About one in three Australian and American adults meets the lab criteria for prediabetes right now. That sounds alarming. But here’s what most articles skip: a huge chunk of that figure exists because doctors added a new test in 2010.
The HbA1c cutoff of 5.7% caught millions of people who never would have been flagged before. So yes, prediabetes is genuinely common. But no, not everyone is quietly spiraling toward diabetes.
If you’re overweight and inactive, this matters a lot for you. If you’re lean, active, and have no family history, the risk picture looks very different.
Why Do the Numbers Look So High?
Three different tests can diagnose prediabetes: the fasting plasma glucose test, the oral glucose tolerance test, and the HbA1c. Each one catches a slightly different metabolic problem.
In the NHANES cohort, 34.6% of U.S. adults had prediabetes when all three criteria were combined. But break that apart and only 19.4% had impaired fasting glucose alone, 5.4% had impaired glucose tolerance alone, and 9.8% had both. When researchers used only glucose-based criteria, the rate dropped to around 10%.
Add HbA1c and it jumps back up. What this means: the test your doctor orders shapes the answer you get. Two people can have the same metabolic health and one gets a prediabetes label and the other doesn’t, depending on which test was run.
One of my clients came in convinced she was heading toward diabetes. Her HbA1c was 5.8%. Her fasting glucose was completely normal. She’d lost weight, was exercising three times a week, and had no symptoms. The HbA1c flag had sent her into a spiral of anxiety that the full picture didn’t warrant. This happens more than it should.
Is Prediabetes Becoming More Common?
Yes. It’s a global pattern. A nationally representative survey in China found rates mirroring what we see in Western countries. Sedentary work, processed food, and rising obesity rates are the main drivers.
The 2010 addition of HbA1c criteria also inflated the numbers overnight without anyone actually getting sicker. What most articles miss is that the reported increase in prediabetes is partly a measurement artifact and partly a real metabolic shift.
Separating those two things matters because the appropriate response to each is completely different. The measurement artifact doesn’t need treatment. The real metabolic shift does.
Why Are You Prediabetic If You Feel Healthy?
This is the question I hear most often. Someone gets a routine blood test, the number comes back slightly elevated, and they have no idea how it happened. They exercise occasionally, they don’t eat terribly, they’re not overweight.
A few things can push blood sugar into the prediabetic range without obvious symptoms. Chronic stress raises cortisol, which raises blood sugar. Poor sleep does the same thing. A diet high in refined carbohydrates, even in someone at a healthy weight, can produce insulin resistance in the liver before it shows up anywhere else.
Certain ethnic backgrounds, particularly South Asian and East Asian populations, show a tendency toward impaired glucose tolerance even at lower body weights.
Here’s the other thing worth knowing: prediabetes has no symptoms. You won’t feel it. That’s exactly why the diagnostic gap is so wide. Only 4.8% of people who meet the lab criteria for prediabetes have actually been told by a doctor that they have it. The rest are walking around with no idea.
When I tried tracking my own fasting glucose for two weeks using a continuous monitor, what surprised me was how much a single bad night of sleep moved the numbers. Not into diabetic range, but enough to understand how lifestyle creates these patterns quietly over years.
Are Most People Over 70 Prediabetic?
Yes, rates climb sharply with age. The majority of adults over 65 meet at least one diagnostic criterion for prediabetes. But the story gets more complicated in a way that actually matters.
Aging naturally changes how the body handles glucose. Muscle mass decreases, insulin sensitivity drops, and the pancreas becomes slightly less responsive. These are normal aging processes, not necessarily signs of disease progressing toward type 2 diabetes.
Risk assessment tools that incorporate multiple factors, not just a single blood test, identify roughly 15% of the population as genuinely high-risk. That’s a much smaller group than the raw lab prevalence suggests.
For an older adult with a stable HbA1c of 5.8%, no weight gain, good activity levels, and no family history, the clinical picture is very different from a sedentary 45-year-old gaining weight steadily every year. Age alone doesn’t make someone high-risk. The combination of age, weight trajectory, activity level, and family history does.
What Actually Happens If You Do Nothing?
Around 10% of people with prediabetes progress to type 2 diabetes each year in the U.S.. That sounds high. But it also means 90% don’t in any given year.
Over a longer period, without intervention, progression becomes more likely. A meta-analysis found prediabetes is linked with a meaningful increase in heart-related events, roughly 8.75 extra events per 10,000 person-years over 6.6 years. The risk is real. It’s just not the emergency the diagnosis label sometimes implies in the moment.
I remember one of my clients, a 52-year-old man told he was prediabetic who did nothing about it for three years because the information he received was vague and the urgency wasn’t communicated clearly. By the time he came to see me, his HbA1c had moved from 5.9% to 6.3%. He was frustrated because he felt like no one had told him what to actually do. That gap between diagnosis and action is the real problem here.
Can You Reverse Prediabetes?
Yes. The evidence on this is strong and consistent.
Losing 5 to 7% of your body weight combined with 150 minutes of moderate exercise per week cuts the progression to type 2 diabetes by approximately 6 cases per 100 people over three years. That’s not a marginal effect. It’s one of the most powerful lifestyle changes in all of preventive medicine.
Metformin, the most commonly prescribed medication for this, reduces progression by about 3 per 100 over the same period. Lifestyle change works roughly twice as well as the medication. This is one of the rare cases where what you do outside a clinic genuinely outperforms what a pill can do.
What I found working with clients is that the 150-minute target sounds like a lot until you break it down. That’s 30 minutes, five days a week. A brisk walk counts. Resistance training counts and arguably matters more for insulin sensitivity because muscle tissue is where most glucose gets stored after a meal.
One of my clients, a 44-year-old woman with an HbA1c of 6.1% and about 12 kilos of extra weight around her midsection, reversed her prediabetes diagnosis within eight months. She didn’t follow a strict diet. She walked 30 minutes most days, did two resistance sessions per week, and cut out the afternoon snacks that had crept into her routine. Her HbA1c dropped to 5.5%. Her doctor was almost surprised. She wasn’t. She’d just done the work consistently.
The Angle Most Articles Get Wrong
Most articles treat prediabetes as a single thing. It’s not. Impaired fasting glucose and impaired glucose tolerance involve different underlying mechanisms, and the evidence for managing them isn’t the same.
Impaired fasting glucose mainly reflects what the liver is doing overnight. Impaired glucose tolerance mainly reflects how muscles respond to insulin after eating. Someone with one condition may need a different approach than someone with the other. This isn’t just academic.
If your problem is primarily impaired fasting glucose, cutting late-night eating and improving sleep may move the needle faster than anything else. If your problem is impaired glucose tolerance, post-meal walks and resistance training hit the issue more directly. Most generic advice treats both the same way. That’s why some people follow standard guidance and see little change. The type of prediabetes matters.
The second thing most articles miss: prediabetes in people of normal body weight is poorly understood and the evidence for intervention in this group is actually thin. If you’re lean, active, and eating reasonably well, a mildly elevated HbA1c warrants monitoring, not panic. You might need a conversation about sleep, stress, and ethnicity-specific risk rather than a weight-loss program you don’t need.
Frequently Asked Questions
Can you stop being prediabetic?
Yes. Lifestyle changes reverse prediabetes for many people. Weight loss and exercise are the most effective tools. A number of people who reduce their HbA1c back below 5.7% stay there long-term if they maintain the habits that got them there.
Do I need medication for prediabetes?
Not automatically. Lifestyle change outperforms medication for most people. Metformin is sometimes prescribed for higher-risk individuals, particularly those with rapidly rising blood sugar or multiple risk factors. But it’s not the default first step.
What foods spike blood sugar most in prediabetes?
Refined carbohydrates eaten on their own, white bread, sugary drinks, and processed snacks cause the sharpest glucose spikes. Eating carbohydrates alongside protein, fat, or fiber slows the response considerably. Meal composition matters as much as food choice.
How quickly does prediabetes progress to diabetes?
Around 10% of people with prediabetes progress to type 2 diabetes per year without intervention. With lifestyle changes, that rate drops significantly. Progression isn’t inevitable and is often reversible in the early stages.
Should I see a personal trainer if I have prediabetes?
Structured exercise is one of the two main interventions with strong evidence behind it. A trainer who understands metabolic health can help you prioritize resistance training and consistency, which is where most people fall short on their own. If you’re in Port Melbourne and want support putting this into practice, working with a personal trainer in Port Melbourne is a practical next step.
What to Do Now
Get tested if you haven’t been recently, especially if you carry extra weight around your midsection, have a family history of type 2 diabetes, or are over 45. Ask which test your result is based on and what your trajectory looks like over time, not just a single number.
If your result is in the prediabetic range, start with two things: 30 minutes of walking most days and two resistance training sessions per week. These two changes, done consistently, produce most of the risk reduction the research shows. You don’t need a perfect diet to start. You need movement and enough muscle to absorb blood sugar properly.
If you’re lean, active, and only mildly elevated, track it over 6 to 12 months before concluding anything. One test result isn’t a diagnosis of your future.
Sources
- Echouffo-Tcheugui JB, Perreault L, Ji L, Dagogo-Jack S (2023) “Diagnosis and Management of Prediabetes: A Review” JAMA. PMID: 37039787
- Unnikrishnan R, Shaw JE, Chan JCN, Wild SH, Peters AL, Orrange S, et al. (2025) “Prediabetes” Nature reviews. Disease primers. PMID: 40676018
- Colagiuri S (2011) “Epidemiology of prediabetes” The Medical clinics of North America. PMID: 21281834
- Wang L, Gao P, Zhang M, Huang Z, Zhang D, Deng Q, et al. (2017) “Prevalence and Ethnic Pattern of Diabetes and Prediabetes in China in 2013” JAMA. PMID: 28655017
- Yip WCY, Sequeira IR, Plank LD, Poppitt SD (2017) “Prevalence of Pre-Diabetes across Ethnicities: A Review of Impaired Fasting Glucose (IFG) and Impaired Glucose Tolerance (IGT) for Classification of Dysglycaemia” Nutrients. PMID: 29165385
- Karve A, Hayward R (2010) “Prevalence, Diagnosis, and Treatment of Impaired Fasting Glucose and Impaired Glucose Tolerance in Nondiabetic U.S. Adults” Diabetes Care. DOI: 10.2337/dc09-1957
- Karve A, Hayward R (2010) “PREVALENCE, DIAGNOSIS, AND TREATMENT OF IMPAIRED FASTING GLUCOSE AND IMPAIRED GLUCOSE TOLERANCE” Journal of the American College of Cardiology. DOI: 10.1016/s0735-1097(10)60554-2
- Menke A, Casagrande S, Cowie C (2018) “Contributions of A1c, fasting plasma glucose, and 2-hour plasma glucose to prediabetes prevalence: NHANES 2011–2014” Annals of Epidemiology. DOI: 10.1016/j.annepidem.2018.07.012
