More than 96 million American adults have prediabetes — a condition in which blood sugar is elevated but not yet high enough to meet the diagnostic threshold for type 2 diabetes. The striking fact is that the vast majority of people with prediabetes don't know they have it. And even more striking: progression to type 2 diabetes is not inevitable. Research from the landmark Diabetes Prevention Program found that modest lifestyle changes — losing just 5 to 7 percent of body weight and accumulating 150 minutes of moderate physical activity per week — reduced the risk of progressing from prediabetes to type 2 diabetes by 58 percent in the general population and by 71 percent in adults over 60.
Understanding how blood sugar works helps clarify why certain choices matter. When you eat carbohydrates, your digestive system breaks them down into glucose, which enters the bloodstream. In response, the pancreas releases insulin, a hormone that signals cells to absorb that glucose for energy. In insulin resistance — the mechanism underlying prediabetes and type 2 diabetes — cells stop responding efficiently to insulin's signal, so the pancreas pumps out more and more to compensate. Over time, the pancreas can't keep up, and blood sugar remains chronically elevated. Foods that cause sharp spikes in blood sugar — refined grains, sweetened beverages, processed snacks — repeatedly stress this system.
The dietary changes most strongly linked to diabetes prevention focus on reducing these spikes. Whole grains instead of refined grains, vegetables and legumes as primary carbohydrate sources, and the elimination of sugary drinks are the highest-leverage shifts. Fiber is particularly important: it slows glucose absorption, blunts blood sugar spikes, and feeds the gut microbiome, which increasingly appears to play a role in metabolic health. Reducing portion sizes of high-glycemic foods matters too — the same carbohydrate eaten alone spikes blood sugar more than when eaten with protein and fat.
Physical activity improves insulin sensitivity directly — muscles that have been exercised absorb glucose more efficiently for hours afterward, even without additional insulin. This is why walking after meals is particularly effective: it clears some of the glucose from the bloodstream at exactly the moment blood sugar would otherwise peak. Resistance training — weight lifting, resistance bands, bodyweight exercises — builds muscle mass, which is one of the body's primary sites of glucose uptake. A combination of aerobic and resistance training has synergistic benefits for blood sugar management that neither provides alone.
If you're concerned about your blood sugar, a simple fasting glucose test or HbA1c test (which reflects average blood sugar over three months) is part of most annual wellness visits. Knowing your numbers is the first step, and your care team can help you interpret what they mean and build a plan that fits your life. AcmeHealth members may also have access to diabetes prevention programs as a covered benefit — check your member portal or call member services to learn more.