Prediabetes
An intermediate state where blood sugar is higher than normal without reaching the diabetes threshold, a reversible warning sign of a risk of type 2 diabetes.
Prediabetes is a metabolic « grey zone »: blood sugar is abnormally high but not yet diabetic. The criteria are a fasting blood glucose between 1.10 and 1.25 g/L, or an HbA1c between 5.7 and 6.4%. It is an early warning signal, as the body is starting to handle glucose poorly (early insulin resistance).
The window of opportunity: prediabetes is the best chance to act, a stage at which type 2 diabetes is still largely preventable, even reversible. It is a crossroads:
- Without action: about 30 to 50% of people with prediabetes progress to type 2 diabetes within a few years
- With action (lifestyle): you can return to normal blood sugar and avoid diabetes
Major studies (the Diabetes Prevention Program in the USA, Finnish studies) have shown that a lifestyle intervention (modest weight loss of about 5 to 7%, physical activity of about 150 minutes a week, an improved diet) reduces the risk of diabetes by about 58%, more effective than the drug (metformin) in these trials! Powerful evidence of the power of lifestyle.
The problem of silent screening: prediabetes is asymptomatic, so you cannot « feel » it. Many people are prediabetic without knowing it (millions undiagnosed). Hence the value of screening (blood glucose or HbA1c) in people at risk: overweight (especially visceral fat), family history, high blood pressure, inactivity, age and a history of gestational diabetes.
The levers (lifestyle first):
- Physical activity: the most powerful lever, since active muscle « sucks up » glucose without insulin and restores insulin sensitivity (an effect even without weight loss)
- Losing visceral fat (even modestly: 5 to 7% of body weight)
- Cutting back on refined sugars, fructose and ultra-processed foods
- Fibre, complex carbohydrate and foods with a controlled GI
- Sleep and stress management (lack of sleep worsens blood sugar)
In practice: prediabetes is not inevitable but a warning to act on. It is the ideal time to act, with lifestyle changes that can reverse the trajectory, far easier than once diabetes has set in. Regular screening for people at risk means this window is not missed.