What causes prediabetes?

Lifestyle risk factors for prediabetes

• Lifestyle includes food and drink (nutrition), movement and exercise, sleep, and mindset.
• Nutrition is typically the most important contributor to prediabetes. Sugar and ultra-processed foods are the major culprits.
• Once prediabetes has developed it is important to improve lifestyle to prevent the development of type 2 diabetes.

I have met some patients who were not suprised when they were diagnosed with prediabetes. They have been adding sugar to their tea and coffee for years, eating sugary foods most days, and spent most of their day sitting. The prediabetes diagnosis told them what they secretly already knew. 

However, for other patients a diagnosis of prediabetes comes as more of a shock. These people typically thought they ate relatively healthily and did not eat a lot of sugar. When I’ve asked more about their diet I usually hear they have been eating quite a lot of refined starchy carbohydrate – such as bread, pasta, breakfast cereals, and white rice. Having discovered this with a patient, we will then discuss how these starchy foods get digested down into glucose, raising blood sugar levels. This realisation seems to help to make sense of why the prediabetes developed and what the person needs to do with their food choices to improve their health.

Food and drink choices seem to be the common theme in the development of prediabetes. However, the amount of movement and exercise someone does, their sleep, and if they are chronically stressed can also have a significant role in the development of prediabetes.

If patients can understand what lifestyle choices led to prediabetes, it is easier for them to take action to improve their health again. Lifestyle improvement will hopefully prevent type 2 diabetes developing, and even better reverse prediabetes and achieve a normal blood glucose level again.

The term lifestyle means the way a person lives their life. There are many aspects of lifestyle that can contribute to the development of prediabetes. These include:

• Nutrition (food and drink)
• Movement (exercise and general activity)
• Sleep
• Mindset (especially chronic stress)

Lifestyle choices can either help or harm health. A lot of research has been done over recent decades to understand how lifestyle contributes to prediabetes. Nutrition plays a very significant role. Consuming sugar, ultra-processed food, and refined carbohydrate over several years seems to be a common feature in the development of prediabetes.

Whilst each aspect of lifestyle can directly contribute to prediabetes, there is also an interaction across all the lifestyle factors. For example, chronic stress can lead to poor sleep and unhealthy food choices. Equally, poor sleep can lead to chronic stress. It is important to know that each person’s situation, circumstances, and body is different. Therefore the development of prediabetes shouldn’t be thought of as developing from any single lifestyle factor. It is usually a bit more complex.

What are the major lifestyle factors that increase the likelihood of prediabetes?

• Sugary drinks.
• Sugar in food.
• Ultra-processed foods (commonly known as “junk foods”).
• Large amounts of refined starchy carbohydrates (these are foods that digest down to glucose when eaten, for example, flour).

• Spending a lot of time sitting (known as being sedentary)
• Lack of activity that challenges big muscles in the arms, legs, and buttocks (known as resistance activity)

• Not sleeping for long enough.
• Not getting refreshing sleep.

• Feeling stressed most of the time (known as chronic stress)