Prediabetes

Prediabetes describes a situation where blood glucose levels are higher than normal, but have not reached the threshold for a diagnosis of type 2 diabetes.

In the UK, prediabetes is commonly identified using an HbA1c blood test, which measures your average blood glucose levels over approximately the previous two to three months.

An HbA1c result of 42-47 mmol/mol (6.0-6.4%) is generally considered to indicate non-diabetic hyperglycaemia, often referred to as prediabetes.

Prediabetes is important because it indicates an increased risk of developing type 2 diabetes and is frequently associated with other cardiovascular risk factors, including high blood pressure, abnormal cholesterol levels and excess abdominal weight.

However, progression to diabetes is not inevitable. Many people can improve their blood glucose levels and significantly reduce their future risk through changes to diet, physical activity and weight management.

Identifying prediabetes provides an opportunity to act early, before more significant metabolic problems develop.

Prediabetes usually causes no noticeable symptoms. Many people discover they have raised blood glucose levels during a routine health check or blood test.

This is one reason why preventative health screening can be valuable, particularly for people with risk factors for type 2 diabetes.

If blood glucose levels rise further, symptoms associated with diabetes may develop, including:

• Increased thirst
• Passing urine more frequently
• Unexplained tiredness
• Blurred vision
• Unexplained weight loss
• Recurrent infections

These symptoms are not typical of uncomplicated prediabetes and should prompt medical assessment to exclude diabetes or another underlying condition.

Prediabetes commonly develops when the body becomes less responsive to insulin, a hormone that helps regulate blood glucose levels. This is known as insulin resistance.

Over time, the pancreas may struggle to produce sufficient insulin to maintain normal blood glucose levels.

Several factors can increase your risk:

• Excess body weight, particularly around the abdomen
• Physical inactivity and prolonged periods of sitting
• Family history of type 2 diabetes
• Increasing age, although prediabetes can develop in younger adults
• Ethnic background, with higher risk in certain populations, including people of South Asian, Black African and African-Caribbean heritage
• Previous gestational diabetes
• Polycystic ovary syndrome (PCOS)
• High blood pressure or abnormal cholesterol levels

Prediabetes often occurs alongside other features of metabolic syndrome, making it important to consider cardiovascular and metabolic health more broadly rather than looking at blood glucose in isolation.

Prediabetes is usually identified through a blood test.

HbA1c blood test

HbA1c measures the proportion of haemoglobin in red blood cells that has glucose attached to it, providing an indication of average blood glucose levels over the preceding two to three months.

HbA1c result Interpretation

Below 42 mmol/mol (6.0%) Normal range

42–47 mmol/mol (6.0–6.4%) Prediabetes / non-diabetic hyperglycaemia

48 mmol/mol (6.5%) or above Diabetes range

An HbA1c result in the diabetes range generally requires confirmation with a repeat test in someone without symptoms.

Other investigations

Depending on your circumstances, your GP may also recommend:

• Fasting blood glucose
• Cholesterol and triglyceride levels
• Kidney function
• Liver function
• Blood pressure measurement
• Weight, BMI and waist circumference

These assessments help build a broader picture of your metabolic and cardiovascular health.

HbA1c is not suitable for everyone. Certain blood disorders, pregnancy and conditions affecting red blood cell turnover can make the result unreliable, in which case alternative glucose testing may be required.

For many people, blood glucose levels can return to the normal range through lifestyle changes.

The most effective approaches generally focus on improving insulin sensitivity and reducing the factors contributing to raised blood glucose.

Healthy eating

A balanced diet with an emphasis on vegetables, fibre-rich foods, wholegrains, lean proteins and healthy fats can help regulate blood glucose.

Reducing sugary drinks, refined carbohydrates and highly processed foods may also be beneficial.

Regular physical activity

Aim for at least 150 minutes of moderate-intensity physical activity each week, alongside muscle-strengthening activities.

Even relatively small increases in daily movement can improve insulin sensitivity.

Weight management

For people who are overweight, losing approximately 5–7% of body weight can substantially reduce the risk of progressing to type 2 diabetes.

Sleep and lifestyle

Adequate sleep, smoking cessation and moderating alcohol intake are also important components of metabolic health.

Medication

Medication is not routinely required for prediabetes. In selected higher-risk individuals, a GP may consider metformin alongside intensive lifestyle interventions.

The most appropriate approach depends on your individual risk factors, medical history and blood test results.

A single blood test provides a useful snapshot of your health, but following results over time can offer a more meaningful understanding of your metabolic health.

For people with prediabetes, monitoring can help establish whether lifestyle changes are working, whether blood glucose levels are improving and whether additional intervention may be needed.

Useful measurements may include:

• HbA1c: To monitor longer-term blood glucose trends
• Cholesterol and triglycerides: To assess associated cardiovascular risk
• Blood pressure: An important marker of cardiovascular health
• Weight and waist circumference: To monitor changes in body composition and metabolic risk
• Liver function: Where there are concerns about metabolic dysfunction-associated fatty liver disease
• Kidney function: Where clinically appropriate, particularly in people with additional risk factors

People with non-diabetic hyperglycaemia are generally advised to have their HbA1c reassessed at least annually, although more frequent monitoring may be appropriate in some circumstances.

Looking beyond individual results

Blood glucose is only one aspect of metabolic health.

Improvements in blood pressure, cholesterol, body composition and physical fitness can all contribute to reducing longer-term health risks, even when changes in HbA1c are relatively modest.

Regular reviews can help identify trends, measure progress and support sustainable lifestyle improvements.

You should consider speaking to a GP if:

• Your HbA1c is within the prediabetes range
• You have a strong family history of type 2 diabetes
• You are overweight or have several metabolic risk factors
• Previous blood tests have shown rising glucose levels
• You would like advice on reducing your risk of diabetes

Symptoms such as excessive thirst, frequent urination, unexplained weight loss or significant fatigue should be assessed promptly, as they may indicate diabetes rather than prediabetes.

Early assessment provides an opportunity to understand your individual risk and agree on a practical plan for improving your health.

Prediabetes Assessment and Monitoring at 222 Healthcare

At 222 Healthcare, we take a proactive approach to identifying and managing metabolic health risks.

Our private GPs can help you understand your blood glucose results, assess your wider cardiovascular and metabolic health, and develop a personalised plan to reduce your risk of type 2 diabetes.

Depending on your circumstances, we can offer:

• HbA1c and blood glucose testing to assess your current blood sugar levels
• Comprehensive health blood tests covering cholesterol, liver function, kidney function and other relevant health markers
• GP consultations to review your results, assess your risk factors and discuss practical lifestyle changes
• Ongoing health monitoring to follow changes in your blood results and overall health over time

HealthTrack - Understanding Your Health Over Time

Our HealthTrack membership is designed for people who want to take a more proactive approach to their long-term health.

Rather than relying solely on occasional blood tests, HealthTrack brings together regular health assessments, blood test results, trend tracking and GP interpretation to help you understand how your health is changing.

For people with prediabetes or an increased risk of diabetes, this can be a useful way to monitor relevant metabolic markers, assess the impact of lifestyle changes and identify when further medical advice may be appropriate.

HealthTrack complements, rather than replaces, any condition-specific monitoring or treatment recommended by your GP.

Whether you have recently been told you have prediabetes or simply want to understand your metabolic health better, our team can help you take the next step.