Prediabetes: the window where you can still turn it

What this article covers

What does prediabetes actually mean?
How to read your HbA1c result
Does prediabetes always progress to diabetes?
What actually makes a difference in diet?
How much exercise is actually enough?
Sleep and stress: two factors that are always overlooked
Do you need medication at this stage?
How to track your progress and when to go back to the doctor
Questions to ask your doctor at the next visit

What does prediabetes actually mean?

Prediabetes is not a disease in the traditional sense. It is a middle zone where blood sugar is higher than normal but has not yet reached the level at which type 2 diabetes is diagnosed. Your body is still responding to insulin, but less efficiently than it should be. This is a genuine opportunity to act before the problem compounds.

Many people discover prediabetes by accident during a routine check because it causes no obvious symptoms in most cases. Some may feel unusually tired, thirsty, or notice more frequent urination, but these are non-specific symptoms shared with many other conditions. The only reliable way to know is a blood test.

Across the Middle East, several factors have contributed to its growing prevalence: diets rich in refined carbohydrates and sweetened drinks, sedentary lifestyles, and genetic susceptibility in certain populations. A 2024 Saudi study in Annals of Medicine found that obesity, physical inactivity, and a family history of diabetes all strongly predict prediabetes in the region.

It is worth knowing the difference between impaired fasting glucose (IFG) and impaired glucose tolerance (IGT). Both are forms of prediabetes and they sometimes overlap. IFG is detected by a simple fasting blood test, while IGT requires an oral glucose tolerance test (OGTT) where you drink a measured glucose solution and your blood is checked two hours later. Knowing which pattern you have helps your doctor choose the most relevant management approach.

Where does your fasting glucose sit?

Fasting glucosemg/dL

Normal

Prediabetes

Diabetes

Example at-risk result 112

70 99 125 200

Source: American Diabetes Association Standards 2024

How to read your HbA1c result

The HbA1c test, also called glycated haemoglobin, reflects your average blood sugar over the past two to three months. It is more informative than a single fasting glucose reading because it is not affected by what you happened to eat on the morning of the test. It is expressed as a percentage.

A normal result is below 5.7%. The prediabetes range is 5.7% to 6.4%. An HbA1c of 6.5% or above on two separate tests meets the diagnostic threshold for type 2 diabetes. Some laboratories in the region use different units (mmol/mol), so ask your doctor to interpret the result in the context of your full picture.

The test does not require fasting, which makes it practical for many people. However, certain medical conditions such as anaemia or haemoglobin disorders can affect its accuracy, so your doctor needs to interpret it alongside your overall health status.

Understanding your HbA1c result

HbA1c%

Normal

Diabetes

Example result 6

4 5.6 6.4 10

Source: Unnikrishnan R et al: Prediabetes, Nature reviews Disease primers, 2025

Does prediabetes always progress to diabetes?

No, and this is the most important message here. Prediabetes is not a one-way road. Research consistently shows that many people return to normal blood sugar levels with lifestyle change, and others remain in the intermediate zone for years without converting to diabetes.

The landmark US Diabetes Prevention Program trial, published in the New England Journal of Medicine in 2002, followed more than 3,000 people with prediabetes. Those who lost 7 percent of their body weight and walked for 150 minutes a week reduced their risk of developing diabetes by 58 percent. This was superior to metformin in the same trial.

A 2024 systematic review in the American Journal of Clinical Nutrition confirmed that lifestyle weight-loss interventions are effective at returning blood sugar to normal, and that each kilogram lost makes a measurable difference. You do not need to reach an ideal weight to see results.

What actually makes a difference in diet?

The goal is not a strict elimination diet or deprivation. It is about shifting the overall balance of what you eat. Reducing refined carbohydrates such as white bread, polished white rice, pastries, and sweetened drinks has a direct impact on blood sugar after meals.

Foods with a low glycaemic index slow the rise in blood sugar and help your body work more efficiently. In Middle Eastern cooking, lentils, chickpeas, broad beans, and vegetable-based stews are excellent choices. Starting a meal with protein or fat before bread and rice also slows glucose absorption meaningfully.

A 2021 study published in the Journal of Diabetes Investigation followed Arab women with prediabetes through a nutrition education programme delivered via social media. It found measurable improvement in blood sugar levels, which shows that targeted dietary education works in this population even through accessible channels.

Smarter swaps from everyday cooking

Food	Blood sugar effect	Better option
White bread	Rapid glucose spike	Wholegrain or barley bread
White polished rice	High glycaemic index	Brown rice or add lentils
Fruit juice	Fast-absorbing sugar	Whole fruit or water with mint
Fried potato	High fat and starch	Boiled or roasted sweet potato
Lentils, chickpeas, beans	Low glycaemic index	Excellent, use daily

How much exercise is actually enough?

One hundred and fifty minutes of brisk walking per week, roughly 20 to 30 minutes on most days, is what the large intervention trials showed is sufficient to produce meaningful improvement in insulin sensitivity. No gym membership or equipment is required.

Walking in the morning or after evening prayers in summer heat is the practical solution across most of the region. If outdoor temperature is a barrier, walking indoors or in a shopping centre is equally effective. The priority is consistency over intensity.

Resistance exercise, whether light weights or bodyweight movements such as squats and wall press-ups, builds muscle mass. This matters because muscle uses glucose more efficiently than fat tissue. Three sessions of 15 to 20 minutes per week is a reasonable starting point and can be built from there.

Do not underestimate accumulated movement throughout the day. Standing rather than sitting, climbing stairs instead of taking a lift, and brief walks between work tasks all count toward your daily total. Research shows that prolonged sitting impairs insulin sensitivity even in people who exercise at other times, so breaking up long seated periods every hour has real independent value.

Sleep and stress: two factors that are always overlooked

Poor sleep raises cortisol, which directly opposes the action of insulin. Fewer than six hours of sleep per night is linked to a significant increase in type 2 diabetes risk. If you snore heavily or wake unrefreshed, discuss this with your doctor, as obstructive sleep apnoea independently worsens glucose control and is under-diagnosed in the region.

Chronic stress, whether from work, family pressure, or broader circumstances, raises blood sugar through multiple hormonal pathways. This does not mean you must eliminate all stress, but learning practical coping strategies such as brief breathing exercises, regular walks, or talking with someone you trust does make a measurable difference over time.

Intermittent fasting and structured meal timing appeal to many people and can be helpful for some, but they are not required for everyone with prediabetes. What is consistently useful is regularity in sleep and meal times, which helps the body maintain better metabolic rhythm.

Do you need medication at this stage?

In most cases, no. The large trials consistently show that lifestyle change outperforms medication as a first step for reversing prediabetes. The main exception is metformin, a safe, long-established medicine that your doctor may consider for specific situations: HbA1c close to the diagnostic threshold, difficulty sustaining lifestyle change, or a history of gestational diabetes.

A 2022 Saudi study in Frontiers in Public Health looked at metformin use for diabetes prevention and found it is used in the region but remains less effective than genuine lifestyle modification when the latter is properly applied. The decision belongs to your doctor after a full assessment.

Do not take any supplement, herbal product, or compound that claims to reverse prediabetes without medical advice. Some interact with other medicines, and others lower blood sugar in unpredictable ways.

A 2025 scoping review of lifestyle modification programmes in Saudi Arabia found that interventions combining group support with individual guidance achieved better outcomes than information alone. If a structured programme is available through your clinic or health insurer, joining it is more effective than self-management without support.

During Ramadan, eating patterns shift dramatically. Many people load up on refined carbohydrates and sweets at iftar, which causes sharp blood sugar swings. If you have prediabetes and plan to fast, discuss your dietary plan with a doctor or dietitian before the month begins. Prioritising protein, vegetables, and pulses at suhoor helps sustain satiety and prevents the sharp post-iftar glucose spike that worries most people in this situation.

How to track your progress and when to go back to the doctor

After three months of consistent dietary and activity changes, recheck your HbA1c or fasting glucose. This window is enough to see a real change if you have been consistent. You do not need to wait a full year to know whether the effort is working.

Weigh yourself weekly rather than daily, because daily weight fluctuates for reasons unrelated to fat loss. A loss of half a kilogram to one kilogram per week is a healthy and sustainable rate. If weight stalls for several weeks, ask your doctor or a dietitian to review the plan rather than abandoning it.

If your numbers are not moving after six months of genuine effort, tell your doctor. This is not a failure. It is useful information that may change the management plan, including consideration of medication or referral to a structured diabetes prevention programme if one is available locally.

Recommended monitoring plan

Now Record baseline HbA1c and fasting glucose
Week 1-2 Make one dietary change and add 20 minutes of daily walking
Month 1 Review your weight and consistency, adjust if needed
Month 3 Recheck HbA1c or fasting glucose and discuss with your doctor
Month 6 Further check if numbers have not reached normal range

Questions to ask your doctor at the next visit

Bring your test result to the appointment and ask: how far am I from the diabetes threshold? Do I need to check cholesterol and kidney function? Do I need blood pressure monitoring? These additional checks together build a complete picture of your cardiovascular risk and help prioritise where to focus.

If you have polycystic ovary syndrome (PCOS), a history of gestational diabetes, or a close family member with type 2 diabetes, tell your doctor, as these factors warrant more frequent monitoring. In these situations your doctor may recommend annual rather than three-yearly checks.

Ask about referral to a dietitian or a diabetes prevention programme if either is available through your local health centre or insurance. Structured support measurably outperforms self-management alone.

The Sihtak app lets you log blood sugar readings and track your meals in one place, making your follow-up visits more informative and your progress easier to see.

Frequently asked questions

Can I return to completely normal blood sugar?

Yes, and this happens for many people. Large trials show that lifestyle change fully reverses prediabetes in a significant proportion of individuals, especially when action is taken early. Returning to old habits after normalisation can push numbers back up, so the goal is a sustained change rather than a temporary diet.

What fasting glucose number puts me in the danger zone?

A fasting glucose between 100 and 125 mg/dL is classified as prediabetes. Below 100 is normal. At 126 mg/dL or above on two separate tests, the diagnosis shifts to type 2 diabetes. The test requires at least eight hours of fasting beforehand.

Do I need a special diet to reverse prediabetes?

No strict diet is required. The key changes are reducing refined carbohydrates and sweetened drinks while increasing pulses, vegetables, and protein. A dietitian can help you build a plan around your existing eating habits rather than replacing them entirely.

Does prediabetes cause any symptoms?

Usually not, which is why it so often goes undetected until a routine blood test. Some people notice fatigue, thirst, or increased urination, but these are non-specific and shared with many other conditions. Regular blood testing is the only reliable way to catch it.

Is metformin suitable for everyone with prediabetes?

No. Metformin is not routinely prescribed for prediabetes. Doctors consider it in specific situations, such as when HbA1c is close to the diagnostic cutoff or when lifestyle change is not achievable. The decision belongs to your doctor after full assessment.

Can complications develop while I am in the prediabetes stage?

Classic diabetes complications such as retinopathy and neuropathy are uncommon at this stage, but vascular risk begins to rise with elevated blood sugar. This is precisely why early action matters before the condition becomes full diabetes.

How often should I test my blood sugar if I have prediabetes?

The general recommendation is to recheck HbA1c or fasting glucose every three to six months while making lifestyle changes, then annually once numbers have stabilised in the normal range. Your doctor will set the exact schedule based on your individual situation.

Sources

This content is for health education only and is not a substitute for medical advice. If you have symptoms that worry you, see your doctor.