Prediabetes represents a significant public health challenge in the United States, indicating that millions of Americans have blood sugar levels that are higher than normal but have not yet reached the threshold for a diagnosis of Type 2 diabetes. This condition dramatically increases an individual’s likelihood of developing Type 2 diabetes, which can lead to severe health complications like heart disease, stroke, and kidney failure. While the condition often presents with no clear symptoms, it serves as an early warning sign that the body is struggling to manage glucose effectively.
Current Prevalence of Prediabetes in the U.S.
The Centers for Disease Control and Prevention (CDC) reports that a substantial portion of the adult population in the U.S. lives with this condition. Specifically, an estimated 38.0% of U.S. adults aged 18 years or older have prediabetes, based on the most recent available data from 2017–2020. This percentage represents approximately 97.6 million individuals. Prevalence varies across demographic groups, with a higher percentage of men (41.0%) having prediabetes compared to women (32.0%). The risk also climbs significantly with age, as nearly half of all adults aged 65 or older are estimated to have prediabetes.
What Defines Prediabetes
Prediabetes is formally defined by specific, elevated blood glucose levels that fall between the normal range and the diagnostic criteria for Type 2 diabetes. Healthcare providers typically use three primary blood tests to confirm this diagnosis. The most common is the A1C test, which measures a person’s average blood sugar over the preceding two to three months. A result between 5.7% and 6.4% indicates prediabetes.
The Fasting Plasma Glucose (FPG) test is administered after an overnight fast of at least eight hours. A prediabetes diagnosis is made when the FPG level falls between 100 and 125 milligrams per deciliter (mg/dL). The Oral Glucose Tolerance Test (OGTT) involves measuring blood glucose two hours after a patient consumes a sugary drink. A level between 140 and 199 mg/dL on the two-hour OGTT indicates prediabetes.
Key Modifiable and Non-Modifiable Risk Factors
Numerous factors contribute to developing prediabetes, categorized as non-modifiable or modifiable. Non-modifiable risk factors cannot be altered, such as age and genetics. The risk increases significantly for individuals aged 45 and older. Family history is another strong non-modifiable factor, as having a parent or sibling with Type 2 diabetes suggests a genetic predisposition to insulin resistance. While prevalence is similar across racial and ethnic groups, certain populations, including African Americans, Hispanic/Latino Americans, American Indians, and Asian Americans, are recognized as having a greater inherited risk.
Modifiable risk factors can be changed through lifestyle choices. Being overweight or having obesity is considered the strongest modifiable factor, as excess adipose tissue can lead to chronic inflammation and impair the body’s response to insulin. Physical inactivity exacerbates this issue, preventing muscle cells from effectively utilizing glucose for energy. A history of gestational diabetes also permanently increases the mother’s risk of prediabetes and Type 2 diabetes later in life.
Strategies for Reversal and Prevention
The diagnosis of prediabetes is a chance to prevent progression to Type 2 diabetes. The landmark Diabetes Prevention Program (DPP) study demonstrated that making specific lifestyle changes is highly effective in reversing the condition. This successful intervention focused on two main goals: achieving modest weight loss and increasing physical activity. Participants aimed to lose 5% to 7% of their initial body weight. Even this relatively small reduction in weight can significantly improve insulin sensitivity.
The second primary strategy involved consistent physical activity, with a goal of at least 150 minutes per week of moderate-intensity exercise. Activities like brisk walking are encouraged, as they help muscles use glucose more efficiently, thereby lowering blood sugar levels. Dietary changes that support these goals include reducing total calorie and fat intake, focusing on whole foods, controlling portion sizes, and limiting sugary beverages.