Prediabetes means an HbA1c of 42 to 47 mmol per mol. It is a warning rather than a disease. Structured change in diet and activity cut progression to type 2 diabetes by 58% over about 3 years in a landmark trial, which was more than medication achieved. The Core panel is £350.
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Any of these needs to be seen the same day. If you are severely unwell, go to your nearest emergency department or call 999.
Prediabetes is an HbA1c between 42 and 47 mmol per mol. It is not diabetes and it is not nothing. It identifies the group most likely to develop type 2 diabetes and the group in whom prevention works best.NICE PH38, 2017
Cardiovascular risk is already raised at this stage, which is why blood pressure and lipids are measured at the same time rather than waiting for the sugar to cross a line.NICE NG238, 2023
There are no symptoms. It is found on a blood test taken for another reason, or on a test taken deliberately because of weight, family history, ethnicity or a previous high reading.NICE PH38, 2017
Weight around the middle, inactivity and inherited risk are the drivers. Risk rises earlier and at a lower body weight in South Asian, African and African Caribbean populations, so the thresholds for testing are different.NICE PH38, 2017
Send us what you are seeing and we will tell you what it is likely to be.
One HbA1c in the 42 to 47 range identifies it, and the test is repeated once a year after that. The reading is distorted by anaemia, by recent blood loss, by pregnancy and by certain inherited haemoglobins, so those are excluded before anything is acted on.World Health Organization WHO/NMH/CHP/CPM/11.1, 2011
The appointment measures blood pressure, weight, waist and a full lipid profile alongside the sugar, and calculates the 10 year cardiovascular risk, because the treatment decisions that follow are as much about the arteries as the glucose.The BMJ Hippisley Cox, 2017
A structured lifestyle programme
In a landmark randomised trial, an intensive programme aimed at 7% weight loss and 150 minutes of activity a week reduced progression to diabetes by 58% over about 3 years. Medication in the same trial reduced it by 31%.New England Journal of Medicine Knowler, 2002
Activity on its own
150 minutes a week of moderate activity improves insulin sensitivity even without weight loss, and it moves blood pressure and lipids in the same direction. It is the part of the programme with the lowest barrier and it is where most people should start.European Heart Journal ESC guideline, 2021
Weight loss of 7%
The target used in the trial that produced the 58% figure. For an 85kg adult that is around 6kg, which is a specific number rather than an instruction to lose weight.New England Journal of Medicine Knowler, 2002
Medication
Considered where lifestyle change has not worked, or where risk is high and progression is likely. It reduced progression by less than the lifestyle programme in the trial that compared them directly.New England Journal of Medicine Knowler, 2002
Annual testing, whatever else you choose
Progression is silent. Once a year is the interval, and it is what turns a warning into something that gets acted on before it becomes a diagnosis.NICE PH38, 2017
HbA1c is rechecked at 6 to 12 months rather than sooner, because it reflects 2 to 3 months of average sugar and a shorter interval measures noise. A falling figure over 2 consecutive tests is the result that matters.NICE PH38, 2017
The inconvenient half. Not everybody with prediabetes progresses, and a proportion return to normal without doing anything. That does not make the finding meaningless, and it does mean the honest framing is a raised probability rather than a countdown.New England Journal of Medicine Knowler, 2002
Set the two targets from the trial rather than a vague intention. 7% of your body weight, and 150 minutes a week of activity that raises your heart rate. Write both as actual numbers for you, because that is what produced the 58% reduction.New England Journal of Medicine Knowler, 2002
Record your waist once a month, measured at the navel with the breath let out. Anything over 94cm in a man or 80cm in a woman raises risk on its own, and the threshold is lower again in South Asian populations, whatever the scale is showing.NICE PH38, 2017
Get your blood pressure measured in the same month as the sugar. Raised pressure travels with prediabetes, and treating one while ignoring the other treats half of what is driving the risk.NICE NG136, 2023
Walk for 10 minutes after your largest meal. It lowers the glucose rise after that meal, it takes nothing but the time, and it is the intervention most likely to still be happening in 6 months.NICE PH38, 2017
Do not buy a continuous glucose monitor for prediabetes. It produces striking graphs, there is no evidence it changes whether you progress, and the annual HbA1c that does predict it costs a fraction of the subscription.NICE NG28, 2022
Do not buy a metabolic supplement stack. Nothing on that shelf has produced anything like the 58% figure the lifestyle programme did, and buying one is the most reliable way to postpone the thing that works.New England Journal of Medicine Knowler, 2002
Step 1
HbA1c with lipids, kidneys, blood pressure, weight and waist, and the 10 year cardiovascular risk calculated at the same time.
Step 2
7% of your body weight and 150 minutes a week. Both come from the trial that produced the 58% reduction, and both are specific rather than aspirational.
Step 3
Two consecutive falling results is the outcome. Progression is silent, so the annual test is the part that has to keep happening.
Ask before you book if you are not sure this is the right appointment.
Between 42 and 47 mmol per mol. Below 42 is normal and 48 or above is type 2 diabetes. The range identifies the group most likely to progress and, equally importantly, the group in whom prevention has been shown to work best.
Often. A landmark randomised trial found that a structured programme aimed at 7% weight loss and 150 minutes of activity a week cut progression to diabetes by 58% over about 3 years. Medication in the same trial achieved 31%.
Usually not as a first step. The lifestyle programme outperformed medication in the trial that compared them directly. Medication is considered where structured change has not worked or where the risk of progressing is high.
The Core panel including HbA1c, a full lipid profile, kidney and liver function is £350 and a doctor reads it with you. A 30 minute appointment to build the plan is £150 and the 6 month check in by telephone is £59.
No. Not everybody with prediabetes progresses and a proportion return to a normal HbA1c without any intervention. It is a raised probability rather than a countdown, and it is the point at which what you do makes the most difference.
Once a year while the reading stays in the 42 to 47 range. Progression causes no symptoms, so the annual test is the only thing that catches it, and it is the part of the plan most people stop doing first.
Not for prediabetes. It produces detailed graphs and there is no evidence it changes whether you progress. The annual HbA1c, which does predict progression, costs a fraction of a year of the subscription.
This page is general information about a condition and it is not a diagnosis. Treatment depends on what a doctor finds when they examine you, and no outcome is guaranteed. If you are severely unwell, or if any of the warnings at the top of this page apply to you, go to your nearest emergency department or call 999.
European Heart Journal, European Society of Cardiology
Guidelines on cardiovascular disease prevention in clinical practiceESC guideline, 2021
New England Journal of Medicine
Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin, Diabetes Prevention ProgramKnowler, 2002
NICE
Type 2 diabetes, prevention in people at high riskPH38, 2017
NICE
Type 2 diabetes in adults, managementNG28, 2022
NICE
Cardiovascular disease, risk assessment and reduction, including lipid modificationNG238, 2023
NICE
The BMJ
Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular diseaseHippisley Cox, 2017
World Health Organization
Use of glycated haemoglobin HbA1c in the diagnosis of diabetes mellitusWHO/NMH/CHP/CPM/11.1, 2011
Written by the clinical team at The Wellness. Awaiting clinical sign off.
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