Prediabetes

HIDDEN CHRONIC DISEASE RISK: PREDIABETES

“Prediabetes affects nearly half of Americans—often undetected—even among fit, active individuals, while rates in children have doubled those of other countries and risk quadrupled over the past 30 years, signaling a devastating, progressive metabolic crisis. Yet this condition is rapidly reversible, often within days, through carbohydrate reduction and targeted lifestyle changes—making inaction by our healthcare system both dangerous and indefensible.”

INCIDENCE: Prediabetes is one of the most common and progressive conditions affecting up to 50% of the United States population defined by elevated circulating glucose levels above normal which signals early underlying metabolic dysfunction and risk for progression into type 2 diabetes.^1-3 Alarmingly, rates of prediabetes are rising and have reached 18% in 2016,⁴ and rate almost double the prevalence observed across the world.⁵ The Center for Disease Control and Prevention reported that over 80% of individuals in the United States are unaware that they have prediabetes⁶ and go untreated. However, this likely underestimated the true incidence of this condition as standard diagnostic laboratory values are limiting and only capture a single snapshot of metabolic health. More advanced and continuous monitoring utilizing continuous glucose monitoring (CGM) revealed detections of glycemic values consistent with prediabetes and/or diabetes in 43% of individuals who were categorized as “healthy” according to

standard laboratory values.⁷ Koutnik et al., recently demonstrated that 30% of middle-aged athletes who have low body fat and high fitness values had glycemic values consistent with prediabetes.⁸ A more robust meta-analysis of prior studies revealed an alarmingly high incidence of glucose values consistent with prediabetes even in athletes, demonstrating that even those individuals who exercise regularly, maintain low body fat, and achieve high fitness levels are not immune to metabolic dysfunction.⁹

BURDEN: Progressively elevating glucose is a key mechanism related to diabetes-related tissue and organ damage.¹⁰ While these rising glucose values are independently damaging, glucose is also a signal for underlying multisystem dysfunction, including insulin resistance, beta-cell dysfunction, and/or excessive adipose tissue.^11,12 resulting in annualized risk of progression to T2D up to 10%.¹² Consequently, prediabetes has been associated with adverse cognitive function,¹³ cardiovascular disease,¹² and all-cause mortality.¹⁴ Prediabetes has also been associated with an incidence of total cancer, total liver cancer, hepatocellular carcinoma, breast cancer and all-cause dementia.¹⁴ These data are consistent with other evidence in more advanced forms of childhood diabetes.^15-21 However, the progressive nature of prediabetes,³ lack of early diagnoses,⁶ hesitancy to treat,^22,23 growing prevalence of risk factors for disease progression (i.e., obesity) which have quadrupled in children in the last 30 years,²⁴ double the incidence in children in the U.S. compared to other countries,^4,5 demonstrates an alarming chronic disease course leading to devastating health consequences, particularly for our youth.²⁵

THERAPEUTIC GAPS: Early intervention is critical, but healthcare professionals have cited hesitancy to medicalization of prediabetes,^26,27 creating a healthcare blind spot in mitigating disease progression when it can be most effectively treated with the lowest healthcare burden. With most Americans having prediabetes and over 80% are unaware, limitations around current laboratory assessments which are often not assessed in children, American is on course for “hidden” chronic disease epidemic which is often hard to reverse.^5,7

PREDIABETES REVERSAL (Days to <4 Weeks): Diet and exercise are frontline therapies for managing prediabetes. Combining moderate-intensity aerobic exercise with low-to-moderate-load resistance training shows significant improvements in glycemic control, weight loss, and cardiovascular health in prediabetic individuals.²⁸ However, exercise alone may be insufficient. Koutnik et al., discovered that even individuals engaging in frequent exercise

and having both low body fat and high fitness levels, can develop glucose levels consistent with prediabetes.⁸ Meta-analyses of studies in similar

populations revealed that body composition and fitness levels were not associated with glucose levels.⁹ However, carbohydrate intake was the most powerful predictor of fasting glucose levels and metabolism in these individuals. Additionally, Prins et al., demonstrated in a crossover RCT that reducing carbohydrate intake rapidly reversed prediabetes in days in athletes.⁸ This data is consistent with multiple reports demonstrating that reducing carbohydrate intake is a powerful therapeutic strategy for rapidly reversing both prediabetes and diabetes while facilitating deprescription and reducing healthcare burden.^21,29-35

SAFETY & FEASIBILITY: American Diabetes Association and others have acknowledged that carbohydrate restriction and exercise are powerful tools for improving diabetes.³⁶ However, current United States Dietary Guidelines for Americans (USDA) acknowledge they are limited to “Health Promotion, Not Disease Treatment,” but over 80% of Americans either have a chronic disease or condition demonstrating that USDA.³⁷ Additionally, USDA current dietary constraints to not account for access to diverse dietary strategies, even those nutritional strategies demonstrated to have the most powerful effects on disease prevention, management, and reversal.³⁸

CALL TO ACTION: We are facing a silent, rapidly growing epidemic—prediabetes now affects nearly half of all Americans, and over 80% don’t even know they have it. Children are uniquely vulnerable; their rates are rising while the incidence of common risk factors have quadrupled, putting them at double the risk of death compared to adults. This condition is progressive but highly reversible—often in days to weeks—through targeted lifestyle changes, especially carbohydrate reduction and structured exercise. Yet, our healthcare system continues to hesitate, missing the critical window to reverse disease before damage is done. It’s time to break through this inertia. We must take action—empower our communities, shift our clinical approaches, and challenge outdated guidelines. The tools exist. The science is clear. Reversing prediabetes is not only possible—it’s urgent.

Andrew Koutnik, PhD, is an award winning Research Scientist and globally recognized authority on metabolic health, diabetes management, and human performance optimization, having collaborated with leading institutions such as NASA, John Hopkins, Harvard Medical School, and the Department of Defense, amongst others. Dr. Koutnik was diagnosed with Obesity and Juvenile Diabetes in adolescence and has investigated lifestyle intervention to prevent and eliminate chronic disease burden.