Prediabetes Management

Lifestyle Modifications

The American Diabetes Association recommends targeting a minimum of 7% body weight reduction through calorie restriction and increased physical activity 1, 2
Even modest weight loss of 5% improves insulin resistance and reduces diabetes risk 3, 4
Performing at least 150 minutes per week of moderate-intensity physical activity, distributed throughout the week with no more than 2 consecutive days without exercise, is recommended 1, 2, 6
Emphasizing nutrient-dense, minimally processed foods and minimizing or eliminating sugar-sweetened beverages, refined grains, sweets, and ultraprocessed foods is advised 1, 4
Reducing total calorie intake by 500-1,000 calories daily from maintenance levels to achieve 1-2 pounds per week weight loss is suggested 7
Enrolling in a CDC-recognized Diabetes Prevention Program or equivalent intensive behavioral counseling program with frequent follow-up is recommended 1, 5

Metformin should be considered for prediabetes in high-risk groups, including those with BMI ≥35 kg/m², age <60 years, or women with prior gestational diabetes 2, 5
Metformin reduces diabetes incidence by 31% relative risk reduction and has the strongest evidence base and demonstrated long-term safety among pharmacological options 2, 5

Referring all individuals with prediabetes to a registered dietitian nutritionist for individualized medical nutrition therapy is recommended 1, 4
Medical nutrition therapy delivered by a registered dietitian achieves A1C reductions and is effective in lowering A1C in prediabetes 1, 3, 4

Monitoring for diabetes development at least annually with fasting glucose, 2-hour glucose tolerance test, or A1C is advised 2, 5
Screening for and treating cardiovascular risk factors, such as hypertension, dyslipidemia, and smoking, is necessary as these patients have increased cardiovascular disease risk 2, 5
Providing ongoing support and follow-up, as sustained behavior change requires continued reinforcement, is essential 1, 2