Pre-diabetes medications: what are the options?

1 in 3 American adults have pre-diabetes – it’s just so common!

A nutritious diet and increased physical activity are some of the common ways to manage prediabetes.

However, sometimes people with prediabetes are prescribed medications to help lower blood sugar and insulin resistance, or to lose weight.

In this article, you’ll find everything you need to know about prescription drugs that help treat pre-diabetes.

What is pre-diabetes?

Prediabetes is a diagnosis where blood sugar levels are consistently higher than normal, but not high enough to warrant an official diagnosis of diabetes.

Without intervention, people diagnosed with prediabetes are much more likely to develop type 2 diabetes.

Blood sugar levels to diagnose prediabetes are as follows:

  • Fasting blood sugar between 100-125 mg/dL
  • Blood sugar 2 hours after a meal between 140-199 mg/dl
  • HbA1c test between 5.7-6.4%

Without intervention, prediabetes usually develops into type 2 diabetes within a few years.

Read more: How often should you be tested for prediabetes?

How you can do it pre-diabetes?

Prediabetes is mainly managed through diet and exercise. The goals are to lose excess weight, improve insulin sensitivity, and delay or prevent the onset of type 2 diabetes.

The Centers for Disease Control and Prevention (CDC) recommends the National Diabetes Prevention Program (NDPP) as an effective way to reverse prediabetes and prevent type 2 diabetes.

In the study, people who participated in the NDPP reduced their risk of developing type 2 diabetes by 58% at the end of the program (and 71% for people aged 60 and over).

If you’ve recently been diagnosed with prediabetes, work with your doctor or registered dietitian to create a meal plan and exercise regimen that fits your lifestyle and health goals.

What medications can I take in pre-diabetes?

While diet and exercise are the first-line treatment for prediabetes, some medications show promising results.

The following medications can control or even reverse prediabetes and delay or prevent the onset of type 2 diabetes:


Metformin is extremely effective in lowering blood sugar levels in people with prediabetes and diabetes. It can also help with moderate weight loss, which can help prevent type 2 diabetes.

This inexpensive and widely available drug is well tolerated by most people.

Studies have shown that taking 850 mg of metformin twice a day can reduce the risk of developing type 2 diabetes by 31% over three years.

This risk reduction was seen in both men and women, but was less effective in people aged 45 and over.

Metformin is most effective when combined with a healthy change in diet and increased daily physical activity.

Glucagon-like peptide 1 (GLP-1) agonists.

GLP-1 agonists are popular injectable medications used to lower blood sugar levels in people with type 2 diabetes.

However, they are commonly prescribed “off-label” to people with metabolic syndrome and insulin resistance, such as prediabetes.

GLP-1 agonists such as liraglutide and semaglutide can improve insulin sensitivity, lower blood sugar and HbA1c, and help with weight loss. These all help to delay and prevent type 2 diabetes.

New research suggests that GLP-1 agonists may prevent the progression of both pre-diabetes and type 2 diabetes. In a study, 2,254 people with pre-diabetes were given 3.0 mg of liraglutide daily for three years.

Not only did this result in significant weight loss, but 66% of the participants’ blood sugar levels returned to normal.

Only 3% of participants in the liraglutide group developed type 2 diabetes compared to 11% in the placebo group.

Thiazolidinediones (TZD)

TZDs are an oral class of type 2 diabetes medications that increase insulin sensitivity.

When prescribed off-label, TZDs can be used to treat prediabetes and prevent progression to type 2 diabetes.

However, they do not help with weight loss – this is one of the main ways to reverse pre-diabetes.

They are readily available and often less expensive than GLP-1 agonists.


Acarbose is an inhibitor of the enzyme alpha-glucosidase, which has been shown to reduce the progression of pre-diabetes and restore normal blood sugar levels.

In the large STOP-NIDDM study, 1,429 patients with pre-diabetes received either placebo or acarbose for four years.

Participants who took acarbose were less likely to develop type 2 diabetes and also experienced cardiovascular benefits.


Meglitinides are oral medications used to treat type 2 diabetes.

They work by binding to potassium channels on pancreatic beta cells. The result is an improvement in insulin sensitivity and blood sugar levels.

When combined with diet and exercise, this drug may be an effective strategy for preventing type 2 diabetes.

SGLT-2 inhibitors

SGLT-2 inhibitors are a class of oral medications used to lower blood sugar levels by releasing excess glucose through the urinary tract.

These drugs can protect against heart disease and heart failure. However, they can stress the kidneys, so they are not recommended for people with chronic kidney disease (CKD).

Taking an SLGT-2 inhibitor causes weight loss by excreting glucose through the kidneys. People taking this drug may excrete 60 to 100 grams of glucose per day in their urine.

What is the best drug for prediabetes?

Medications are not universal and the right choice will vary from person to person.

The best medicine is one that works with your body and doesn’t cause too many unwanted side effects.

Some people prefer to take oral medications, while others don’t mind injections. Many people will also choose to manage pre-diabetes by changing their diet and exercise regime.

The best way to treat pre-diabetes is to consider which medications will improve your insulin sensitivity the most and help you lose weight if needed. Achieving these two goals will ultimately help delay and even prevent the onset of type 2 diabetes.

Work with your doctor to determine which management style will work best for your lifestyle and health goals.

What are the disadvantages of taking medications for prediabetes?

Many pre-diabetes medications can cause unwanted side effects such as nausea, vomiting and diarrhea – especially when you first start taking them.

Several medications are used to treat type 2 diabetes, such as sulfonylureas and DPP-4 inhibitors.

They can cause weight gain and even hunger, which would be contraindicated to losing weight to control and reverse pre-diabetes.

Talk to your doctor about the adverse side effects of prescribed medications before taking them.

In addition, many drugs, in particular SGLT-2 inhibitors and GLP-1 agonists, are very expensive. Your health insurance may not cover their costs if you don’t have type 2 diabetes.

Always check that prescribed medications are covered as they can be too expensive.

If you’re taking pre-diabetes medication, can you ever stop?

Yes, but talk to your doctor first.

Side effects may occur if you suddenly stop taking your medicine. These include higher blood sugar levels, insulin resistance, and weight gain.

If you want to stop taking the drug, your doctor will likely want to reduce your dose to avoid these unwanted side effects. They may also suggest alternative treatment.

On the other hand, many people have been successful in taking medication to reverse pre-diabetes. Ultimately, they no longer need a prescription to control blood sugar and insulin resistance.

Many people have come off their medications after making lifestyle changes and successfully reversing their pre-diabetes.

Read more: How long does it take to reverse pre-diabetes?

Can taking pre-diabetes medications prevent type 2 diabetes?

Yes! many yes. The goal of using prescription drugs to treat prediabetes is to delay or prevent the progression of type 2 diabetes.

These types of therapies are most effective when used in conjunction with lifestyle changes such as increased daily physical activity and dietary changes.

What is the best way to reverse pre-diabetes?

The “best” way to reverse pre-diabetes looks different for everyone. However, it has been proven that changes in a healthy lifestyle are very effective.

Losing unnecessary kilograms, improving your diet and increasing daily physical activity significantly increases the chances of reversing prediabetes.

Studies have compared the effectiveness of lifestyle change programs, such as the National Diabetes Prevention Program (NDPP), with metformin.

Researchers found that positive changes in diet and physical activity significantly reduced the risk of developing type 2 diabetes in a person with prediabetes.

The NDPP group reduced the risk of developing type 2 diabetes by 58%. For people aged 60 and over, the risk was reduced by 71%. Participants in the metformin group reduced their risk of developing diabetes by 31%.

About 5% of those in the NDPP group developed diabetes each year, compared to 7.8% in the metformin group. Every year, 11% of people in the placebo group developed diabetes.

Are you feeling inspired to start a healthy routine? Check out ten effective changes you can make to support your efforts to reverse pre-diabetes.

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