My doctor says prediabetes, what can I do now?

For type 2 diabetes this is as well evidenced as in almost any other area of prevention, and the reason is the trial evidence: two large randomised studies, the US Diabetes Prevention Program and the Finnish Diabetes Prevention Study, examined exactly the situation in question. Participants with impaired glucose tolerance, that is, a finding from early detection, received either a structured lifestyle programme or the control condition. In both trials the number of new cases in the programme group was roughly half. The finding was the trigger, the intervention the effect — the measurement alone would have changed nothing.

Prediabetes describes a glucose metabolism that deviates measurably from the reference range without meeting the criteria for diabetes. It is captured through fasting glucose, HbA1c as a long-term value, or the oral glucose tolerance test, which measures the response to a defined amount of sugar. The three methods measure different aspects and do not always agree. The interpretation matters: prediabetes is a risk constellation, not a disease, and in many cases it is reversible. A proportion of those affected never develop diabetes.

The first step is to have the finding interpreted: which value was abnormal, how far off it was, and what the accompanying values such as fasting insulin, HOMA index and liver values say. That determines how urgent it is. What worked in the trials was not a single piece of advice but a structured programme over years: dietary change, regular exercise and support that tracks the trajectory. A website cannot give an individual recommendation, that belongs in a medical consultation — but the direction is well evidenced.

Beyond the abnormal value, fasting insulin and the HOMA index are informative, because they show whether the pancreas is already keeping glucose normal through increased insulin output. An oral glucose tolerance test captures the response to a challenge and detects disturbances that stay invisible in a fasting value. Liver values and liver ultrasound belong with it, because fatty liver and insulin resistance frequently occur together, as do blood pressure and lipid profile, because cardiovascular risk shifts in parallel. At YEARS these values run together within the programme on a single day.