Prediabetes is a precursor condition to diabetes with elevated risks of heart disease and stroke due to blood sugars being higher than what they should be.
What is Prediabetes?
Prediabetes is a condition where blood sugar levels are higher than normal, yet not high enough to meet the diagnostic threshold for type 2 diabetes. It indicates that the body’s ability to manage glucose is impaired due to insulin resistance, — a state where our body’s cells no longer respond effectively to insulin, the hormone responsible for getting rid of glucose from the bloodstream.
Fasting blood glucose levels range from 5.6 to 6.9 mmol/L
2-hour blood glucose during an oral glucose tolerance test range from 7.8 to 11.0 mmol/L
Left unaddressed, prediabetes can easily progress to type 2 diabetes and in itself carries a higher risk of heart attack, and stroke. Much like diabetes and high blood pressure, the condition is often silent and without symptoms. This makes regular screening, particularly in individuals with risk factors like obesity, family history of diabetes, gestational diabetes, sedentary lifestyle, or metabolic syndrome, crucial for early detection and subsequent intervention.
Dr Dinesh Mahendran has had experience reversing prediabetes in his patients. The most important step is realising what prediabetes is, its adherent risks and what needs to be done. With timely lifestyle changes to decrease energy intake and improve energy expenditure through an improved diet, increased physical activity and muscle mass, and subsequent weight loss, you can restore normal glucose regulation and prevent the progression to diabetes. Failing this pharmacotherapy may be required.
With the right steps and adopting better lifestyle choices, prediabetes can be reversed.
How common is Prediabetes in Singapore?
Prediabetes is a growing health concern in Singapore, affecting a significant portion of the adult population. As of 2017, approximately 430,000 Singaporeans aged 18 to 69 years — about 14% of this age group—were estimated to have prediabetes. Projections indicate that by 2035, the prevalence of prediabetes among Singapore residents aged 21 and above could rise to nearly 25%.
Alarmingly, a substantial number of individuals with prediabetes are unaware of their condition. A 2024 survey revealed that nearly 40% of health-screening participants had prediabetes, yet almost 70% of them believed they did not have diabetes. This lack of awareness underscores the importance of regular health screenings and subsequent patient education, for early detection and intervention.
Without appropriate lifestyle changes, prediabetes can progress to type 2 diabetes. Studies suggest that at least 35% of individuals with prediabetes in Singapore may develop type 2 diabetes within eight years if no preventive measures are taken.
At The Metabolic Clinic, we emphasise the importance of early detection and proactive management of prediabetes. Through comprehensive screening and personalised care plans, we aim to help individuals reverse prediabetes, reduce risk of heart attack and stroke and ultimately prevent the onset of type 2 diabetes.
What causes Prediabetes?
Prediabetes develops when the body’s ability to manage blood sugar becomes impaired, resulting in higher than normal blood sugar levels. This is due to defects in the way the body responds to insulin (insulin resistance) combined with an inability to increase insulin production to overcome this (impaired insulin secretion) . The two key processes involved are insulin resistance and impaired insulin secretion.
Prediabetes is caused by insulin resistance, where cells no longer respond properly to insulin, preventing glucose from entering and building up in the bloodstream.
Impaired insulin secretion — refers to the gradual decline in the pancreas’s ability to produce enough insulin. In prediabetes, insulin production may initially increase to compensate for insulin resistance, but eventually, it is not sufficient to overcome the resistance in the body’s tissues.
Hepatic glucose overproduction — takes place when the liver releases too much glucose into the bloodstream, especially during fasting. This process should normally be regulated by insulin, but in prediabetes, the liver does not respond properly to hormonal signals.
Defective glucose uptake — muscle and fat tissues are unable to absorb glucose efficiently. This leads to elevated blood sugar levels even after meals, contributing to postprandial (after-meal) hyperglycaemia — one of the early signs of prediabetes.
Chronic low-grade inflammation — is increasingly recognised as a contributor to prediabetes. Inflammatory molecules released by fat tissue, particularly visceral fat, can interfere with insulin signalling pathways and worsen insulin resistance.
Mitochondrial dysfunction — refers to impaired energy production within cells. When the mitochondria do not function properly, the body’s metabolic flexibility declines, making it harder to utilise glucose for energy.
Hormonal imbalances — such as elevated cortisol or abnormal levels of adipokines (hormones released by fat tissue), may disrupt glucose metabolism and further impair insulin sensitivity.
What are the warning signs and symptoms of Prediabetes?
Prediabetes typically develops without any obvious symptoms, which is why many people are unaware they have the condition. It is often detected only during routine health screenings or blood tests.
Prediabetes often remains undiagnosed until it becomes diabetes and symptomatic. That is why early screening is crucial, especially for individuals with known risk factors.
Who is at risk of Prediabetes in Singapore?
Prediabetes is a growing health concern in Singapore, often developing silently without noticeable symptoms. Recognising who is at risk is crucial for early detection and prevention.
Individuals aged 40 and above — the risk of developing prediabetes increases with age, particularly for those over 40.
Physically inactive individuals — leading a sedentary lifestyle contributes to insulin resistance, a precursor to prediabetes.
Individuals with high blood pressure or abnormal cholesterol levels — these conditions are often linked with insulin resistance and can increase the risk of prediabetes.
Women with a history of gestational diabetes — women who developed diabetes during pregnancy or gave birth to a baby weighing more than 4 kg are at higher risk.
Individuals with impaired glucose tolerance or impaired fasting glucose — these conditions are early indicators of disrupted blood sugar regulation.
What health complications can arise due to Prediabetes?
Prediabetes is more than just a warning sign — it is a metabolic imbalance that can quietly damage the body over time if left unmanaged. While it has not yet progressed to type 2 diabetes, the underlying issues with insulin resistance and elevated blood sugar levels can trigger a range of complications affecting multiple organs and systems. Endocrinologist, Dr Dinesh Mahendran published a study in Australia on the cardiovascular effects of prediabetes, showing that hospitalised heart patients had a high prevalence of prediabetes and those with prediabetes suffered a greater risk of poor cardiovascular outcomes [1].
Prediabetes increases the risk of developing health complications, such as type 2 diabetes, heart disease, and stroke.
Dr Dinesh commented that the negative effect of having higher blood sugar levels does not magically appear at a certain level (for example when diagnosed with diabetes), its negative effects start at the prediabetes level and worsens as prediabetes worsens and eventually progresses into diabetes where the highest risk lies.
Progression to type 2 diabetes — the most immediate and well-known complication. Without lifestyle changes or medical intervention, many individuals with prediabetes will go on to develop type 2 diabetes, often within five to ten years.
Cardiovascular disease — including heart attacks, strokes, and high blood pressure, is significantly more likely in individuals with prediabetes. Even modestly raised glucose levels can damage blood vessels and increase inflammation, contributing to atherosclerosis.
Fatty liver disease — particularly non-alcoholic fatty liver disease (NAFLD), is frequently linked with insulin resistance. Prediabetes increases the risk of liver fat accumulation, which can progress to inflammation and scarring over time.
Chronic kidney disease — can begin developing even before diabetes is diagnosed. Elevated blood sugar can stress the kidneys and impair their function, especially in the presence of high blood pressure or poor metabolic control.
Nerve damage — also known as peripheral neuropathy, may occur in some individuals with prediabetes. Early nerve damage can cause tingling, numbness, or pain in the hands and feet, and may worsen as blood sugar rises. This is also a common cause for erectile dysfunction.
Retinal changes — although more common in diabetes, early changes to the small blood vessels in the eyes can begin during prediabetes. Over time, this can increase the risk of diabetic retinopathy and vision problems.
Sleep apnoea — is not only more common in individuals with prediabetes but may also worsen insulin resistance. The link between poor sleep and metabolic dysfunction makes this a two-way concern.
Cognitive decline — has been associated with elevated blood sugar levels. Some studies suggest that prediabetes may contribute to a higher risk of dementia and cognitive impairment later in life.
Prediabetes can still be reversed as the body is still in a stage where it can regulate blood sugar effectively with the right support.
Can I reverse Prediabetes?
Yes, prediabetes can often be reversed with the right lifestyle changes and medical support. Unlike type 2 diabetes, which may require lifelong management, prediabetes is a stage where your body is still capable of restoring healthy blood sugar control — but only if action is taken early.
Here’s how you can reverse prediabetes and reduce your risk of future complications:
Healthy weight loss — losing even 5 to 7% of your body weight can significantly improve insulin sensitivity and lower blood sugar levels. For someone weighing 70 kg, this means shedding 3.5 to 5 kg can make a meaningful difference.
Balanced eating habits — focus on portion-controlled whole foods such as vegetables, whole grains, lean proteins, legumes, and healthy fats. Reducing intake of sugary drinks, refined carbohydrates, and processed snacks helps to stabilise blood glucose and prevent insulin spikes.
Regular physical activity — aim for at least 150 minutes of moderate-intensity exercise per week, such as brisk walking, swimming, or cycling. Physical activity helps muscles absorb glucose without relying solely on insulin, easing the strain on your pancreas.
Better sleep and stress management — poor sleep and chronic stress can increase cortisol levels, which in turn worsen insulin resistance. Establishing healthy sleep routines and incorporating stress-reduction techniques like deep breathing or mindfulness can support glucose control.
Regular monitoring — keeping track of your blood sugar through regular health checks allows you to stay informed and make timely adjustments to your lifestyle or treatment plan.
Medical support — in some cases, medications such as metformin may be prescribed to support blood sugar regulation, especially if lifestyle changes alone are not enough or if you have additional risk factors like obesity or PCOS.
How is prediabetes diagnosed?
Prediabetes is diagnosed through simple blood tests that measure how your body processes glucose. These tests help identify whether your blood sugar levels are elevated beyond the normal range but not high enough to qualify as type 2 diabetes.
Oral glucose tolerance test (OGTT) — involves checking blood sugar levels two hours after drinking a glucose solution. A two-hour value between 7.8 mmol/L and 11.0 mmol/L confirms prediabetes.
These tests may be recommended during routine screenings, especially if you have risk factors like excess weight, a family history of diabetes, or high blood pressure. As prediabetes often presents with no symptoms, testing is the only reliable way to detect it early. Dr Dinesh can also help patients who have discordant results (for e.g. a normal fasting glucose but abnormal glucose tolerance test.
Medical therapy — when lifestyle changes are not enough
Even with lifestyle interventions, it may be hard for individuals to reverse prediabetes. For individuals who are unable to achieve glycaemic targets through lifestyle modifications alone, or who have additional risk factors, pharmacotherapy may be considered. Metformin is the most commonly prescribed medication for prediabetes in Singapore, particularly for those with a BMI ≥ 23 kg/m², individuals under 60 years of age, or women with a history of gestational diabetes.
Metformin works by reducing hepatic glucose production and improving insulin sensitivity. It has been shown to lower the risk of progression to type 2 diabetes, especially when combined with lifestyle interventions.
Ongoing monitoring — tracking progress and adjusting plans
Regular monitoring of blood glucose levels is essential in managing prediabetes. Continuous Glucose Monitoring (CGM) devices are becoming increasingly popular as a relatively non-invasive way of providing real-time feedback on how diet and lifestyle choices affect blood sugar levels.
By observing glucose trends, individuals can make informed decisions about their health behaviours and adjust their management plans accordingly.
Summary
Regular exercise can greatly help reverse prediabetes at any age by improving insulin sensitivity and blood sugar control.
Prediabetes is a critical early warning sign that your body is struggling to regulate blood sugar, but the condition is reversible with the right interventions. At The Metabolic Clinic, we offer a comprehensive approach to prediabetes — from accurate diagnosis and early detection to personalised lifestyle plans, medical support, and long-term monitoring.
Early action is crucial. If you're at risk or have been diagnosed with prediabetes, our goal is to help you take control, restore healthy glucose balance, and prevent the onset of type 2 diabetes. Schedule a consultation with us to start your journey towards better metabolic health.
Frequently Asked Questions (FAQs)
Can I have prediabetes if I feel perfectly healthy?
Yes. Most people with prediabetes feel completely well and have no symptoms. That’s why regular screening is important, especially if you have risk factors.
Is prediabetes the same as borderline diabetes?
Yes, the terms are often used interchangeably. Both refer to blood sugar levels that are higher than normal but not high enough to be classified as type 2 diabetes.
Does prediabetes always lead to diabetes?
No. With early lifestyle changes, such as healthy eating, regular exercise, and weight management, many people can prevent progression to diabetes or even reverse prediabetes.
How often should I be tested for prediabetes?
If you are at risk, screening is typically recommended every 1 to 2 years, depending on your age, weight, and overall health status.
Does prediabetes affect fertility?
In women, prediabetes, especially when linked with conditions like PCOS, can affect ovulation and fertility. Managing blood sugar can improve reproductive health.
Is prediabetes considered a chronic condition? Prediabetes is a reversible metabolic condition, but it is considered chronic if left unmanaged and is not improved. Early intervention can halt or even reverse its progression.
Will I need medication if I have prediabetes? Not always. Most people start with lifestyle changes, but in some cases, especially if you have a higher risk of progressing to diabetes, your doctor may recommend medications like metformin.
How does prediabetes affect cholesterol levels?
Prediabetes often co-exists with abnormal lipid levels, including high triglycerides and low HDL, which increases the risk of cardiovascular disease.
Should I avoid all sugar if I have prediabetes?
You don’t need to eliminate all sugar, but reducing added sugars and refined carbohydrates is one of the pillars of dietary management. Focus on balanced meals with low glycaemic index foods to keep your blood sugar stable.
How long does it take to reverse prediabetes? With consistent lifestyle changes, many people see improvements within 3 to 12 months. However, the time frame varies depending on individual health status and adherence.
Can prediabetes return after it’s reversed? Yes. Even after reversing prediabetes, it’s important to maintain healthy habits, as blood sugar levels can rise again if old habits return/ there is a gain in weight.
References
[1] Mahendran DC, Hamilton G, Weiss J, Churilov L, Lew J, Khoo K, Lam Q, Robbins R, Hart GK, Johnson D, Hare DL. Prevalence of pre-existing dysglycaemia among inpatients with acute coronary syndrome and associations with outcomes. Diabetes research and clinical practice. 2019 Aug 1;154:130-7.
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