Prediabetes is a warning sign that your blood sugar is higher than normal but not yet at diabetes levels. About 464 million people worldwide have it, and this number is growing. New research shows that people with prediabetes have a 5-10% yearly chance of developing type 2 diabetes. The big question doctors are asking: should we treat prediabetes aggressively with medicine, or just watch it carefully? This research explores both sides—showing that lifestyle changes can prevent diabetes in 40-70% of cases, but also questioning whether medication is always necessary.

The Quick Take

  • What they studied: Whether people with prediabetes (blood sugar levels between normal and diabetic) should receive medical treatment or just lifestyle changes to prevent developing type 2 diabetes
  • Who participated: This is a review article that examined research on millions of people worldwide with prediabetes, including data from major studies like the Diabetes Prevention Program
  • Key finding: Lifestyle changes like diet and exercise can reduce the risk of developing diabetes by 40-70%, while certain medicines like metformin can reduce risk by 31%. However, doctors disagree about whether everyone with prediabetes needs medicine
  • What it means for you: If you have prediabetes, lifestyle changes should be your first step. Medicine may help if you have additional risk factors like obesity, family history of diabetes, or other health conditions. Regular check-ups are important to track your progress

The Research Details

This is a review article that examines existing research and expert opinions about prediabetes treatment. Rather than conducting a new study, the authors looked at what we already know from major research projects, including the famous Diabetes Prevention Program that followed thousands of people over many years. They considered evidence from multiple types of medicines and lifestyle interventions to understand what works best for preventing diabetes.

The researchers weighed two different viewpoints: one side argues that prediabetes should be treated aggressively because it can progress to diabetes, while the other side questions whether treating prediabetes is necessary since the blood sugar levels are still below the targets doctors use for treating actual diabetes. This balanced approach helps readers understand the ongoing debate in the medical community.

This type of review is important because it helps doctors and patients understand the current state of knowledge about a common health condition. Prediabetes affects hundreds of millions of people globally, and the decision about whether to use medicine has big implications for healthcare costs, patient wellbeing, and how people feel about their health. By examining both sides of the debate, this research helps guide better decision-making

This article was published in a respected medical journal and represents expert medical opinion. However, because it’s a review rather than a new research study, it doesn’t provide new experimental data. The strength comes from examining many existing studies and presenting balanced arguments. Readers should note that medical experts still disagree on the best approach, which is why the authors present both perspectives

What the Results Show

The research shows strong evidence that lifestyle changes work well for preventing diabetes. When people with prediabetes make changes like eating healthier foods, exercising regularly, and losing weight, they can reduce their risk of developing diabetes by 40-70%. This is a very significant benefit. The medicine metformin also helps, reducing diabetes risk by about 31% based on the major Diabetes Prevention Program study.

However, the authors found that doctors don’t all agree on whether everyone with prediabetes should take medicine. Some doctors argue that because prediabetes is just a warning stage, lifestyle changes alone should be tried first. Others believe that certain high-risk patients—those with obesity, strong family history of diabetes, or other health problems—should receive medicine right away to prevent progression.

The research also highlights a concern about overtreatment: labeling someone with prediabetes and giving them medicine might cause unnecessary worry and cost, especially if their condition isn’t likely to progress to diabetes. This is why the authors suggest a personalized approach based on individual risk factors.

The review found that several other medicines besides metformin can help prevent diabetes, including newer drugs like SGLT2 inhibitors, DPP-4 inhibitors, and GLP-1 receptor agonists. These medicines work by targeting different ways the body controls blood sugar. However, these newer medicines may have side effects and are more expensive than metformin, so there’s debate about when to use them. The research also notes that prediabetes is connected to other health risks beyond just diabetes, including heart disease, kidney problems, and vision issues, which strengthens the case for treatment in high-risk individuals.

This research builds on decades of diabetes prevention studies. The Diabetes Prevention Program, conducted in the 1990s and 2000s, was groundbreaking in showing that lifestyle changes could prevent diabetes. This new review confirms those findings still hold true and adds information about newer medicines. The article also acknowledges that medical organizations like the European Association for the Study of Diabetes have been updating their recommendations, though complete agreement hasn’t been reached yet

The main limitation is that this is a review of existing research rather than a new study, so it doesn’t provide fresh data. The authors note that long-term studies are still needed to fully understand the risks and benefits of treating prediabetes with medicine. Additionally, most research has been done in certain populations, so results may not apply equally to everyone. The review also highlights that there’s no clear consensus among doctors, meaning the evidence doesn’t point to one obvious answer for all patients

The Bottom Line

If you have prediabetes: (1) Start with lifestyle changes—eat healthier, exercise regularly, and aim for weight loss. This approach has strong evidence and no side effects. (2) Get checked regularly, at least once a year, to see if your blood sugar is improving or getting worse. (3) If you have additional risk factors like obesity, family history of diabetes, or other health conditions, talk to your doctor about whether medicine might help you. (4) Don’t feel pressured to take medicine immediately unless your doctor identifies specific high-risk factors. Confidence level: High for lifestyle changes; Moderate for medication decisions (doctors still debate this)

Anyone diagnosed with prediabetes should pay attention to this research. It’s especially important for people with family history of diabetes, those who are overweight, or those with other health conditions like high blood pressure or heart disease. People in their 40s and older should be particularly attentive since prediabetes becomes more common with age. This research is less relevant for people with normal blood sugar levels, though the lifestyle recommendations apply to everyone for general health

Lifestyle changes can show results within 3-6 months, with improvements in blood sugar levels and weight. However, preventing progression to diabetes is a long-term goal that requires sustained effort over years. If you start medicine, it may take several months to see the full benefit. Regular check-ups every 6-12 months help track progress and guide treatment decisions

Want to Apply This Research?

  • Track fasting blood glucose levels monthly (if you have a home glucose monitor) or at doctor visits, plus HbA1c levels every 3-6 months. Also monitor weight weekly and waist circumference monthly, as these are key indicators of prediabetes progression or improvement
  • Use the app to log daily exercise (aim for 150 minutes per week), track meals to monitor carbohydrate and sugar intake, and set weight loss goals (5-10% reduction is beneficial). Create reminders for regular doctor appointments and blood sugar testing to catch any changes early
  • Set up quarterly reviews in the app comparing your blood sugar trends, weight changes, and lifestyle metrics. Create alerts if blood glucose readings trend upward or if you miss exercise goals for more than a week. Share monthly summaries with your healthcare provider to guide treatment decisions

This article reviews medical research about prediabetes treatment but is not a substitute for professional medical advice. Prediabetes diagnosis and treatment decisions should be made with your doctor based on your individual health situation, blood test results, and risk factors. Do not start, stop, or change any medications without consulting your healthcare provider. If you have been diagnosed with prediabetes, schedule regular appointments with your doctor to monitor your condition and discuss whether lifestyle changes, medication, or both are right for you.