Read time: 8 minutes

• A diagnosis of prediabetes can be overwhelming, but it doesn’t mean that progressing to type 2 diabetes is inevitable.
• Improving your diet, increasing physical activity, and losing weight have all been proven to help prevent type 2 diabetes from developing.
• Metformin, a type 2 diabetes medication, can help prevent type 2 diabetes.

Whether you suspected you might have prediabetes or your diagnosis came out of the blue, it’s normal to feel a whole range of emotions, including fear, hopelessness, and maybe even some shame, when you get a prediabetes diagnosis. The truth is that prediabetes is incredibly common: more than 96 million adults have it, which is roughly 38% of the adult U.S. population. Not only is it common, but it’s treatable, too. 

For most people, the first thing they want to know after a prediabetes diagnosis is how to prevent type 2 diabetes from developing. Bottom line: a prediabetes diagnosis doesn’t mean you’ll definitely get type 2 diabetes. 

We don’t know the exact cause of type 2 diabetes, but we do know that lifestyle and genetics play roles. While we can’t control our genetics, we can make changes in our lifestyle. A medication called metformin has also been proven to help prevent type 2 diabetes. 

Read on to learn about what’s happening in your body when you have prediabetes, tips on changing key lifestyle habits, and how metformin works to prevent type 2 diabetes. 

What is Prediabetes?

Prediabetes is a serious health condition in which blood sugar levels are higher than normal, but not high enough for a type 2 diabetes diagnosis. 

Prediabetes is diagnosed with an A1C blood test which measures your average blood sugar over the last two to three months. An A1C of under 5.7% is considered normal while a result of 5.7%  to 6.4% is diagnosed as prediabetes and an A1C of 6.5% or higher on at least two tests means you have diabetes. (To learn more about A1C, check out our article, “The Ultimate Guide to A1C.”)

Insulin is a hormone made by your pancreas that acts like a key to let blood sugar into your cells, so you can use it as energy. If you have prediabetes, the cells in your body don’t respond well to insulin. This is known as insulin resistance.

Your pancreas then makes more insulin to try to get cells to respond. Eventually your pancreas can’t keep up and your blood sugar rises, increasing your risk for developing type 2 diabetes down the road.

If you have prediabetes, you are at a high risk of developing type 2 diabetes within five years unless you take preventive measures.

Steps to Prevent Type 2 Diabetes

In 2002, the Diabetes Prevention Program (DPP) studied people with prediabetes who underwent lifestyle changes: increased exercise, dietary changes, and at least 7% weight loss. After these lifestyle changes, 58% of the study participants prevented (or significantly delayed) the development of type 2 diabetes. 

It sounds pretty simple, right? But making these changes (exercising more, improving your diet, and losing weight) takes time and patience. Having the right support can make a big difference, too.

1. Cut your calories

Calories are a unit of measurement when it comes to food. Consuming more calories than you need can potentially lead to weight gain. One way to achieve weight loss is to eat fewer calories and increase your physical activity. Here are a few tips to get you started as you try to prevent type 2 diabetes.  

Tip: Be mindful of your drinks

You may be drinking more sugar and calories than you think. For example, a 12-ounce orange soda has 13 teaspoons of sugar and 195 calories. It’s a lot. For someone eating a 2,000 calorie diet, it’s recommended that no more than 200 calories should come from added sugar. By drinking more than one soda per day, you could be consuming double that amount. Gradually cutting back on sugary drinks and getting creative with your beverages can support weight loss and improve your overall health, too.  

Tip: Create a healthy plate

Remember the food pyramid? Many of us grew up thinking that grains should make up the bulk of our diet. In 2011, the United States Department of Agriculture (USDA) changed their recommendation to a new system called MyPlate and diabetes organizations took the change one step further creating the Diabetes Plate Method.

The Diabetes Plate Method suggests filling half your plate with non-starchy vegetables (broccoli, spinach, bell peppers, Brussels sprouts, green beans, okra, cabbage), a quarter of your plate with whole grains, starchy foods, or fruits (baked sweet potato, oatmeal, brown rice, barley, beans, apples, pears), and a quarter of your plate with protein (chicken, eggs, turkey, lean meat, fish, tofu, beans).

Tip: Track your food

If you don’t know exactly what and how much you’re eating, it can be difficult to match your body’s needs, making weight loss a lot more difficult. If you’re eating too much, tracking what you eat can help you figure out where those extra calories are coming from. Having the right equipment can be helpful in figuring how much you’re eating. Some people find these tools helpful: measuring cups and spoons, kitchen scale, food labels, calculator, and the One Drop food logging feature. 

2. Get plenty of exercise

Fitting in at least 150 minutes of activity each week can feel intimidating if you’re not very active right now. But the good news is that you don’t have to do it all at once nor do you have to do what’s traditionally considered “exercise” at a gym for movement to count. Simply making more effort to move your body in ways you enjoy can make a huge difference when you’re trying to lose weight and prevent type 2 diabetes. 

Tip: Get moving throughout the day

Each day, find a way to incorporate a bit of activity into your routine. Breaking up your 150 minutes of exercise per week into 10-minute chunks and taking advantage of little opportunities to move your body can be much more realistic than trying to commit to an elaborate exercise routine, especially if you’re just starting out. Here are a few ways to incorporate activity into your day:

• Get off the bus or train one stop early and walk the rest of the way.
• Park your car farther from the place you want to go.
• Take the stairs instead of the elevator.
• Walk or ride your bike to your destination.

When you’re ready to kick it up a notch, consider these no-equipment exercises that you can do at home while watching TV.  

Tip: Create a habit loop

When it comes to increasing your physical activity, habits are your best friends. A habit is a pattern of behavior followed regularly until it has become almost involuntary. 

A habit loop happens when you’ve created the right cues (e.g. setting your running shoes out the night before you want to go for a run), responding to the cues with your desired action (e.g. going for a run), and being rewarded (e.g. treating yourself to a massage or watching the numbers on your scale go down). 

To learn all about habits and how they can help you increase activity and prevent type 2 diabetes, read our article, “Goodbye, Willpower. Hello, Habits.”

Tip: Get fit with other active people

Humans are social creatures, so it makes sense that there are a whole slew of benefits to getting physical activity with someone else. A recent study found that people who exercised with a companion—especially an emotionally supportive companion—increased the amount of time they exercised. 

It’s also been shown that we unconsciously match the exertion level of the people we’re exercising with, so if you’re looking for a tough workout, find a friend who goes hard. On the other hand, if you’re looking for a more gentle approach, find someone who isn’t competitive and may enjoy an easier pace.

3. Ask your doctor about metformin

While lifestyle changes are effective for people trying to prevent type 2 diabetes, the DPP study mentioned earlier included another approach as well: using metformin, a type 2 diabetes medication. People treated with metformin were 31% less likely to have their prediabetes develop into diabetes.

Metformin was not quite as effective as cutting calories, increasing physical activity, and losing weight, but a 31% reduction in the rate of progression to diabetes is still significant. Since lifestyle modifications and metformin are both somewhat effective in preventing diabetes, but neither is 100% effective, it may seem logical to combine them.

Many medical experts have recommended that metformin, as well as other diabetes drugs, be approved for people with prediabetes. Metformin has several advantages over the other drugs: it's very safe and inexpensive, with co-pays generally around $4 per month. It's also associated with lower mortality, lower rates of heart disease, and lower rates of cancer. However, despite experts' recommendations, the FDA has not approved any medication for the treatment of prediabetes.

Although metformin hasn’t officially been approved for prediabetes, some doctors prescribe metformin “off label” meaning the medication is being prescribed for a condition that it hasn’t been officially approved to treat. If you feel you’d benefit from metformin, have an honest and informed conversation with your doctor to discuss benefits, risks, and if metformin is right for you personally. 

4. Find the right support

One of the biggest advantages you can give yourself as you embark on making lifestyle changes is finding the right support. Feeling supported, comforted, and assisted has been correlated to lower A1C and therefore, reduction in risk for type 2 diabetes. 

The consistent support of a certified diabetes care and education specialist (CDCES) can provide you with the knowledge, personalized advice, and feedback that even the most supportive family and friends can’t give you. Consider working with a One Drop clinical health coach. Every One Drop health coach is a CDCES with years of professional experience helping people reach their health goals.  

This article has been clinically reviewed by Alexa Stelzer, RDN, LD, CDCES, clinical health coach at One Drop.