Treatment of Prediabetes

Primary Treatment: Intensive Lifestyle Modification

The American Diabetes Association recommends prescribing at least 150 minutes per week of moderate-intensity aerobic activity, which approximates 700 kcal/week energy expenditure, for patients with prediabetes 1, 4
Resistance training should be included at least 2 times per week in addition to aerobic exercise for patients with prediabetes 1, 5
Breaking up prolonged sedentary time is encouraged, as this moderately lowers postprandial glucose levels in patients with prediabetes 1, 4
Moderate-intensity physical activity has been specifically shown to improve insulin sensitivity and reduce abdominal fat in young adults with prediabetes 1, 4
A high-quality eating pattern emphasizing whole grains, legumes, nuts, fruits, and vegetables with minimal refined and processed foods should be implemented for patients with prediabetes 1, 4
The American Heart Association suggests considering Mediterranean or DASH eating patterns, both associated with lower risk of developing type 2 diabetes, for patients with prediabetes 1, 6

The American College of Clinical Endocrinologists recommends metformin be considered in addition to lifestyle therapy if the patient meets high-risk criteria, such as BMI ≥35 kg/m² or age <60 years, for patients with prediabetes 2, 5, 7
Metformin has the strongest evidence base and demonstrated long-term safety for diabetes prevention in patients with prediabetes 6, 7

The Centers for Disease Control and Prevention recommends referring patients with prediabetes to a CDC-recognized Diabetes Prevention Program, which provides evidence-based lifestyle change programs shown to be cost-effective 1, 5

The American College of Cardiology recommends obtaining a baseline lipid panel at diagnosis, as prediabetes is associated with heightened cardiovascular risk, and measuring blood pressure to screen for hypertension 3
Evaluating for tobacco use and referring for cessation if applicable is recommended for patients with prediabetes 2, 7

The American Diabetes Association recommends performing annual diabetes screening with fasting glucose or HbA1c, as approximately 10% of people with prediabetes progress to diabetes annually, and reassessing lifestyle adherence every 3-6 months 3