Prediabetes
Prediabetes reflects early insulin resistance with beta-cell compensation still mostly intact -- blood sugar is higher than normal but not yet diabetic, per ADA Standards of Care in Diabetes-2026 criteria. It affects an estimated 96 million American adults.
Symptoms
Prediabetes is silent by definition. From an endocrine standpoint, it represents the window where the pancreas is still compensating for insulin resistance -- which is exactly why intervention here is disproportionately effective.
Causes and risk
Excess weight, inactivity, and family history are the main drivers -- the same insulin-resistance biology that eventually becomes type 2 diabetes, just earlier in its course.
How it is evaluated
Screening follows the same ADA schedule as type 2 diabetes, per ADA prevention guidance, with annual monitoring once prediabetes is identified.
Treatment
Structured lifestyle change (roughly 7% weight loss, 150 minutes of activity weekly) reduces progression to type 2 diabetes by 58%, more effective than metformin's 31% reduction -- a rare case in endocrinology where the non-drug intervention outperforms medication. Metformin is added for people under 60 with a BMI of 35 or higher, fasting glucose of 110 or higher, an A1c of 6.0% or higher, or prior gestational diabetes.
When to seek care
Prediabetes is not an emergency. The relevant follow-up is annual monitoring to catch progression to type 2 diabetes while it's still most reversible.