Your labs came back with an A1C of 5.7 or higher, and someone used the word prediabetes. You still feel fine. You still ski, ride and work full days. So it is easy to file the number away and wait.
More than 2 in 5 American adults have prediabetes, by the count of the Centers for Disease Control and Prevention. Many of them never hear the word until type 2 diabetes arrives. GLP-1 medicines can act on your weight and your blood sugar at the same time, and large trials have now tested them in people with prediabetes. Here is what those trials found, including what happened after people stopped the medicine.
What prediabetes means on your lab report
Prediabetes means your blood sugar runs higher than normal but below the line for diabetes. Two tests on a standard lab panel show it. The CDC sets these ranges:
- A1C shows your average blood sugar over about three months. Prediabetes runs from 5.7 to 6.4 percent, and diabetes starts at 6.5 percent.
- Fasting blood sugar shows your level after a night without food. Prediabetes runs from 100 to 125 mg/dL, and diabetes starts at 126 mg/dL.
Behind both numbers sits the same problem. Insulin moves sugar out of your blood and into your cells. In prediabetes, your cells answer insulin less well, so sugar stays in your blood longer. Your pancreas then makes more insulin to keep up. Extra weight makes the problem worse. Fat deep in the belly and fat inside the liver both add to insulin resistance. Our post on GLP-1 and insulin resistance explains this process in more depth.
Weight loss lowers the risk of diabetes
The best evidence on prediabetes comes from the Diabetes Prevention Program. The trial enrolled 3,234 adults with blood sugar in the prediabetes range. One group joined a lifestyle program. Its goals were a weight loss of at least 7 percent and 150 minutes of activity a week. Over an average of 2.8 years, that program cut new cases of type 2 diabetes by 58 percent against placebo. The New England Journal of Medicine published the results in 2002.
A 2006 analysis in Diabetes Care looked at the 1,079 people in that lifestyle group. Weight loss was the strongest predictor of who stayed free of diabetes. Each 2.2 pounds of weight loss cut the risk by 16 percent.
Reaching that weight loss is the hard part. Hunger often rises as weight falls, and many people regain the weight they lost. GLP-1 medicines target that hunger.
How a GLP-1 medicine works on weight and blood sugar
GLP-1 is a hormone your gut releases after you eat. Your own GLP-1 breaks down within minutes. GLP-1 medicines copy the hormone and stay active far longer. Semaglutide and tirzepatide are the two most people know. Tirzepatide also acts on a second gut hormone named GIP.
These medicines lower blood sugar along two paths.
- The direct path. GLP-1 tells your pancreas to release insulin while your blood sugar runs high. It also slows how fast your stomach empties, so sugar from a meal enters your blood more gradually.
- The weight path. Fullness comes sooner, and cravings get quieter. As weight comes off, fat in the belly and liver shrinks, and your cells answer insulin better.
When your blood sugar falls back to normal, the extra insulin stops. For that reason, the FDA labels list a low risk of low blood sugar for a GLP-1 medicine taken alone. The risk rises when you take it with insulin or certain other diabetes medicines. Our post on how GLP-1 controls blood sugar covers the hormone itself.
What the trials found for prediabetes
Semaglutide in the STEP trials
The STEP 1 trial tested semaglutide in 1,961 adults without diabetes. Both groups also followed a lifestyle program. A 2022 analysis in Diabetes Care then pulled out only the members who started the trial with prediabetes. After 68 weeks, 84.1 percent of that group on semaglutide had normal blood sugar. On placebo, 47.8 percent did. A1C and fasting blood sugar both improved more on semaglutide.
Tirzepatide in SURMOUNT-1, over three years
The SURMOUNT-1 trial followed 1,032 adults with obesity and prediabetes for 176 weeks, a little over three years. At week 176, people on tirzepatide had lost between 12.3 and 19.7 percent of their body weight on average, depending on the dose. People on placebo had lost 1.3 percent.
The blood sugar results followed the weight. Over the 176 weeks, 1.3 percent of people on tirzepatide developed type 2 diabetes. On placebo, 13.3 percent did. The New England Journal of Medicine published the results in 2025. Most side effects in the trial affected digestion. Most were mild to moderate, and most came in the first 20 weeks.
What happens to blood sugar after you stop
The SURMOUNT-1 team then stopped the medicine and the placebo and watched for 17 more weeks. By the end, 2.4 percent of the tirzepatide group had type 2 diabetes, up from 1.3 percent. On placebo, the share rose from 13.3 to 13.7 percent. The tirzepatide group still came out far ahead. Even so, its share with diabetes nearly doubled in about four months off the medicine.
The STEP 1 team ran a longer check. They followed 327 people for one year after semaglutide and the lifestyle program both ended. Those people had lost 17.3 percent of their body weight at week 68. One year later, they had regained 11.6 percentage points, about two thirds of the loss. Most heart and blood sugar markers drifted back toward where they started. A1C rose from 5.2 to 5.6 percent. Diabetes, Obesity and Metabolism published the results in 2022.
These results describe a medicine that works while you take it. So a good plan looks past the first year. Muscle matters here. Your muscles pull sugar out of your blood after every meal, and part of the weight you lose can come from muscle. Protein at each meal and regular strength training help you keep it. Our posts on protein during weight loss and macros and weight lifting on a GLP-1 explain how.
Is a GLP-1 right for your prediabetes?
No GLP-1 medicine carries FDA approval for prediabetes alone. The versions sold for weight loss carry approval for adults with a body mass index of 30 or more. They also cover adults at 27 or more who have a weight-related health problem.
For some people, food and movement come first. The CDC puts a helpful weight loss at 5 to 7 percent of your body weight. These medicines fit best when diet and exercise have not moved your weight enough on their own.
Side effects are common at the start. Nausea and stomach upset often show up in the first weeks and then fade for most people. The FDA labels also warn about less common problems, including gallbladder disease and pancreatitis. A woman planning a pregnancy stops these medicines ahead of time. The labels rule them out for anyone with a personal or family history of medullary thyroid cancer, a rare type, or a related gene condition called MEN 2.
How Contours approaches prediabetes and weight loss
At Contours, care starts with how you feel and what your labs show. An A1C of 6.0 or a fasting blood sugar of 112 gives you and your provider a clear starting line. Your provider reads those numbers alongside your health history and your goals. Together, you decide whether a GLP-1 medicine fits. When it fits, the plan includes nutrition guidance and ongoing monitoring. Your provider retests your labs and adjusts the plan as your body responds. Visits take place by telehealth for patients across all of Colorado.
We help active adults optimize their health so they can enjoy life for decades. Our medical weight loss program page explains the care in more detail. For the wider view, read GLP-1 benefits beyond weight loss.
When your labs show prediabetes, bring them with you and start the conversation.