Prediabetes and weight: what the numbers mean and what to do next.

"Borderline" is a real result, and a useful one

Maybe a lab result came back with a note, or someone used the word "borderline" and moved on. Prediabetes is easy to shrug off because it usually doesn't feel like anything.

Diabetes Canada defines prediabetes as blood sugar levels that are "higher than normal, but are not yet high enough to be diagnosed as type 2 diabetes." It's also clear about why it matters: "Although not everyone with prediabetes will develop type 2 diabetes, many people will."

The useful part is the timing. Diabetes Canada says that "taking steps to manage your blood sugar can prevent or delay type 2 diabetes," and that "the key is a healthy lifestyle." Prediabetes is the point where looking at the whole picture, weight included, can still change the direction. If you're wondering whether an assessment makes sense for you, see who the program is for.

What the numbers mean

Prediabetes is found with blood tests. Diabetes Canada's clinical practice guidelines use these ranges:

• A1C (a longer-term measure of blood sugar): 6.0% to 6.4% is prediabetes.
• Fasting plasma glucose (blood sugar after not eating overnight): 6.1 to 6.9 mmol/L is called impaired fasting glucose.
• Oral glucose tolerance test (blood sugar two hours after a sugary drink): 7.8 to 11.0 mmol/L is called impaired glucose tolerance.

A single number isn't the whole story. Diabetes Canada notes that usually two abnormal blood tests are needed to diagnose diabetes, and your clinician reads your results alongside your history, medications and other labs. If one of your numbers falls in these ranges, it's a reason for a conversation, not a reason to panic.

How weight and insulin resistance connect

Insulin is the hormone that moves sugar out of your blood and into your cells. With insulin resistance, the body needs more insulin to do the same job, and blood sugar can start to creep up. That creep is often what shows up as prediabetes.

Weight is part of this picture. Diabetes Canada's screening guidance lists having overweight and abdominal obesity (extra weight around the waist) among the risk factors for type 2 diabetes. The same list includes:

• Being 40 or older.
• A close family member (parent, sibling or child) with type 2 diabetes.
• A history of prediabetes or diabetes during a pregnancy.
• High blood pressure, or high triglycerides or low "good" cholesterol.
• Belonging to a higher-risk population, for example people of African, Arab, Asian, Hispanic, Indigenous or South Asian descent.
• Health conditions such as polycystic ovary syndrome, obstructive sleep apnea or non-alcoholic steatohepatitis (an inflammatory kind of fatty liver disease).

None of these are about character. Most of them aren't choices at all. They're simply what a clinician looks at when deciding how closely to watch your blood sugar.

What helps, according to Diabetes Canada

"Prediabetes treatment" mostly means changing what can be changed, with support. Diabetes Canada's guidance for people with prediabetes says that healthy behaviour changes that lead to modest weight loss can delay or prevent type 2 diabetes, and that "regular physical activity is also important to reduce your risk of diabetes."

It also says that if healthy changes aren't enough to bring blood sugar back to normal, a health-care provider may recommend medication in addition to those changes. That's a clinical decision about your blood sugar, made with you.

What this doesn't mean: a crash diet, or being handed a sheet of rules. Diets that don't fit your life tend not to last, which is the whole story of yo-yo dieting. The aim is a plan you can actually live with.

How often to get checked

Diabetes Canada recommends screening with a fasting glucose and/or A1C test every three years for adults 40 and over, or for anyone at high risk on a risk calculator. People with more risk factors may need testing earlier or more often. Once you know you have prediabetes, follow-up testing is part of the plan.

What an assessment looks at

A weight-focused assessment with prediabetes in the picture looks at:

If prescription treatment for weight comes up, your clinician explains whether it's appropriate for you, the benefits and the side effects, and you decide. If something in your labs needs another kind of care, you'll hear that plainly, with a referral where it helps.