Diabetes Prevention Program (DPP) with a focus on weight loss and physical activity. Eating well and getting enough sleep are examples of other healthy choices that can lower blood sugar.
Prediabetes Medication: Medications can help lower blood sugar and reduce type 2 diabetes risk. Metformin is most common, but there are other types of prediabetes medications that are sometimes prescribed. You are more likely to have prediabetes medications if you are at higher risk for diabetes or if you have not been able to control your prediabetes with lifestyle modifications.
Blood Pressure and Cholesterol Screening: Prediabetes and diabetes are risk factors for high blood pressure and high cholesterol. In turn, those can lead to stroke, kidney disease, and heart disease. Your prediabetes treatment plan may include regular blood pressure measurements and blood tests for cholesterol levels. Prescription medications may be necessary to control your numbers.
Most Common Medications for Prediabetes
Classes of medications for patients with prediabetes include biguanides, thiazolidinediones, and α-Glucosidase Inhibitors. The best-known biguanide may be metformin, with Glucophage being the most common brand name. Metformin lowers glucose levels in a few ways.
It increases insulin sensitivity in your liver to decrease your body’s glucose production.
It increases insulin sensitivity in skeletal muscle, which allows your muscle cells to remove glucose from the bloodstream to lower blood sugar levels.
It increases anaerobic respiration, which uses glucose, in your gastrointestinal cells.
It increases glucagon-like peptide-1 (GLP-1) and beta cell GLP-1 receptors, which lowers blood glucose.
Metformin also improves cholesterol levels and may help you control your weight. It only appears to aid in a few pounds of weight loss and benefits may only last for a few months to a year, but that is better than most other diabetes medications, which can lead to weight gain.
There are other possible medications for prediabetes. Thiazolidinediones increase insulin sensitivity. They also lower blood glucose by increasing glucose metabolism, but they do this by reducing fat metabolism, and weight gain can occur. Thiazolidinediones raise “good” HDL cholesterol, but there are concerns with heart health because they also raise “bad” LDL cholesterol. Rosiglitazone and pioglitazone are examples of thazolidinediones.
The α-Glucosidase inhibitors are medications that interfere with the digestive process. They inhibit the action of α-Glucosidase, which is an enzyme that breaks down carbohydrates, such as table sugar and starches in foods, into glucose. The result is that less glucose gets into your bloodstream after you eat. Side effects of these medications can include flatulence and diarrhea.
Weight Loss in Prediabetes
For most people who have prediabetes and are overweight or obese, weight loss can greatly reduce your risk of type 2 diabetes. Weight loss can be daunting if you take an all-or-nothing approach, but it’s not necessary to lose 100 lb. to benefit. Every pound you lose helps prevent or delay type 2 diabetes.
Losing 2.2 lb. (1 kg) lowers your risk of developing type 2 diabetes by 16%.
Losing 5 to 7 percent of body weight lowers your risk by over 50%. That is 8 to 11 lb. if you start at 160 lb., or 10 to 14 lb. if you currently weigh 200 lb.
Hitting a “healthy/normal” weight if you are currently overweight or obese further reduces your risk.
Weight loss only lowers diabetes risk for as long as you keep off the weight. That means that your prediabetes weight loss plan should consider your ability to stick to your plan for the long-term. Here are a few do’s and don’ts of a prediabetes weight loss plan.
- Increase consumption of vegetables and lean proteins to stay full on fewer calories.
- Fewer staff needed per patient, so lower costs.
- Choose water and low-calorie beverages instead of sugar-sweetened ones.
- Make small changes, such as removing fat from meat, taking skin off chicken, and choosing whole instead of refined grains.
- Limiting sugary foods and desserts.
- Allow for special occasions, restaurant meals, and occasional treats.
- Take smaller portions of restaurant meals and high-calorie or high-sugar foods.
- Track your food intake.
- Plan ahead so you always have a healthy option available.
- Be active most days.
- Depend on bars, shakes, cookies, and other processed meal replacement diet products.
- Expect to lose a lot of weight quickly. Lose it slowly to increase your chances of keeping it off.
- Start a diet without asking your doctor.
- Skip meals, especially breakfast.
- Depend on fast food or processed ready-to-eat meals and snacks.
- Try to over-exercise to compensate for any over-eating.
Metformin is one of the few diabetes medications that helps with weight loss; the other ones can lead to weight gain. Metformin’s weight loss effect is small – about 2 percent of body weight, or about 3 lb. if you weigh 150 lb. – but every little bit helps. Metformin can promote weight loss by reducing your appetite so you eat less. It can also increase your calorie burn during exercise. It is important to understand that metformin only helps you lose weight if you follow a diet and exercise program for weight loss.
Exercise for Prediabetes
Exercise burns calories and helps with weight loss, but it does far more for prediabetes beyond its weight loss effects. Exercise increases insulin sensitivity in your muscles so they take up more glucose from the blood and lower blood sugar. The effects last for 24 hours, and that is great incentive to get active every day.
How much do you need, and what counts? Any increase you make in your daily activity levels can help. The general goal is 150 minutes per week of moderate to vigorous-intensity aerobic physical activity, plus 2 to 3 sessions per week of strength training, such as with weights, body weight, resistance bands, or medicine balls.
It is not hard to get started. Almost anything counts, whether you walk, jog, swim, cycle, garden, or dance. As little as 5 minutes at a time helps, too. Just be sure to ask your doctor before you get started, and choose exercises that are safe and comfortable for you.
Medication versus Weight Loss and Exercise for Prediabetes
What is better: a pill or a lifestyle change? Can either of them really work, or are you going to get diabetes regardless of what you do? Researchers asked those very questions and set out to answer them in a clinical trial that compared metformin to lifestyle changes to a control group among participants with prediabetes. They made some important discoveries.
You can prevent diabetes! Most cases of diabetes are largely preventable if you treat your prediabetes properly.
Metformin lowered risk of diabetes by 31% compared to the control group.
Lifestyle changes lowered risk of diabetes by 58% compared to the control group.
This study and similar ones have consistently shown that lifestyle changes, such as losing weight and getting active, are the most effective strategies for lowering blood sugar and preventing diabetes for most people. Most people who are diagnosed with prediabetes are likely to receive a recommendation to make healthier choices before their doctors decide to prescribe medications.
You are more likely to be prescribed metformin for prediabetes if your body mass index (BMI) is over 35, if you had gestational diabetes (diabetes that came during pregnancy and then left), or you are younger than 60 years old. Your doctor may also ask you to consider metformin if lifestyle changes have not worked to bring down your blood sugar levels.
|Medications||Weight Loss and Exercise|
Nearly all patients
Effect on Diabetes Risk
31% lower type 2 diabetes risk over 2.8 years
58% lower type 2 diabetes risk over 2.8 years (Diabetes Prevention Program)
Effect on Blood Sugar
Gastrointestinal discomfort, hypoglycemia, possible weight gain
Negative effects are unlikely. Positive side effects can include better energy, mood, sleep, and focus.
Possible complications such as liver disease and heart disease
Safe if done cautiously
Other Health Effects
Risk of vitamin B12 deficiency
Lowered risk for heart disease, certain cancers, Alzheimer’s disease, stroke, depression, and more
Healthy Lifestyle Changes: Diabetes Prevention Program
The lifestyle intervention in that landmark clinical trial was a Diabetes Prevention Program (DPP). The DPP focuses on hitting weight loss of 5 to 7% of starting weight and achieving 150 minutes per week of physical activity. It is a year-long program that includes 16 lessons in the first 6 months and another 6 lessons in the final 6 months.
There are many DPP providers nation-wide, and many healthcare providers offer them as a benefit. Lark DPP is recognized by the Centers for Disease Control and Prevention (CDC) as a fully online program. You can access it at your convenience with no need to travel to in-person meetings on a specific schedule. Lark’s program is personalized and designed to help you not only with weight loss and physical activity, but also with healthy eating, stress management, better sleep, and motivation.
Healthy Eating and Other Natural Remedies for Prediabetes
Losing weight and getting active are the two most effective strategies for lower blood sugar and diabetes risk, but there are other natural prediabetes remedies. Healthy eating, aside from whether you lose weight, can lower blood sugar. So can managing stress, getting adequate sleep, and certain dietary supplements.
Healthy eating for prediabetes means eating more of the foods that lower blood sugar and insulin resistance, and less of the ones that increase those measures. In general, look for fresh foods, fiber, healthy fats, and lean proteins. When you can, limit sugary foods, refined starches, fast foods, fried foods, and highly processed foods.
- Beans, lentils, and other legumes
- Whole grains
- Fish, eggs, chicken, and other proteins
- Low-fat yogurt and cheese
- Fresh fruit
- Candy, desserts, jelly
- Sugar-sweetened beverages
- White bread and other refined grain products, such as white rice and pasta
- French fries, fried chicken, doughnuts, chips, and other fried foods
- Red meat, bacon, and processed meat
Dietary and nutritional supplements could help lower blood sugar or raise insulin sensitivity, but research is ongoing. Ask your doctor before taking any supplements, since they can have side effects or may not be effective. Cinnamon, chromium, Gymnema sylvestre, and bitter melon are a few of the more common nutritional supplements for blood sugar.
If you have prediabetes, it is worth taking steps to treat it because you can greatly lower your risk for type 2 diabetes. Medications for prediabetes are a strategy that can help, but they are more effective with lifestyle treatments, and may not even be necessary. Talk to your doctor about your options, and see if a DPP such as Lark can help you turn healthy choices into habits that can change your life.
5. Prevention or Delay of Type 2 Diabetes: Standards of Medical Care in Diabetes—2018. American Diabetes Association. Diabetes Care 2018 Jan; 41(Supplement 1): S51-S54. http://care.diabetesjournals.org/content/41/Supplement_1/S51
Bansal N. Prediabetes diagnosis and treatment: A review. World J Diabetes. 2015;6(2):296-303. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4360422/
Hostalek U, Gwilt M, Hildemann S. Therapeutic Use of Metformin in Prediabetes and Diabetes Prevention. Drugs. 2015;75(10):1071-94. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4498279/
Diabetes Prevention Program Research Group. Long-term safety, tolerability, and weight loss associated with metformin in the Diabetes Prevention Program Outcomes Study. Diabetes Care. 2012;35(4):731-7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3308305/
Diabetes Prevention Program Research Group. Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin. N Engl J Med 2002; 346:393-403. DOI: 10.1056/NEJMoa012512. https://www.nejm.org/doi/full/10.1056/NEJMoa012512