Is Prediabetes Medication Necessary?

Dr Jedha, Host

Hello wonderful people, Dr. Jedha here, and today we’re diving into a topic that hits close to home for many people diagnosed with prediabetes, and that is whether medication is necessary.

Prediabetes is one of the most overmedicalized conditions out there. In many cases, medications are prescribed as a first step, when the truth is that for most people, they’re completely unnecessary. So, in this episode, we’ll unpack some key questions:

• Why has prediabetes become so medicalized?
• When might medication actually be helpful?
• And most importantly, what can you do to take control of your health without relying on a prescription?

Now, here’s the thing: prediabetes has become a bit of a catch-all diagnosis. It’s often based on slightly elevated blood sugar levels that might not even pose a significant risk if addressed early with simple changes. Unfortunately, many people are left with the impression that medication is their only option.

But the truth is, prediabetes is highly reversible, and diet and lifestyle are incredibly powerful tools for turning it around. So, whether you’ve been recently diagnosed or you’re just looking for ways to support your health, this episode will give you clarity and actionable insights.

Let’s dive in.

02:45

To really understand whether medication is necessary for prediabetes, let’s start with the basics. What exactly is prediabetes, and how do doctors determine if you have it?

Prediabetes is what we call a gray area. It’s not quite normal blood sugar, but it’s not high enough to be considered type 2 diabetes either. It’s a warning sign, essentially, that your body isn’t handling blood sugar as well as it should, and without intervention, it could progress into type 2 diabetes.

Now, here are the numbers that typically define prediabetes:

• A fasting blood sugar level between 100 and 125 milligrams per deciliter.
• An A1c—your average blood sugar over the past 3 months—between 5.7% and 6.4%.

If you fall into these ranges, your doctor might ‘label’ you as prediabetic.

04:19

But here’s the thing—prediabetes has become overmedicalized in recent years. Once upon a time, there was no such label as prediabetes, and it wasn’t that long ago. The term prediabetes began gaining traction in the early 2000s as a way to identify people at higher risk of type 2 diabetes. Prior to that, it wasn’t widely used or recognized as a separate “condition.” Instead, people with higher-than-normal blood sugar were often described as having impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)—technical terms that were more commonly used in research and clinical guidelines.

In 2002, the American Diabetes Association introduced the term prediabetes in its guidelines, aiming to make the concept more understandable and actionable for the general public. The idea was to highlight an opportunity for early intervention, emphasizing that people with prediabetes could reverse the progression to type 2 diabetes with lifestyle changes.

However, this shift also contributed to the overmedicalization of slightly elevated blood sugar levels. Millions of people are now being diagnosed with it, and for many, this diagnosis doesn’t mean they’re destined to develop diabetes. In fact, research shows that a significant percentage of people with prediabetes never progress to type 2 diabetes—especially if they make even small changes to their diet and lifestyle.

Yet, medications are often prescribed right away, without giving people the chance to address the root causes through natural means first. This approach can leave people feeling overwhelmed, disempowered, or even stuck relying on pills.

And let’s be honest: no one wants that if there’s a better way.

06:16

So, who’s most at risk for prediabetes? Well, some factors are beyond our control, like age and genetics. If you’re over 45, have a family history of type 2 diabetes, or belong to certain ethnic groups, you may be at higher risk. But an increased risk doesn’t mean that prediabetes is your destiny. Even with risk factors that are out of our control, we can aim for optimal health and dramatically reduce or even remove these risks.

There are also many risk factors that are entirely within our control. Things like carrying extra weight, especially around the waist, being inactive, or eating a diet high in sugar and processed carbohydrates can all increase our risk. And those are the areas where we can make changes—and see incredible results.

07:11

So, now that we’ve set the stage for what prediabetes is, let’s get into the heart of today’s topic: is medication really necessary? And the answer, in most cases, is no.

First, let’s look at the evidence. Research shows that lifestyle changes—things like adjusting your diet, increasing physical activity, and managing stress—can reduce the risk of progressing to type 2 diabetes by up to 58%. For older adults, that number is even higher, 71% reduced risk. Now that’s pretty amazing, reducing risk of type 2 diabetes by 58-71%. This data was from a huge trial conducted in the US In the late 90s, the first landmark trial to show that people who engaged in lifestyle changes, such as improving their diet and increasing physical activity could cut their risk, and of course, lifestyle change outperformed medication. Metformin alone reduced risk by only 31%. There have been many trials since, all showing weight reduction, dietary changes, and increased physical activity can all slash risk of diabetes and outperform medication. For prediabetes, lifestyle intervention is better than medication.

And here’s something even more exciting: in many cases, these changes can completely reverse prediabetes. I’ve seen it time and time again with the people I work with—small, consistent changes often lead to huge results. And of course, there have been clinical trials that prove it. Know this: early lifestyle changes have durable benefits. The findings from trials provide hope and concrete evidence that a diagnosis of prediabetes doesn’t have to be a stepping stone to diabetes but rather an opportunity to turn things around.

09:27

So why are lifestyle changes so effective? Because prediabetes is a condition of insulin resistance. Insulin resistance occurs when the cells in your body don’t respond properly to insulin, a hormone that helps move glucose (sugar) from your blood into your cells. It’s like your body is trying to unlock a door, but the key (insulin) isn’t working as well as it should. Key triggers for spiking blood sugar and insulin are sugar and carbohydrates, especially processed carbohydrates.

By reducing the sugar and processed carbohydrates in your diet and moving your body regularly, you can improve your insulin sensitivity, which helps your body use blood sugar more effectively. And guess what? That’s something no pill can do quite as well.

Now, let’s talk about medications. The most commonly prescribed medication for prediabetes is metformin. Metformin works by helping to reduce insulin resistance and slowing the liver’s release of glucose into the bloodstream.

While metformin can be helpful in certain cases, it’s important to remember that it’s not a cure. It might help lower your blood sugar temporarily, but it only masks symptoms and doesn’t address the root cause of prediabetes and medication can’t address key things like poor diet, lack of exercise, or even stress.

And let’s not forget about potential side effects: nausea, digestive discomfort, and a risk of vitamin B12 deficiency over time.

That said, there are situations where medication might play a role. If you’re at a very high risk of developing type 2 diabetes, or if you have additional conditions like polycystic ovary syndrome or severe insulin resistance, your doctor might recommend medication as a supportive tool.

But even in these cases, medications should complement—not replace—nutrition and lifestyle changes. Think of them as a temporary bridge, not a long-term solution.

The key takeaway here is that medication isn’t a substitute for addressing the root causes of prediabetes. Most people are prescribed pills because it’s quick and easy, because that’s the default of the medical model, not necessarily because it’s the best solution for their health.

The truth is, you have the power to reverse prediabetes naturally, and most people can do so without ever needing medication.

12:59

Alright, let’s get into the good stuff—what you can actually do to reverse prediabetes naturally. Well, the power is in your hands, and it all starts with the choices you make every day. Small, consistent changes in your diet, activity levels, and lifestyle can make a huge difference. We’ve covered these things in previous episodes but let’s break it down here as well.

Let’s talk about food first. What you eat is one of the biggest factors in achieving normal blood sugar and targeting insulin resistance.

Here’s the key: prediabetes isn’t about counting calories; it’s about managing carbohydrates. When you eat foods high in carbs—especially refined ones like sugary drinks, sugary snacks, sodas, and processed foods, and when you eat too many high carb starchy foods like pasta, noodles, cereals, crackers and rice—your blood sugar spikes, your insulin spikes too. Over time, these constant spikes wear out your body’s ability to handle glucose. They worsen blood sugar control and they worsen insulin resistance.

So, what can you do?

Cut out the sugary drinks, sugary snacks, sodas, and processed foods. Reduce the amount of carbohydrates in your overall eating plan. Our modern diet is based on many high carbohydrate processed foods – cereals or toast for breakfast, sandwiches for lunch, a big bowl of pasta for dinner or a pizza – it’s all carbohydrate.

If your meal plan looks like this, where is the protein you need to build cells and regulate hormones, the healthy fats needed for your brain to function? In most cases people are not eating a balanced diet, but one full of poor quality carbohydrate foods – and that’s a large part of the problem.

Instead, focus on eating whole, nutrient-dense foods that are naturally lower in carbohydrates.

• Non-starchy vegetables like broccoli, spinach, and cauliflower should make up the bulk of your meals.
• Protein-rich foods like eggs, fish, chicken, and tofu are fantastic because they help keep you full and don’t raise blood sugar.
• Healthy fats like avocado, olive oil, and nuts not only taste great but also help you feel satisfied, reducing cravings for sugary or starchy foods.

What you eat is going to have the biggest impact on your prediabetes, so start there.

Next up: movement. Exercise is a powerful tool for improving insulin sensitivity, which is exactly what your body needs to reverse prediabetes.

You don’t need to spend hours at the gym. In fact, walking for just 20-30 minutes after meals can make a big difference, even 5-10 minutes is beneficial. Why? Because it helps your muscles use glucose for energy, lowering your blood sugar naturally.

If you’re ready to step it up, try adding resistance training—things like lifting weights, using resistance bands, or even bodyweight exercises like squats and push-ups. Building muscle is a game-changer because muscle tissue is highly effective at absorbing and using glucose. And any type of exercise improves insulin sensitivity in your body’s cells.

Now, let’s talk about two areas that often get overlooked: stress and sleep.

When you’re stressed, your body releases a hormone called cortisol. It’s part of the fight-or-flight response, but chronically high cortisol levels can make your blood sugar harder to manage. So, stress management is crucial. You can try techniques like deep breathing, mindfulness, or even taking a 10-minute walk to clear your head.

And sleep? It’s a non-negotiable. Poor sleep can increase insulin resistance and make it harder to control cravings. Aim for 7-9 hours of quality sleep each night. Simple habits like setting a consistent bedtime, avoiding screens before bed, and creating a calming evening routine can make a big difference.

18:00

At this point, you might be thinking, ‘Okay, I get it—diet and lifestyle can work. But what happens if my doctor suggests medication anyway?’ This is where advocating for yourself becomes so important. You have the right to take control of your health journey and make informed decisions about your care. After all, you are the boss of you.

The first step in avoiding overmedicalization is to ask the right questions. If your doctor recommends medication, try asking:

• ‘Is this absolutely necessary, or can I try diet and lifestyle changes first?’
• ‘What are the risks and benefits of starting medication versus making lifestyle changes?’
• ‘How long would I need to be on this medication, and are there alternatives to explore?’

It’s really important to have the conversation, to speak up. These questions aren’t about being confrontational; they’re about getting clarity so you can make the best decision for you.

It’s also important to remember that you are your own best advocate. If you feel like the conversation is too focused on medication and not enough on lifestyle, don’t be afraid to speak up. You can say something like:

• ‘I’d like to focus on reversing this naturally before considering medication. Can we set a goal to reassess in three or six months?’

Most healthcare providers will respect that approach, especially if you’re committed to making changes.

And remember, it’s okay to seek a second opinion or work with a provider who supports a lifestyle-first approach. You deserve care that aligns with your goals and values. If you prefer to take a lifestyle approach, which is the recommended pathway, it’s even the recommended pathway in the Medical Care Guidelines—lifestyle-first, so any healthcare provider should respect and support that.

20:06

If there’s one thing to take away from today, it’s this: prediabetes doesn’t have to lead to medications or diabetes. By advocating for yourself and making small but powerful changes, you can take charge of your health and achieve incredible results, reversing your prediabetes to normal.

The biggest takeaway from today: Prediabetes doesn’t have to be a lifelong condition, and it certainly doesn’t mean you’re destined to rely on medication. In fact, in most cases, medication is not necessary at all. Importantly, take your diagnosis as an opportunity to change your health and change your life.

If you need help with putting all this stuff into place, head to our website and join us as a member where we make it easier, providing you with a clear and proven pathway to reverse prediabetes with nutrition and lifestyle.

If you’re one of our members already, your initial step is to focus on the weekly action steps provided in the Prediabetes Reset Program, as most members are achieving normal blood sugar and A1c levels in the 16 week program. If you’re taking Metformin and wish to stop taking it, head to the Healthmap on reducing or stopping medication, which lays out the step-by-step process to make this happen and provides a checklist and letter for your doctor to help support this process too. We’ll also link to these resources and others alongside this episode in the members library.

Okay, that’s all from me today and thanks for joining me.

Dr Jedha, over and out.