Prediabetes guide
Snapshot
- Definition: A1c 5.7–6.4%, fasting glucose 100–125 mg/dL, or 2-hour OGTT 140–199 mg/dL.
- Clinical goal: Delay or prevent progression to type 2 diabetes and reduce ASCVD risk.
Core management
- Weight reduction target: 5–10% within 6–12 months.
- Nutrition: Reduce ultra-processed carbs; emphasize high-fiber, protein-forward meals.
- Physical activity: 150+ minutes/week moderate activity + resistance training 2x/week.
- Sleep + stress: Improve sleep quality and stress load to improve insulin sensitivity.
Medication considerations
- Consider metformin in higher-risk groups (BMI ≥35, age <60, prior gestational diabetes, rising A1c despite lifestyle).
- Evaluate obesity-focused therapies if weight is a major driver and benefits outweigh cost/tolerability barriers.
Monitoring plan
- Recheck A1c every 3–6 months.
- Track BP, lipids, renal function, and weight trajectory.
- Escalate care when glycemic markers rise or cardio-renal risk profile worsens.