As Type 2 diabetes continues to rise across the United States, medical experts are urging a reassessment of how prediabetes is identified and managed. According to the American Diabetes Association, roughly one in ten Americans currently meets the diagnostic criteria for Type 2 diabetes, defined by a hemoglobin A1C level of 6.5% or higher.
Beyond that, the Centers for Disease Control and Prevention (CDC) estimates that nearly 100 million U.S. adults fall into the prediabetes category, with A1C levels between 5.7% and 6.4%. This group faces a significantly increased risk of progressing to Type 2 diabetes.
Traditionally, a prediabetes diagnosis has been used as an early warning, signaling the need for lifestyle changes to prevent more serious disease. However, experts say the effectiveness of this approach varies widely. Dr. Eva Tseng, an associate professor of general internal medicine at Johns Hopkins School of Medicine, explained that while the diagnosis motivates some patients to adopt healthier habits, others struggle to act on the information. “Lifestyle change is difficult and often hard to maintain,” she noted, adding that awareness alone does not always lead to meaningful action.
Preventing the progression to Type 2 diabetes typically requires a combination of behavioral changes—such as improved diet and increased physical activity—and, in some cases, medication. Yet a major barrier remains awareness: an estimated 80% of individuals with prediabetes have not been formally diagnosed.
In recent research, Dr. Tseng and her colleagues reviewed insurance claims from 4,000 adults diagnosed with prediabetes between 2016 and 2021. The analysis revealed that only 10% of these individuals were officially documented as having the condition. Tseng cautioned that the data reflect practices from several years ago and may not fully represent current clinical awareness, noting that public health messaging around prediabetes has improved in recent years.
Access to care presents another challenge. The study found that just 1% of patients were referred for nutrition counseling, and only 5% received medications aimed at lowering A1C levels. The CDC’s National Diabetes Prevention Program was created to support lifestyle interventions nationwide, but insurance coverage remains inconsistent. While Medicare and Medicaid offer coverage in some states, many private insurers do not. Even when coverage exists, Tseng said reimbursement rates often fail to cover the true cost of delivering effective programs, despite evidence that prevention saves money over time.
Dr. Ralph DeFronzo, a professor of medicine at the University of Texas Health Science Center at San Antonio, pointed to another concern: many physicians underestimate the seriousness of prediabetes. “Doctors often don’t treat prediabetes as a major risk factor, and that message gets passed on to patients,” he said. Although prediabetes is not classified as Type 2 diabetes, individuals with the condition face elevated risks of heart disease, stroke, kidney damage, and vision problems, and may benefit from earlier intervention.
Both Tseng and DeFronzo highlighted the absence of medications specifically approved for prediabetes as a contributing factor. DeFronzo argued that formal drug approval could elevate the condition’s perceived seriousness among both clinicians and patients.
At the same time, treatment options for Type 2 diabetes have expanded. Newer medications, including GLP-1 receptor agonists such as dulaglutide and semaglutide, have shown strong results in lowering blood sugar and reducing cardiovascular risk. However, their high annual cost—often exceeding $12,000—limits widespread use.
More affordable alternatives remain available. Metformin, long used in diabetes care, continues to be a low-cost option, while studies suggest that pioglitazone may reduce the likelihood of progressing from prediabetes to Type 2 diabetes by up to 75%.
Looking ahead, DeFronzo and his team have proposed a new risk category known as “pre-prediabetes.” In a recent study published in Diabetes Care, they found that many individuals with normal blood glucose levels already show signs of severe insulin resistance, a condition that can precede diabetes by years. “We can detect insulin resistance long before diabetes develops,” DeFronzo said, emphasizing that Type 2 diabetes develops gradually rather than appearing suddenly.
Together, experts argue that viewing diabetes as a continuum—rather than a condition that begins at a single diagnostic threshold—could lead to earlier intervention, better prevention strategies, and improved long-term health outcomes.
Team Health Accessible
Health & Wellness Editorial Team
HealthAccessible editorial team delivers trusted, accessible, and evidence-based health information for everyone.
