What is prediabetes? A guide for people who've just been told
You've had a blood test and the result came back higher than expected. Your GP has used the word prediabetes, or perhaps "impaired fasting glucose." Here's what that actually means, what the numbers are, and what you can do about it.
What the numbers mean
Prediabetes is defined by blood sugar levels above normal but below the diabetes threshold. Specifically: a fasting glucose between 5.6-6.9 mmol/L (100-125 mg/dL), or an HbA1c between 42-47 mmol/mol (6.0-6.4%). Above these thresholds is type 2 diabetes. Below is normal.
HbA1c measures your average blood sugar over the previous 2-3 months. Fasting glucose measures a single point in time. Both are useful but neither tells you what's happening after meals, during sleep, or under stress. Those patterns often deteriorate long before fasting glucose or HbA1c cross the clinical threshold.
What it means for your body
Prediabetes indicates that your cells are becoming resistant to insulin. Your pancreas is compensating by producing more, which keeps your blood sugar in range most of the time, but the system is under strain. The higher insulin levels promote fat storage, increase inflammation, and gradually wear down the pancreas's capacity to compensate.
The progression from prediabetes to type 2 diabetes isn't inevitable. Research consistently shows that lifestyle interventions, specific dietary changes, regular movement, improved sleep, can reverse prediabetes in the majority of cases. The landmark Diabetes Prevention Programme trial found that lifestyle intervention reduced diabetes risk by 58%, more effective than metformin (31%).
What a blood test misses
A fasting glucose test captures your blood sugar at one moment: first thing in the morning, after an overnight fast. It doesn't show the glucose spike after your lunchtime sandwich, the crash at 3pm, the instability during the night. These patterns are where prediabetes lives day to day, and they're invisible to periodic blood tests.
HbA1c averages everything out. A person who spikes to 12 mmol/L after every meal but returns to normal quickly might have the same HbA1c as someone whose glucose is gently elevated all day. The average is the same; the metabolic experience is completely different, and so is the intervention.
What you can actually do
A continuous glucose monitor shows you the patterns between blood tests. For someone with prediabetes, this is immediately practical: you can see which meals spike your glucose beyond a healthy range and which don't. You can see whether a post-meal walk makes a measurable difference. You can track your progress week over week rather than waiting three months for the next HbA1c.
Nico pairs a CGM with coaching that reads your data and guides you through changes based on what it sees. For prediabetes, the coaching focuses on the interventions with the strongest evidence: meal composition, post-meal movement, sleep quality, and stress. The goal is to improve your glucose patterns enough that your next blood test tells a different story.
Nico is a wellness and coaching platform, not a medical product. If your GP has diagnosed prediabetes, continue working with them. Glucose data and coaching complement medical oversight; they don't replace it.
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