8 Essential Strategies to Reverse Prediabetes

Detect Early. Act Early. Change the Course.

China’s 1986 Da Qing Diabetes Prevention Study was the world’s first clinical trial to demonstrate the long-term benefits of lifestyle intervention in people with impaired glucose tolerance (prediabetes). Participants received a 6-year lifestyle intervention and were subsequently followed for up to 30 years, providing some of the strongest evidence that early lifestyle intervention can have lasting health benefits [1–3].

The 30-year Da Qing Diabetes Prevention Outcome Study showed that the benefits of the original lifestyle intervention extended far beyond the six-year intervention period. Compared with the control group, participants who received lifestyle intervention had lower risks of cardiovascular events, microvascular complications, cardiovascular death, and all-cause mortality over the 30-year follow-up [1,2].

Importantly, some participants returned to normal glucose tolerance by the end of the six-year intervention-evidence that prediabetes is not necessarily a one-way path toward diabetes [4].

The earlier we act, the greater the opportunity to change the course of prediabetes.

Participating in the CDC’s National Diabetes Prevention Program can provide guidance and support for adopting a healthier lifestyle.

Nutrition plays a central role in managing prediabetes and reducing the risk of progression to T2D. For general guidance, see the Dietary Guidelines for Americans, 2025-2030, American Diabetes Association(ADA):Understanding Carbs, Endotext: Nutritional Recommendations for Individuals with Diabetes [5-7]. Because nutritional needs vary by body size, activity level, metabolic status, and health goals, personalized guidance from a registered dietitian nutritionist (RDN) or other healthcare professional can be especially helpful.

1. Build a Real, Whole-Food, Nutrient-Dense Diet

Start with real, whole, and nutrient-dense foods.  Dietary Guidelines for Americans, 2025-2030 emphasizes prioritizing whole, healthy, and nutritious foods as the foundation of a healthy dietary pattern (Figure 1,2) [5,8].

Figure 1. The New Food Pyramid

Use the Food Pyramid as a simple visual guide to choosing nutritious foods, building a balanced diet, and limiting highly processed and engineered foods.

Figure 2. Daily Servings by Calorie Level [9]

Use these serving recommendations as a general guide to daily intake at different calorie levels. Individual needs vary according to age, sex, body size, activity level, and health goals.

2. Choose Carbohydrates Wisely [10,11]

What are high-quality carbohydrates?

High-quality carbohydrates are generally fiber-rich, nutrient-dense, and minimally processed [12]. Examples include whole grains, vegetables, whole fruits, beans, and legumes.

Higher intakes of dietary fiber and whole grains are associated with lower risks of all-cause mortality, T2D, cardiovascular disease, obesity, and colorectal cancer [13].

How to choose high-quality carbohydrates:

• Prioritize whole, minimally processed, fiber-rich foods.

  
  

•  Limit refined grains, added sugars, sugar-sweetened beverages, and highly processed carbohydrate products.

  
  

•  Choose whole fruit over fruit juice.

  
  

•  Treat starchy vegetables such as potatoes, sweet potatoes, corn, and winter squash as a carbohydrate source and manage portions.

  
  

How much?

Choose high-quality carbohydrates first, then adjust quantity to individual needs and health goals [5,14]. Use the serving recommendations in Figure 2 as a general guide.

3. How to Apply It to Your Meals

The Diabetes Plate [15] serves as a practical visual guide. For people with prediabetes, its core principles are broadly consistent with healthy eating for diabetes prevention and the general population [7] .

Adopt this simple approach for every meal:

• Fill ½ your plate with non-starchy vegetables.

• Fill ¼ with high-quality carbohydrate foods.

• Fill ¼ with protein foods.

• Choose water or zero-calorie beverages over sugary drinks.

  
  

  

Note: Eating patterns are not one-size-fits-all. RDNs can provide personalized Medical Nutrition Therapy (MNT) when additional nutrition support is needed.

Move after meals. Build muscle. Improve insulin sensitivity.

Skeletal muscle is a major site of glucose disposal after meals and plays a central role in glucose metabolism. Skeletal muscle insulin resistance is a key feature of T2D, and both prediabetes and T2D are associated with muscle mass loss and sarcopenia [16–18]. Maintaining healthy muscle is therefore important for metabolic health.

During exercise, muscle not only takes up glucose but also releases myokines that communicate with other organs and may improve insulin sensitivity and metabolic health (Figure 4) [19,20]. Muscle contractions also promote the translocation of glucose transporter 4 (GLUT4) to the cell membrane, increasing glucose uptake independently of insulin [21]. This can help lower blood glucose and reduce the demand for insulin secretion by pancreatic β-cells. Regular physical activity can improve glucose control and insulin sensitivity, while sustained resistance training may support a return to normoglycemia in people with prediabetes [22].

Figure 4. Myokine-mediated systemic regulation. During exercise, skeletal muscle releases myokines that communicate with other organs and contribute to glucose metabolism, insulin sensitivity, mitochondrial function,and overall metabolic health.

Make Postmeal Movement a Daily Habit

Current guidelines recommend at least 150 minutes of moderate-intensity physical activity per week, together with muscle-strengthening activities on at least 2 days per week [23]. High-intensity interval training (HIIT) is another time-efficient option that may help improve glucose control. For people with prediabetes, however, exercise is not only about meeting a weekly target. When you move can also matter-especially after meals, when blood glucose rises.

Research in older adults at risk for glucose intolerance found that three 15-minute bouts of moderate walking after meals improved 24-hour glycemic control and were particularly effective in lowering postdinner glucose [24]. Postmeal movement can therefore be a simple and practical strategy for improving daily glucose control after carbohydrate-rich meals [25].

Make Every Step Count

Based on evidence from postmeal walking [24,25], people with prediabetes may consider incorporating postmeal movement into their daily activity rather than relying on one long exercise session. Walking after meals can help distribute daily activity while supporting postmeal glucose control. In a large observational study of U.S. adults aged 40 years and older, approximately 8,000–12,000 daily steps were associated with substantially lower all-cause mortality than approximately 4,000 steps per day (Figure 5)[26]. These findings are observational and do not establish 8,000–12,000 steps as a specific target for everyone.

Figure 5. Daily Steps and All-Cause Mortality. Mortality rates were adjusted for demographic, lifestyle, and health-related factors[26].

A Simple Daily Movement Plan

Breakfast:

Consider 20–30 minutes of moderate exercise before breakfast, such as brisk walking, when appropriate. Premeal resistance exercise has also been shown to improve postprandial glucose metabolism and insulin sensitivity in men with obesity and prediabetes [27].

Lunch: Walk or engage in other light-to-moderate movement for 10–15 minutes after lunch.

Dinner: Walk or engage in other light-to-moderate movement for 10–15 minutes after dinner. When appropriate, add a longer session of moderate exercise or resistance training later in the evening.

2–3 times per week: Include resistance training with bands, body-weight exercises, or light weights to build and maintain muscle [27].

Start at a comfortable level and gradually increase your activity. If you monitor your blood glucose, your postmeal response can help you understand how meal composition, portion size, and physical activity affect your individual glucose control.

Regular blood glucose screening can help identify prediabetes early and provide a clearer picture of your metabolic health. For people with prediabetes, ADA recommends monitoring for the development of diabetes at least annually, with testing frequency adjusted according to individual risk [28]. When appropriate, periodic fasting or postmeal glucose monitoring can help you understand how your body responds to meals and lifestyle changes.

Manage stress. Chronic stress can negatively affect metabolic health and may contribute to insulin resistance and impaired glucose regulation [29,30]. Stress cannot always be avoided, but learning effective ways to respond to and manage stress can support metabolic health and long-term well-being. For more practical strategies to manage stress and support mental and emotional well-being, see Post 3: Boosting Mental & Emotional Health. Maintaining a healthy balance between school, work, and personal life can also help.

Prioritize sleep. Aim for 7–8 hours of quality sleep each night. Insufficient or poor-quality sleep can interfere with glucose regulation and reduce insulin sensitivity [31,32].

Spend time outdoors. Regular time outdoors can support mood, sleep, physical activity, and overall well-being. Whenever possible, make outdoor time part of your daily routine and choose activities you enjoy.

The gut microbiome plays an important role in human health and may influence glucose regulation, insulin sensitivity, inflammation, and metabolic health. A diverse and balanced gut microbiome is supported by a diet rich in dietary fiber and a variety of minimally processed, plant-based foods. Prebiotic foods provide fuel for beneficial gut bacteria, while probiotic-containing fermented foods may help maintain a healthy gut microbiome and support the production of short-chain fatty acids (SCFAs), which may contribute to metabolic health [33-36].

Choose a variety of fiber-rich whole foods, including vegetables, fruits, legumes, whole grains, nuts, and seeds, and include fermented foods when appropriate. At the same time, limit highly processed and sugary foods and avoid unnecessary or inappropriate use of medications that may negatively affect the gut microbiome [37,38].

Figure 6．Your Gut. Your Health. Your Future.

A healthy weight supports metabolic health and may reduce the risk of insulin resistance and T2D. Focus on healthy eating, regular physical activity, and preserving muscle rather than pursuing weight loss alone. The normal body mass index (BMI) range is 18.5–24.9 [39]. Use the ADA BMI Calculator to calculate your BMI [40]: https://diabetes.org/bmi-calculator

Fill your plate with colorful vegetables, fruits, legumes, nuts, seeds, and whole grains.

Antioxidants and other phytonutrients found in plant foods may support metabolic health. Vegetables and fruits are rich sources of polyphenols, carotenoids, and other beneficial compounds, and increasing their intake has been shown to increase circulating antioxidants and improve some cardiometabolic risk markers [41].

Choose whole foods first. Supplements are not a substitute for a nutrient-rich diet.

Reversing prediabetes is a journey built on everyday choices. Put these eight strategies into practice, stay consistent, and keep moving forward. Remember: Action is better than waiting.

1. Qiuhong Gong, Ping Zhang, Jinping Wang, et al. Morbidity and mortality after lifestyle intervention for people with impaired glucose tolerance: 30-year results of the Da Qing Diabetes Prevention Outcome Study. Lancet Diabetes Endocrinol. 2019 Jun;7(6):452-461. doi: 10.1016/S2213-8587(19)30093-

2. Qiuhong Gong, Ping Zhang, Jinping Wang, et al. 1471-P: Efficacy of Lifestyle Intervention in     Preventing Diabetes in People with IGT with and without Impaired Fasting Glucose: A Secondary Analysis of Da Qing Diabetes Prevention Outcomes Study (DQDPOS). Diabetes    2020;69(Supplement_1):1471- https://doi.org/10.2337/db20-1471-P.3.  

3.  https://finance.sina.com.cn/hy/hyjz/2019-11-27/doc-iihnzahi3702739.shtml                                   

4. Yanyan Chen, Ping Zhang, Jinping Wang, et al. Associations of progression to diabetes and

regression to normal glucose tolerance with development of cardiovascular and microvascular disease among people with impaired glucose tolerance: a secondary analysis of the 30 year Da Qing Diabetes Prevention Outcome Study. Diabetologia. 2021 Jun;64(6):1279-1287. doi:10.1007/s00125-021-05401x. 

5.  Dietary Guidelines for Americans, 2025–2030

6. https://diabetes.org/food-nutrition/understanding-carbs

7. https://www.ncbi.nlm.nih.gov/books/NBK279012/

8. Real Food Wins, https://realfood.gov

9. Daily Servings By Calorie Level, https://cdn.realfood.gov/Daily%20Serving%20Sizes.pdf

10.The Scientific Foundation For The Dietary Guidelines For Americans, Chapter 4. Carbohydrates：https://cdn.realfood.gov/Scientific%20Report_508.pdf

11.The Scientific Foundation ForThe Dietary Guidelines For Americans Appendices:        https://cdn.realfood.gov/Scientific%20Report%20Appendices_FINAL_1.28.26.pdf

12.Kevin B Comerford, Yanni Papanikolaou, Julie Miller Jones, et al. Toward an Evidence-Based       Definition and Classification of Carbohydrate Food Quality: An Expert Panel Report.   Nutrients.  2021;13(8):2667.doi: 10.3390/nu13082667.

13.Andrew Reynolds, Julia Mann, John Cummings, et al. Carbohydrate quality and human health: a series of systematic reviews and meta-analyses. Lancet. 2019 Feb 2;393(10170):434-445. doi: 10.1016/S0140-6736(18)31809-9.

14. American Diabetes Association Professional Practice Committee. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in

Diabetes—2026. Diabetes Care. 2026;49(Suppl 1):S89–S131.

15. American Diabetes Association, What is the Diabetes Plate?  Diabetes Plate

      https://diabetesfoodhub.org/blog/what-diabetes-plate

16. Karla E Merz, Debbie C Thurmond. Role of Skeletal Muscle in Insulin Resistance and

Glucose Uptake. Compr Physiol. 2020 Jul 8; 10(3): 785–809.doi: 10.1002/cphy.c190029.

17. Mandlakazi Dlamini, Andile Khathi. Prediabetes-Associated Changes in Skeletal Muscle Function and Their Possible Links with Diabetes: A Literature Review. Int. J. Mol. Sci. 2024, 25, 469. doi:10.3390/ijms25010469.

18. Shuying Li, Jiangfeng Mao, Weihong Zhou. Prediabetes is associated with loss of appendicular skeletal muscle mass and sarcopenia. Front Nutr. 2023 Mar 1:10:1109824.         https://doi.org/10.3389/fnut.2023.1109824

19. Rekha Balakrishnan, Debbie C Thurmond.  Mechanisms by Which Skeletal Muscle Myokines       Ameliorate Insulin Resistance. Int J Mol Sci. 2022 May; 23(9): 4636.  doi:  10.3390/ijms23094636.

20. Christoph Hoffmann, Cora Weigert.Skeletal Muscle as an Endocrine Organ: The Role of Myokines in Exercise Adaptations. Cold Spring Harb Perspect Med. 2017 Nov; 7(11): a029793. doi: 10.1101/cshperspect.a029793.

21. Erik A Richter, Mark Hargreaves. Exercise, GLUT4, and skeletal muscle glucose uptake.       Physiol Rev. 2013 Jul;93(3):993-1017.doi: 10.1152/physrev.00038.2012.

22. Davy BM, Winett RA, Savla J, et al. Resist diabetes: A randomized clinical trial for resistance training maintenance in adults with prediabetes. PLoS One.  2017;12(2):e0172610. doi:10.1371/journal.pone.0172610. 

23. https://diabetes.org/health-wellness/fitness/weekly-exercise-targets

24. Loretta DiPietro, Andrei Gribok, Michelle S Stevens, et al. Three 15-min Bouts of Moderate Postmeal Walking Significantly Improves 24-h Glycemic Control in Older People at Risk for Impaired Glucose tolerance. Diabetes Care 2013;36(10):3262–3268. doi: 10.2337/dc13- 0084. 

25. Reynolds AN, Mann JI, Williams S, Venn BJ. Advice to walk after meals is more effective for lowering postprandial glycaemia in type 2 diabetes mellitus than advice that does not specify timing: a randomised crossover study. Diabetologia. 2016;59(12):2572–2578. doi:10.1007/s00125-016-4085-2. 

26. Pedro F Saint-Maurice, Richard P Troiano, David R Bassett Jr. et al. Pedro F. Saint-Maurice, et al. Association of Daily Step Count and Step Intensity With Mortality Among US Adults. JAMA. 2020 Mar 24; 323(12): 1151–1160. doi: 10.1001/jama.2020.1382.

27. Bittel AJ, Bittel DC, Mittendorfer B, et al. A Single Bout of Premeal Resistance Exercise Improves Postprandial Glucose Metabolism in Obese Men with Prediabetes. Medicine & Science in Sports & Exercise. 2020;52(12):2523–2531. DOI: 10.1249/MSS.0000000000002538.  28. American Diabetes Association Professional Practice Committee for Diabetes. 3. Prevention or Delay of Diabetes and Associated Comorbidities: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1):S50–S60.

29. Yu-Xiang Yan, Huan-Bo Xiao, Si-Si Wang, et al. Investigation of the Relationship Between Chronic Stress and Insulin Resistance in a Chinese Population. J Epidemiol. 26(7): 355–360, (2016).  doi: 10.2188/jea.JE20150183.

30. Kapil Sharma, Shivani Akre, Swarupa Chakole, et al.Stress-Induced Diabetes: A Review. Cureus. 2022 .Sep; 14(9): e29142. doi: 10.7759/cureus.29142.

31. Ibasaraboh D Iyegha, Angela Y Chieh, Bianca M Bryant, et al. Associations between poor sleep and glucose intolerance in prediabetes. Choneuroendocrinology. 2019 Dec; 110:104444. doi: 10.1016/j.psyneuen.2019.104444.

32. Francesco P Cappuccio, Lanfranco D'Elia, Pasquale Strazzullo, et al. Quantity and Quality of Sleep  and Incidence of Type 2 Diabetes. Diabetes Care. 2009 Nov 12;33(2):414–420. doi: 10.2337/dc09- 124.

33. Ya Li, You Wu, Lili Wu, et al. The effects of probiotic administration on patients with prediabetes: a meta-analysis and systematic review, J Transl Med. 2022 Nov 2;20(1):498.  doi: 10.1186/s12967-022-  03695-y.

34. Ashwinipriyadarshini Megur, Eric Banan-Mwine Daliri, Daiva Baltriukienė, et al. Prebiotics

as a Tool  for the Prevention and Treatment of Obesity and Diabetes: Classification and Ability to Modulate the Gut Microbiota. Int J Mol Sci. 2022 May 29;23(11):6097.  doi: 10.3390/ijms2311609.

35. Hao Wu, Valentina Tremaroli, Caroline Schmidt, et al. The Gut Microbiota in Prediabetes and Diabetes: A Population-Based Cross-Sectional Study. Cell Metab. 2020 Sep 1;32(3):379-390.e3. doi: 10.1016/j.cmet.2020.06.011.

36. Alexandra Zhernakova, Alexander Kurilshikov, Marc Jan Bonder, et al. Population-based       metagenomics analysis reveals markers for gut microbiome composition and diversity. Science. 2016 Apr 29;352(6285):565-9.  doi: 10.1126/science.aad3369.

37. Damian Maseda, Emanuela Ricciotti. NSAID-Gut Microbiota Interactions. Front Pharmacol. 2020 Aug  7:11:1153.  doi: 10.3389/fphar.2020.01153.

38. Hannah C Wastyk, Gabriela K Fragiadakis, Dalia Perelman, et al.Gut-microbiota-targeted diets modulate human immune status. Cell. 2021 Aug 5;184(16):4137-4153.e14. doi:

     10.1016/j.cell.2021.06.019.

39. https://www.heart.org/en/healthy-living/healthy-eating/losing-weight/bmi-in-adults

40. https://diabetes.org/bmi-calculator

41. U.S. Department of Health and Human Services and U.S. Department of Agriculture. The Scientific Foundation for the Dietary Guidelines for Americans, 2025–2030: Scientific Report.  2026.