{"id":1584,"date":"2026-09-15T14:35:55","date_gmt":"2026-09-15T14:35:55","guid":{"rendered":"https:\/\/flatplanplus.io\/bbc-sciencefocus\/?p=1584"},"modified":"2026-09-15T14:35:56","modified_gmt":"2026-09-15T14:35:56","slug":"the-real-cause-of-prediabetes-and-5-expert-backed-ways-to-reverse-it","status":"publish","type":"post","link":"https:\/\/flatplanplus.io\/bbc-sciencefocus\/2026\/09\/15\/the-real-cause-of-prediabetes-and-5-expert-backed-ways-to-reverse-it\/","title":{"rendered":"The real cause of prediabetes \u2013 and 5 expert-backed ways to reverse it"},"content":{"rendered":"\n
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Health<\/p>\n\n\n\n

The real cause of prediabetes \u2013 and 5 expert-backed ways to reverse it<\/h1>\n\n\n\n

Even people at a healthy weight can develop it without knowing<\/p>\n\n\n\n

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By James Lloyd<\/p>\n\n\n\n

–<\/p>\n<\/div>\n<\/div>\n\n\n\n

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Photo credit: Getty<\/figcaption><\/figure>\n<\/div>\n<\/div>\n\n\n\n

Right this second, a staggering number of people are living with diabetes. Globally, around 590 million adults<\/a> have the condition, including some 40 million Americans<\/a>.<\/p>\n\n\n\n

But there\u2019s an even more common blood sugar disorder that gets far less attention: prediabetes. An estimated 635 million people worldwide<\/a> have the condition, including some 115 million Americans<\/a> \u2013 more than two in five US adults \u2013 and most are thought to have no idea they have it.<\/p>\n\n\n\n

Prediabetes occurs when blood sugar levels are higher than normal, but not yet high enough to meet the threshold for diabetes. It usually causes no obvious symptoms and can affect people who are a healthy weight, meaning there may be little reason to suspect anything is wrong.<\/p>\n\n\n\n

But no symptoms doesn\u2019t mean no harm. Prediabetes is an independent risk factor for heart attack and stroke, and not just because it can develop into diabetes down the line.<\/p>\n\n\n\n

One large US study<\/a> found that people with prediabetes had 25 per cent higher odds of a heart attack even after accounting for other risk factors like blood pressure, cholesterol and weight. High blood sugar, it turns out, starts damaging blood vessels well before it crosses the line into diabetes.<\/p>\n\n\n\n

So far, so scary. But the good news is that prediabetes doesn\u2019t have to progress. In many cases, it can be reversed with relatively simple lifestyle changes \u2013 and, for some people, without even losing weight.<\/p>\n\n\n\n

The path to diabetes<\/h2>\n\n\n\n

To understand what makes prediabetes different from diabetes, it helps to know how blood sugar is supposed to work in the first place.<\/p>\n\n\n\n

When we eat, our body breaks down carbohydrates into a sugar called glucose \u2013 one of our main sources of energy. <\/p>\n\n\n\n

Getting that glucose out of the bloodstream and into our cells is the job of insulin, a hormone made by the pancreas. Insulin acts a bit like a key, unlocking cells so glucose can enter and be used for energy.<\/p>\n\n\n\n

Insulin binds to receptors on the cell surface, unlocking the cell so glucose can enter. Credit: Getty<\/figcaption><\/figure>\n\n\n\n

Diabetes develops when this system stops working properly and blood glucose levels become too high. Left unmanaged, high blood sugar can cause serious health complications, including cardiovascular disease, stroke and problems affecting the eyes, feet, kidneys and nerves.<\/p>\n\n\n\n

There are several types of diabetes, but the two you\u2019ve probably heard of are type 1 and type 2. <\/p>\n\n\n\n

Type 1 is an autoimmune condition in which the body attacks the cells that produce insulin, and isn\u2019t caused by lifestyle factors.<\/p>\n\n\n\n

Type 2, which accounts for more than 90 per cent of cases, develops when the body doesn\u2019t produce enough insulin or stops responding to it properly \u2013 a problem known as insulin resistance.<\/p>\n\n\n\n

But these changes don\u2019t happen overnight. Before someone develops type 2 diabetes, their body may begin struggling to keep blood sugar under control, causing glucose levels to creep above the healthy range without becoming high enough for a diabetes diagnosis. This is prediabetes.<\/p>\n\n\n\n

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A blood test is the only reliable way to catch prediabetes, since it rarely causes any noticeable symptoms. Photo credit: Getty<\/figcaption><\/figure>\n\n\n\n

Because prediabetes usually causes no obvious symptoms, it is typically detected with a blood test. One of the most common is the A1C (or HbA1c) test, which gives an indication of average blood glucose levels over the previous two to three months. <\/p>\n\n\n\n

There is no internationally agreed threshold for prediabetes, but in the US, an A1C result of 5.7\u20136.4 per cent falls within the prediabetes range.<\/p>\n\n\n\n

Crucially, though, prediabetes is a warning sign rather than a diagnosis of type 2 diabetes. And crossing into that range doesn\u2019t mean developing the disease is inevitable.<\/p>\n\n\n\n

What really causes prediabetes?<\/h2>\n\n\n\n

So why do some people develop prediabetes while others don\u2019t? There\u2019s no single cause. Instead, your risk is shaped by a mixture of factors \u2013 some you can influence, and others you can\u2019t.<\/p>\n\n\n\n

Among those you can\u2019t control are your genes. Having a family history of type 2 diabetes raises your own risk of prediabetes. <\/p>\n\n\n\n

Age matters too, as does ethnic background: people from Black African, South Asian or African Caribbean backgrounds, for example, are at higher risk than those from a White background.<\/p>\n\n\n\n

Then there are the factors you can influence. \u201cBody weight is a crucial factor,\u201d says Roy Taylor<\/a>, Emeritus Professor of Medicine and Metabolism at Newcastle University, UK.<\/p>\n\n\n\n

Taylor\u2019s pioneering work with people with type 2 diabetes has shown that substantial, sustained weight loss can put the condition into remission, returning blood glucose to healthy levels.<\/p>\n\n\n\n

He\u2019s found weight doesn\u2019t affect everyone in the same way. Some people develop prediabetes despite having a healthy body mass index (BMI), while others can live with obesity without developing it.<\/p>\n\n\n\n

According to Taylor\u2019s research, one reason may be not simply how much fat we carry, but where our bodies are able to store it.<\/p>\n\n\n\n

Taylor\u2019s work suggests that each of us has a genetically determined \u201cpersonal fat threshold\u201d \u2013 essentially, a limit to how much fat our body can safely store beneath the skin. <\/p>\n\n\n\n

Once this subcutaneous storage begins to reach capacity, excess fat starts spilling over into less healthy places, accumulating as \u2018visceral\u2019 fat around our internal organs and as \u2018ectopic\u2019 fat within the organs themselves.<\/p>\n\n\n\n

Two organs appear to be particularly important here: the liver and pancreas. When too much fat accumulates in the liver, it interferes with the organ\u2019s ability to regulate the amount of glucose it releases into the bloodstream. <\/p>\n\n\n\n

\u201cYour liver constantly supplies your body with fat for energy, but if there\u2019s too<\/em> much fat in the liver, it produces more than is needed,\u201c says Taylor.<\/p>\n\n\n\n

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When too much fat builds up in the liver, it starts releasing more glucose into the bloodstream than the body needs<\/figcaption><\/figure>\n\n\n\n

The liver also sends excess fat out into the bloodstream, some of which can accumulate in the pancreas. There, too much fat can disrupt the insulin-producing beta cells, making it harder for the pancreas to release enough insulin to keep blood glucose under control. <\/p>\n\n\n\n

Rising blood glucose can then contribute to the production of yet more fat, helping to drive the cycle onwards.<\/p>\n\n\n\n

Importantly, this process begins before someone crosses the threshold into type 2 diabetes. \u201cThe fat inside the liver is at a maximum before<\/em> type 2 diabetes develops,\u201c says Taylor.<\/p>\n\n\n\n

This helps explain why BMI alone can be a poor guide to someone\u2019s risk. A person with a relatively low personal fat threshold may begin storing fat around and inside their organs at a lower body weight, while someone with a higher threshold may be able to store considerably more beneath their skin before that happens.<\/p>\n\n\n\n

People who develop this pattern despite having a healthy BMI are sometimes described as TOFI \u2013 \u2018thin outside, fat inside\u2019 or \u2018metabolically obese, normal weight\u2019.<\/p>\n\n\n\n

Unsurprisingly, diet and physical activity both also shape our risk of prediabetes \u2013 partly by affecting how much fat we store, and partly through their own direct effects on blood sugar control. <\/p>\n\n\n\n

Poor sleep and chronic stress have also been linked to the condition, though Taylor says these likely play a smaller role.<\/p>\n\n\n\n

With so many factors at play, and so few visible signs, it\u2019s hard to know just from looking at someone \u2013 or even from how you feel \u2013 whether prediabetes is present. The only way to know for sure is to get your blood sugar tested. <\/p>\n\n\n\n

The information below can help you get a sense of where you stand, but if you\u2019re concerned, Taylor recommends asking your doctor for a blood test.<\/p>\n\n\n\n

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Know your risk<\/h3>\n\n\n\n

A handful of organisations, including the American Diabetes Association (ADA) and the US Centers for Disease Control and Prevention (CDC), have developed short questionnaires that estimate someone\u2019s chances of developing prediabetes or type 2 diabetes, based on factors like age, weight and family history. <\/p>\n\n\n\n

The quickest way to check is the ADA\u2019s 60-second quiz<\/a> \u2013 but broadly speaking, these tools flag a higher risk if:<\/p>\n\n\n\n