Can prediabetes be reversed? How diet and exercise can help

While you may be aware of type 2 diabetes and its associated health risks, you may not be as familiar with the underlying metabolic changes that happen years before a formal diagnosis. 

Prediabetes is the condition that develops in individuals before their glucose (blood sugar) reaches type 2 diabetes levels. In fact, many people who fall under the prediabetes category don't even know they have it.¹

The good news is that you can take action now to prevent the progression and even reverse prediabetes (return glucose levels to normal) through lifestyle changes in nutrition and physical activity, often enabling weight loss. 

In this article, we'll explore strategies to implement if you’ve been diagnosed with prediabetes or are looking to prevent it, and how this can help you in the long term.

What is prediabetes?

Prediabetes is a metabolic condition where your body grows increasingly resistant to the effects of insulin, making it more difficult to clear glucose from the bloodstream. As a result, your glucose (blood sugar) becomes elevated, although not yet to the levels of type 2 diabetes.

Prediabetes impacts about 1 in 3 adults in the United States, and only a reported 19% of adults with prediabetes (by A1c or fasting glucose) were aware they had the condition.¹

Globally, more than 760 million adults have either impaired glucose tolerance or impaired fasting glucose—conditions often used to define prediabetes. This number is projected to exceed 1 billion by 2045.³

Reversing prediabetes: Is it possible?

Yes, it’s possible to return glucose levels back to normal with lifestyle changes, especially through nutrition and physical activity.

When we talk about “prediabetes reversal,” we mean bringing blood sugar back into the normal range (sometimes called “reversion to normoglycemia”). This can be loosely defined as meeting the following: 

• Fasting glucose below 100 mg/dL 

• HbA1C of 5.6% or less 

• 2-hour glucose below 140 mg/dL following an oral glucose tolerance test 

It’s important to note: “reversal” doesn’t necessarily mean “cure.” If healthy lifestyle habits aren’t maintained, blood sugar can rise again, and prediabetes may return.

Landmark clinical trials have demonstrated that intensive lifestyle interventions can significantly reduce the risk of progression from prediabetes to type 2 diabetes and, in many cases, lead to a return to normal glucose levels (i.e., reversal).^4,5,6

These lifestyle programs focus on healthy eating and regular physical activity, with the goal of losing around 5% of body weight (i.e., 10 lbs for a 200-lb individual) and getting at least 150 minutes of moderate-intensity exercise per week.

These recommendations are not only backed by landmark clinical trials, they’re the same standards used in the CDCs National Diabetes Prevention Program—the gold standard for proven diabetes prevention that many healthcare providers rely on.⁷

While there’s no single “perfect” plan, most successful approaches share a few core elements: 

• Following a healthy dietary pattern. 

• Engaging in regular physical activity. 

• Achieving and maintaining weight loss. 

Reversing prediabetes: what the research shows

In the Diabetes Prevention Program, participants who improved their eating habits, became more physically active, and lost modest weight reduced their risk of progressing to type 2 diabetes by 58% over three years.⁶

Results from the follow-up study found that these benefits persisted, with the lifestyle group maintaining a 27% lower incidence of diabetes after 15 years, especially among those who sustained weight loss.⁸

These results aren’t unique. A large meta-analysis found that lifestyle changes focused on healthier eating and physical activity can reliably prevent or delay type 2 diabetes and even help return blood sugar to normal.⁹

More recently, digital and community-based programs have shown similar success. In one 12-month trial, a digital Diabetes Prevention Program led to greater weight loss (-5.5% vs -2.1%) and helped more people return to normal glucose levels (58% vs 48%) compared to standard care.¹⁰

There is also growing interest in nutrition strategies aimed at normalizing glucose, not just achieving a specific weight-loss target. In a two-year pilot study focused on lowering glucose through carbohydrate reduction, about 52% of participants returned to normal A1C levels, while only 3% progressed to type 2 diabetes.¹¹

These results reinforce that prediabetes reversal is possible, especially when people follow an approach that supports healthier glucose while reducing excess body weight.

Importantly, there is no single “best” diet. Research shows that several dietary patterns—including Mediterranean-style, lower-fat, and lower-carbohydrate approaches—can be effective for improving blood sugar in prediabetes, as long as they emphasize whole foods, minimize refined carbohydrates, and support sustainable weight loss.^{12, 13} Ultimately, the “best” diet approach for prediabetes is one that supports healthy glucose levels and that you can stick to long-term.

Can you treat prediabetes with medication?

Some medications have been shown to reduce the risk of progressing to type 2 diabetes, particularly for people at higher risk.^{6, 13} However, no medications are currently FDA-approved to treat prediabetes, and lifestyle changes remain the most effective and recommended first step ¹³.

The prescription medication metformin may be considered for those with prediabetes (along with diet and exercise), especially for people who are at higher risk, such as those who:¹³ 

• Are 25-59 years old  

• Have a BMI of 35 or higher  

• Have a higher fasting glucose (>/=110 mg/dL)  

• Have a higher A1C (>/=6.0%)  

• Have a history of gestational diabetes  

Diet and lifestyle changes that help with prediabetes 

As mentioned, diet and lifestyle interventions can be effective in preventing progression and, for some people, reversing prediabetes.

Since carbohydrates in food cause the biggest rise in glucose and insulin compared with protein or fat¹⁴, research suggests the type and amount of carbs we eat plays an important role in navigating insulin resistance, prediabetes, and type 2 diabetes.¹⁵

Diets high in simple and refined carbohydrates (such as cookies, chips, candies, and sugar-sweetened beverages) can cause sharp increases in blood sugar. Over time, this may contribute to insulin resistance and a higher risk of diabetes.¹⁶ Recent research using CGMs found that those who spend less time above the healthy glucose range (70-140mg/dL) have a lower risk of developing diabetes over the next 5 years.¹⁷

Diet changes to help prediabetes 

• Reducing the carbohydrate load of your diet. Skip the sugar-sweetened beverages, cookies, sweets, and much of the white stuff (sugar, bread, pasta, crackers, etc.). 

• Eating enough protein. Adding protein helps reduce the size of glucose spikes,¹⁸ helps you feel full,¹⁹ and helps maintain muscle mass.²⁰ Muscle plays a vital role in insulin sensitivity and the ability to utilize glucose.²¹  

• Focusing on fiber. Fiber helps you feel satiated and can stabilize glucose after eating.²²  

• Choosing healthy fats. When a diet is very low in carbohydrates, fat can be a source of energy and doesn’t spike glucose. Some healthy sources include olive oil, avocados, nuts, full-fat dairy, and fatty fish.  

How exercise can help prediabetes

Regular physical activity is an effective way to improve blood sugar in people with prediabetes. Research shows that exercise can lower fasting glucose,²³ improve A1C, and support healthy weight loss,²⁴ and is most effective when aerobic and strength training are combined.²⁵

Different types of exercise offer unique benefits:  

• Aerobic exercise like brisk walking, biking, or swimming can lower A1C, fasting glucose, and glucose after meals.²⁴

• Resistance/strength training such as weights or bodyweight exercises can lower fasting glucose and help improve insulin sensitivity over time, while adding muscle that can use more glucose.²⁶

• Combination training: doing both aerobic and strength work may produce the greatest improvements in blood sugar, body weight, and overall metabolic health.²⁵

• Breaking up long periods of sitting with short movement breaks can help reduce post-meal glucose spikes.²⁷ 

Physical activity to aim for: 

• Move regularly: work towards 150 minutes of moderate aerobic activity per week to support healthier glucose and insulin levels. 

• Build muscle: add strength training 2-3 times per week to improve how your body uses glucose. 

• Break up sitting: stand or move briefly every 30-60 minutes, especially after meals, to help reduce glucose spikes. 

Start simple: 

• New to exercise? --> 10-minute walks after meals 

• Already walking? --> add strength training 

• Sit most of the day? --> set a reminder to stand or walk briefly 

• Like variety? --> mix aerobic and strength training for the best results 

Bottom line: All movement helps, but the most effective approach for prediabetes is a mix of regular aerobic activity, strength training, and breaking up long sitting time.

Using a continuous glucose monitor (CGM)

Using a CGM can help provide more insight into how your body uniquely responds to the foods you eat, since everyone processes carbs differently.

Lingo is a CGM that’s designed to help you see the impact of your diet and exercise habits, providing real-time glucose data that supports building new healthy habits and understanding what keeps your glucose levels in a healthy range.

Research indicates that CGMs can not only help people spot when their glucose levels are regularly outside a healthy range, but also guide changes to diet and lifestyle that can help prevent glucose issues from progressing.²⁸

A final note from Lingo 

A diagnosis of prediabetes can feel overwhelming, but the good news is there are practical strategies you can implement today to support your health and even reverse the metabolic changes that have started to occur.

Lingo, a CGM, can help you personalize your approach even more. Fine-tuning your nutrition based on your own unique response to foods is an effective strategy to keep glucose in a healthy range more often and lower your risk of progressing to type 2 diabetes.

Every individual has a different amount of carbohydrates their body can tolerate while keeping their glucose in a healthy range. Wearing a CGM can help you identify the foods that cause glucose spikes and how incorporating physical activity may help.

This real-time data can help you work toward changing your habits to reduce those glucose and insulin spikes.

Over time, consistently keeping glucose in a healthy range and minimizing insulin surges may help improve metabolic health and reduce your risk of progressing to type 2 diabetes.¹⁷

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