Managing prediabetes

An introduction to treating prediabetes

• The core goal of treating prediabetes is to return blood glucose levels to normal. People can also expect to feel better and achieve a slimmer waist. Benefits are often noticed within a few weeks.
• Most people can improve prediabetes and prevent type 2 diabetes. Many can completely reverse prediabetes.
• Lifestyle changes are the mainstay of treatment. This includes nutrition, movement, sleep, and mindset.
• Nutrition often has the largest impact. Specific dietary approaches that reduce sugar and starchy carbohydrates having the most evidence.
• People should pick lifestyle improvements that work for them and are enjoyable.

I find patients can become really motivated when they have hope and confidence that they can improve and reverse prediabetes.

I explain that it is nearly always possible to improve prediabetes and often completely reverse it. I tell them with the right lifestyle changes they can expect to notice benefits within two or three weeks, including: less hunger, a slimmer waist, and more energy.

Every patient's situation and journey is different. So, there is no one-size-fits-all to treating prediabetes. However, there is agreement that dietary changes that reduce sugar, highly-processed foods, and refined carbohydrate has the most evidence.

Most patients know they need to reduce sugar, but less are aware of the importance of reducing starchy carbohydrate foods. Because starchy carbohydrate foods get digested into sugar.

"What should I eat?" is a common question. Food lists are very helpful for this. The traffic light diet sheets are particularly popular. 

Improving prediabetes, avoiding type 2 diabetes, and feeling better is possible for almost everyone. In addition, many people can reverse prediabetes and achieve a completely normal blood glucose level once again.

Lifestyle changes are the mainstay of treating prediabetes. These changes make it easier for the body to control blood glucose by improving insulin resistance.

Lifestyle includes nutrition (food and drink), movement, sleep, and mindset. It is nutrition that has the greatest impact on improving prediabetes.

With the right lifestyle changes health benefits can be noticed in under three weeks. This can include loss of belly fat and a shrinking waistline, reduced hunger, more energy, and better blood glucose. If the successful lifestyle changes are continued, then an HbA1c test after three months will typically show improvement.

Individuals should find a lifestyle that works for them.

There is not a one-size-fits all approach to what people with prediabetes should eat. People’s body’s work in different ways, and there are many factors that influence a person’s food preferences.

In 2019 the American Diabetes Association published a very useful article that looked at what food choices were most helpful for people with prediabetes and diabetes.

The article states:

A variety of eating patterns (combinations of different foods or food groups) are acceptable for the management of diabetes.

Until the evidence surrounding comparative benefits of different eating patterns in specific individuals strengthens, health care providers should focus on the key factors that are common among the patterns:

• Emphasize non-starchy vegetables.

• Minimize added sugars and refined grains.

• Choose whole foods over highly processed foods to the extent possible.

Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia and may be applied in a variety of eating patterns that meet individual needs and preferences.

In simple terms, this means reducing sugar, highly-processed foods, and starchy carbohydrates. And fitting with a person’s other dietary needs and preferences.

For some people simply cutting out sugary foods and drinks is an effective and achievable approach. For other people minimising starchy foods such as bread, breakfast cereals, rice, and pasta is also important. Even brown or whole-grain version of these foods will usually need to be reduced as the starch in them will raise blood glucose levels.

Many people find it easier to follow a specific dietary approach. Common approaches that can fit with most personal preferences include:

• Very low carbohydrate diet
• Low carbohydrate diet
• Moderate carbohydrate diet
• Higher protein diet

Typically, the lower carbohydrate intake will lead to a greater and more rapid improvement in prediabetes. But not everyone needs or wants to follow a very low carbohydrate diet. For others, a high protein diet suits better and helps with weight loss.

Moving the body provides many health benefits. These benefits are not all due to “burning calories”. Simply moving the body and activities that challenge muscles are beneficial.

The national recommendations for adults are:

• Minimise sedentary time. This means moving frequently. When awake, do not spend long periods of time sitting or lying down.
• Aerobic activity. About 150 minutes a week of moderate activity or 75 minutes of vigorous activity. Ideally spread across the week. Moderate activity is at an intensity which causes an increase in breathing rate but a person can still complete a sentence. Vigorous activity is at an intensity where the breathing rate increases so a person cannot complete a sentence before breathing again.
• Resistance activity. This is activity that challenges the big muscles of the body. The legs, thighs, buttocks, and arms. Resistance activity should be undertaken at least twice a week. Even a few minutes is beneficial. Activities can range from heavy gardening or house work, to body weight exercises such as squats and press-ups, to lifting weights.

Adequate sleep helps the body to improve blood glucose. Enough sleep also helps to reduce cravings for sugary food. Sleep should be prioritised where possible. It is perhaps important not to aim for perfection, which could risk worry and insomnia.

The key elements for adequate sleep are:

• A regular bed time. Aiming to get to bed within the same hour every day.
• Allowing enough time for between 7 and 9 hours sleep. A small number of people may have sufficient sleep with less.
• Waking up naturally, without needing an alarm.

Chronic stress can lead to increased insulin resistance in the body and a rise in blood glucose. Reducing chronic stress where possible can benefit prediabetes, and may also support more helpful food choices.

• Evert AB, Dennison M, Gardner CD, et al. Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. Diabetes Care.
• https://www.gov.uk/government/publications/physical-activity-guidelines-uk-chief-medical-officers-report