A person with prediabetes has a higher chance of developing type 2 diabetes as a warning sign. Prediabetes can cause long-term harm, including to the heart and blood vessels if left untreated. But can it be reversed? Can diet and exercise modifications help achieve this? Type 2 diabetes, in particular, is fast emerging as one of the most difficult health issues of the twenty-first century. It is also anticipated that 380 million people globally will receive a diabetes diagnosis by 2025. Diabetes management and treatment are increasingly important because it is a risk factor for many other diseases and chronic health conditions, including stroke, kidney disease, cardiovascular disease, and blindness, to name a few.

However, many people are thought to be in a precursor stage known as prediabetes before they go on to develop type 2 diabetes. This medical condition is characterized by blood sugar levels that are higher than normal but not high enough to be classified as type 2 diabetes. However, a significant risk factor for type 2 diabetes is prediabetes. The numbers of individuals with prediabetes provide a clear picture when it comes to scaling this issue: more than one in three individuals in the U.S. S. along with the U.K. have been identified as prediabetic. Therefore, if prediabetes is considered an early warning sign of type 2 diabetes, what steps can people take to reverse the course of this condition? Is it not possible to reverse this condition with significant lifestyle changes?

On our May podcast, “In Conversation: Can diet and exercise help reverse prediabetes?” Dr. Thomas Barber, an associate clinical professor at Warwick Medical School and consultant endocrinologist at University Hospitals Coventry and Warwickshire, joined Dr. Hilary Guite and me. Additionally, Healthline Media and Medical News Today Managing Editor Angela Chao shared her personal story of reversing her diagnosis of prediabetes and the lifestyle changes she made to maintain it. An unusual case: In Angela’s instance, few medical professionals would have thought that her blood sugar levels were cause for concern. She is not thin, youthful, and energetic like most people with prediabetes or those at risk of getting diabetes. She did, however, admit that at the time she led a fairly sedentary lifestyle.

She said that because my readings were so low on the spectrum, I don’t even think my primary care physician at the time talked to me about it beyond providing the range and the diagnosis. She did, however, add that some doctors and her medical friends seemed concerned about the changes to the cutoff point for readings that qualified as prediabetes. Being diagnosed with prediabetes: In my opinion, receiving the diagnosis was a bit of a wake-up call. Whether or not the threshold has changed, “You need to increase your exercise level; you need to make some changes to your lifestyle to get back to a healthy range.

How to measure prediabetes
According to Dr. Barber, the diagnosis of diabetes and prediabetes was previously made using fasting glucose readings or a conventional glucose tolerance test. In this test, participants were given 75 grams of a sugar-filled beverage, and their blood sugar levels were monitored for the following two hours. Additionally, the definition of prediabetes is constantly changing and may vary from nation to nation. Definitions vary amongst societies and prestigious organizations. And the most important thing to remember, in my opinion, is that there is a continuum when it comes to diabetes and prediabetes, Dr. Barber stated. Should we choose the U. S. along with the U. K. For instance, there are variations in the thresholds and units of measurement applied when diagnosing prediabetes.

As you point out, there are various units, which makes it a little confusing. However, in essence, in the U. K. for glucose, we use millimoles per liter, and in the U.S. S. milligrams per deciliter, to be exact. We typically use millimoles per mole in clinical settings these days, and we have for a while, according to Dr. Barber. He went on, “I think that further complicating matters is the hemoglobin A1C, which has two different percentage units—one that we have historically used and the other that is now replaced by millimoles per mole. Dr. According to Barber, glucose is a continuous variable rather than a discrete measure. He clarified that while everyone can agree on what is elevated and what is normal, there are kind of disagreements about everything in between. The World Health Organization approved hemoglobin A1C as a test for diabetes a few years ago. While additional glucose readings can be useful, Dr. Barber stated that medical professionals primarily rely on A1C in current clinical practice. About prediabetes in the U.S. K, he said, this is based on an A1C range of 39 to 47 mmol per mol, with 39 corresponding to an A1C of 5 points 7 percent.

Anything that raises the hemoglobin A1C level above 48 millimoles per mole, or 60.5 percent, is statistically defined as diabetes. He stated that to diagnose type 2 diabetes, we should ideally have at least two of those readings that are elevated. When Angela was diagnosed, her A1C was 5 points8 percent, and anything above 5 points7 was considered prediabetes. Dr. Barber reminded us that, in the United States, Angela’s readings would not have been regarded as prediabetes and that, in recent years, the diagnostic criteria for diabetes have gradually decreased. K. at the time, since the values were extremely near to normal and not quite below the cut-off. Usually, prediabetes shows no symptoms at all. But occasionally, people might get frequent thirst, wake up in the middle of the night to urinate, experience blood sugar spikes, or have energy slumps.

Prediabetes is frequently asymptomatic, so many people who are diagnosed with it may have had it for months or even years. Furthermore, it can easily go unreported unless people are tested for it, according to Dr. Barber.

Angela recounted her own experience:
I most definitely didn’t experience a variety of symptoms. But drinking water was something I was definitely already doing quite a bit of the time. I therefore found it difficult to determine whether anything was changing. Low blood sugar, particularly if she went for prolonged periods without eating, was something she did notice before the diagnosis. Over the years, she said, there has been a consistent pattern of significant fluctuations in her blood sugar levels, which she could feel physically. She can, however, fast trouble-free for more than 16 hours now because of certain lifestyle adjustments. Sugar surges and falls may be considered preemptive indicators of diabetes. According to Dr. Dot Barber, prediabetes is a general term that can refer to either elevated fasting glucose or elevated postprandial glucose. Dr. Dot Barber stated that fluctuations in blood sugar levels, or glycemia, were often observed in the context of insulin resistance. Glucose levels tend to rise a little higher than they should, he explained, because the beta cells can’t produce enough insulin, for example, or the insulin isn’t as effective after a meal.

The main difference, I suppose, is that most of the time we are unaware of this when it comes to prediabetes because the majority of patients actually do not. monitor their blood glucose, he said, noting that people might not notice these changes physically if blood sugar levels are not closely monitored throughout the day. It makes perfect sense that as you lead a healthier lifestyle, lose weight, and reverse prediabetes, your blood sugar levels will stabilize. He mentioned Angela’s description of the changes she saw and said that the insulin becomes more effective and can handle the fluctuations in glycemia better.

Who is most at risk of developing prediabetes?
Obesity, having a high body mass index, and being overweight are some of the most well-known risk factors for type 2 diabetes. Additionally, as we age, our vulnerability increases. And the reason for that is that as we age, the beta cells and insulin receptors can no longer function as well, and insulin itself becomes slightly less effective. Accordingly, as we age, our chance of having prediabetes and diabetes rises, according to Dr. Barber. Dr. Barber added that eating a diet heavy in high-glycemic foods and sugary drinks, as well as stress, can all raise risk. Conversely, he asserted that a diet low in simple carbohydrates and high in fiber can delay the onset of dysglycemia. Being sedentary means spending most of the day sitting or lying down, especially when it comes to watching TV, which is, in my opinion, the least sedentary activity that can increase risk. Sedentary behavior raises the risk of insulin resistance, a condition that increases the likelihood of prediabetes and type 2 diabetes. Genetics and ethnic origin are other factors to consider.

Dr. Barber presented the results of a recent investigation they carried out in the U.S. K. which revealed that, at a BMI of 23.9%, individuals of South Asian ethnicity had the same risk of developing diabetes as did white people at 30. In contrast, Angela’s risk was increased by her family history. My mother, a retired medical doctor, had warned me since I was a teenager about the slight family history of type 2 diabetes on my father’s side. She also mentioned that everyone on that side of the family was thin and had no weight problems. Dr. According to Barber, diabetes is frequently attributed to lifestyle decisions, but many people are unaware that it is a hereditary disorder. According to him, patients with a strong family history may not always exhibit the characteristics of type 2 diabetes, such as obesity, middle age, male gender, and large abdomen. That’s the idea that most people with type 2 diabetes have of the typical person. He added that, as you point out, Angela defies all of those stereotypes about what that entails. Dr. Barber also emphasized that having a genetic predisposition to diabetes at birth can result in dysglycemia even in the absence of those other factors. More than 40 genes and gene mutations have been found to increase your risk of developing type 2 diabetes. Additionally, he added, that even though each effect alone is rather weak, adding them all together can have a cumulative effect.

Lifestyle changes to reverse prediabetes
Through a combination of intermittent fasting, a balanced diet with an increased amount of lower-glycemic index foods and complex carbohydrates, and significantly increased physical activity, Angela was able to reverse her diabetes. She added that she did not make any significant dietary changes and that she also worked with a personal trainer on weight and resistance training. She advised against strict dieting, keto, and quick, drastic changes that aren’t long-term. Dr. Barber conceded that while this approach obviously worked for Angela, it might not be feasible for many others to make such drastic life changes and that doing so can be challenging. We are aware that rigorous lifestyle interventions that emphasize food, exercise, weight loss, and other factors can significantly aid in preventing type 2 diabetes, or at least postponing its onset, according to Dr. Barber. In my opinion, it serves as a kind of early warning system that indicates when a person needs to make a lifestyle change. And it has to be beneficial if it inspires or motivates people to alter [their] way of life, he added.

Why building muscle is important
Angela’s BMI was already low, so losing weight would not have been a wise course of action. I was diagnosed with a sedentary lifestyle behavior [issue] because I could not afford to lose weight. Without a doubt, I wasn’t working out frequently. She recalled, “I was working [in] very high-stress, high-demanding journalism jobs, covering disasters, traveling, breaking news, you name it.”. Strength training is a useful tool for improving insulin sensitivity and reducing insulin resistance. Dr. According to Barber, the benefits of cardiometabolism may be mediated by the act of exercising and the release of myokines from muscles. In fact, having more muscle mass can increase your metabolic rate overall, which will help you maintain your current weight. He went on to say that burning fat and oxidizing it through exercise also helps because your muscles use this energy source.

Moving throughout the day
Regular exercise, not just intense exercise, has been demonstrated in studies to help stabilize blood sugar and enhance blood sugar management. Although working up a sweat on a treadmill or running a 5k is certainly a form of exercise, Dr. Barber stated that the real message when it comes to fitness should be avoiding inactivity. We are aware that standing up increases caloric expenditure and is therefore beneficial to health. It’s even better if you’re moving around, he said. Additionally, some intriguing studies have examined ways to modify sedentary behavior, such as getting up every hour or every 30 minutes, taking short walks, and performing squats in a room corner. He went on to say that they demonstrated how just that amount of activity throughout the day can have transformative effects on glucose levels.

What it actually means to be active: You don’t have to run on a treadmill or scale Mount Everest. All you have to do is get up occasionally and move around. And that will now significantly improve your metabolic health on its own.

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