Overwhelm. It’s the feeling parents and teens often experience during the course of normal life. But imagine how that stress magnifies after a pre-diabetes diagnosis. 

There are so many questions…What do I do about this? How do we reverse it? Can we stop it before it turns into full blown diabetes? 

Gary Keller’s book, The One Thing, helps people eliminate overwhelm and get results by simply focusing on ONE thing that changes everything. 

He asks, “What’s the ONE Thing you can do such that by doing it everything else will be easier or unnecessary?”

So we asked 200 of the top diabetes experts in the world: For teens diagnosed with pre-diabetes, can it be reversible? And if so, what is the one most important thing teens and their parents can do to start reversing it?

Their answers consistently identified one thing – weight loss – as the first and most important step in reversing, or at least preventing pre-diabetes from developing into real Type 2 diabetes.

Most of their other answers also followed the theme of weight loss:

• Give up beverages with sugar
• Reduce sugar overall in foods
• Reduce processed foods and processed grains
• Reduce total carbohydrates
• Increase consumption of non-starchy vegetables (think: green beans, lettuce, spinach, broccoli, cabbage, etc.)
• Increased exercise, and regular ongoing exercise (this, we learned, has benefits to pre-diabetics even without weight loss)

The good news? Most of the experts think pre-diabetes is reversible for teens.

This experts were clear that this advice applies only to teens that are overweight.  A BMI of 25 or more is considered overweight. And anything over 30 is considered obese, according to Stanford Children’s Health.

Also, it’s important to mention:

• The focus of this article is on Type 2 pre-diabetes, not Type 1
• A few of the experts pointed out, is that any teen with a pre-diabetes diagnosis should also make sure they don’t actually have Type 1 by consulting with their doctor.
• The term “reversible” should not be confused with “cure” because the pre-diabetes can always come back with weight gain or nutrition or other factors

Read on to discover what the world’s leading diabetes experts have to say about this important topic.

Thank you, doctors, researchers and nutritionists, for the outpouring of support and advice you contributed to this article. 

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“There are two major types of diabetes:  Type 1 and Type 2. Type 1 used to be called “juvenile onset” diabetes because we see it mostly in kids.  Now we know that adults can get it, so it was renamed. Type 1 diabetes (0.5 % of the population) is an autoimmune disease, where the cells that make the hormone insulin, the “beta cells” are destroyed by the immune system. It is quite difficult to detect prediabetes in those at risk for Type 1; it requires difficult and complex analysis. Therefore, it is not likely that you will be able to suggest prevention of Type 1 in teens.  

The causes of Type 2 diabetes, which we are now seeing in large numbers in teens, is more complicated. Type 2 is very much related to something called “insulin resistance,” which means that insulin is released by the pancreas (the beta cells) but it is relatively ineffective metabolically. Also, in Type 2 diabetes we see a failure of the pancreatic beta cells to release enough insulin to compensate for insulin resistance. So to identify pre Type 2 diabetes, we look for kids who are insulin resistant. 

The most common cause of insulin resistance is overweight and obesity. We now know that in teens, obesity, secondary to overeating and lack of exercise, results in risk for diabetes. Therefore, we can improve kids, and avoid the occurrence of Type 2 diabetes by getting them to lose weight and get more exercise. Losing weight is most important, and requires an improved diet, and overall, reducing the amount they eat of fattening foods like fast food and pizza. It is a slow process, but it is the best way to counter pre-diabetes in Teens.”

Richard Bergman, PhD
Cedars-Sinai
Alfred Jay Firestein Chair in Diabetes Research
Assistant Clinical Professor, Artherioschlerosis Research Center
Director, Diabetes and Obesity Research Institute
Professor, Biomedical Sciences
Professor, Medicine

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“It’s in part a question of how “pre-diabetes” is defined. It’s usually defined based on some measure related to the level of glucose in plasma – for example, based on fasting plasma glucose or HbA1c. According to these definitions, many people will be able to take measures to lower their glucose levels so that they no longer meet the definition of “pre-diabetes”. This does not, however, guarantee that they will never develop diabetes over the course of a lifetime. Of course, even if a person meets the definition for “pre-diabetes”, this not always progress to diabetes.

The most useful thing to do is to lose weight – ideally by a combination of decreased caloric intake and increased physical activity. Further, it is critical to sustain the weight loss, which is harder to do than losing weight in the first place. Of course, it’s not easy to accomplish these goals. I wish I knew how to provide a magic formula that would work for everyone.”

Simeon I. Taylor, MD, PhD
University of Maryland School of Medicine
Professor, Medicine
Director of the Mid-Atlantic Nutrition Obesity Research Center

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“Yes, pre-diabetes is reversible and with the right lifestyle choice, even if it is not reversed then can avoid the transition to full blown type 2 diabetes. The one most important thing you can do is to reduce and eventually minimize or stop drinking sugary beverages which include sodas, fruit juices, iced tea/coffee drinks. Then move on to eliminating processed foods and other sources of added sugars in the diet.

Another answer would be weight loss but this is a bigger and more difficult challenge. Reducing sugar is more important because this will reduce the stress on your pancreas to stop having to pump out so much insulin, and cutting sugary beverages will give you more energy, clarity of mind and eventually will lead to weight stability or loss.”

Michael Goran, PhD
Keck School of Medicine, USC
Professor of Pediatrics
Dr. Robert C. Atkins Chair in Childhood Obesity and Diabetes;
Co-Director, Diabetes and Obesity Research Institute

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“There are two types of diabetes that can occur in teens.

One is called type 1 diabetes. It is an auto-immune disease and is not reversible.

The other is type 2 diabetes. It is related to obesity, and often, a sedentary lifestyle. In the pre-diabetes phase, there are signs of diabetes but not enough for a definite diagnosis of diabetes. In this stage, the signs can improve or even go away if someone loses weight, exercises more, and eats a healthier lower calorie diet.”

Roy W. Beck, MD, PhD
Physician and epidemiologist
Executive Director JAEB Center for Health Research

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What a good question and the one key thing is weight loss. Almost all teens with pre-diabetes have a significant issue with weight gain and weight loss can reverse the pre-diabetes. This is not any different to adults as well, so this advice holds for both groups.

Weight loss however is much easier said than done! We have a genetic make-up that has evolved to allow us to gain and maintain weight and not lose it. So our metabolism will be resistant to this and once we appreciate this challenge, we can appreciate the task ahead. It is not a short-term plan, but a concerted effort to alter what is essentially a life-style disorder. 

Pre-diabetes is caused by a lifestyle that finds the most susceptible of us (a combination of genetics and environment) and we need to tackle this in that setting. Poverty, fresh and healthy food ‘deserts’, access to people who motivate and keep one engaged, strategies to reduce stress etc. are all part of this. Throw in teenage transitions which can also be hard for some people (especially if the family support is stretched thin with not enough family time), it will be hard.

So:

1. As a family, plan and commit to changes to lifestyle and diet, with attention to calorie control.

2. Get a plan that becomes part of habit as it is habits that keep us doing the same things over and over. Exercise regularly as a family (as it improves bonding and motivation).

3. Avoid diets (all diets work but eventually fail as these can never become a ‘habit’). Instead, use lifestyle changes you will adhere to 1-2 years from now.

Shailesh Patel, MD, PhD
Albert W. Vontz, Jr Chair in Diabetes
Director, Division of Endocrinology, Diabetes and Metabolism
University of Cincinnati

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“Yes, pre-diabetes can be reversed. By far the most important thing to do is to adopt a healthy lifestyle, which means regular daily exercise, eating healthy non-processed foods, and losing weight if you are overweight (which most teens with pre-diabetes are). This is advice specifically for type 2 diabetes (type 1 is a very different disease).”

Richard W Grant MD MPH
Research Scientist III
Director, Delivery Science Fellowship
KPNC Division of Research
Adjunct Associate Professor
Department of Epidemiology & Statistics
UCSF School of Medicine

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“Most of what we know about pre-diabetes relates to adults, but it can be extrapolated to teens. Usually, the best thing to reverse or change it’s progression is exercise and weight loss. 

Most people with pre-diabetes are also insulin resistant. Generally speaking, for most people, exercise and weight loss are the first line of defense.”

Adrian Vella, MD, FRCP
Professor, Endocrinology, Diabetes, Metabolism, and Nutrition
The Mayo Clinic

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There is now evidence that the type 2 diabetes clinical diagnosis can be delayed. The major risk factor for type 2 diabetes is obesity. Thus, lifestyle and nutrition improvement are important, but that is easier said than done. We all believe we can change things easily, but in reality this is very difficult. Many little steps with positive reinforcement seem to work better than large lofty goals. I should add that having a high body mass index or being obese is thus less a controllable issue than a being an actual disease (genetics and appetite setpoint etc). 

Matthias von Herrath, M.D.
Professor, La Jolla Institute for Immunology
Vice President and Head, Diabetes R&D Center, Novo Nordisk, Inc.

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“Probably the best thing to do is to consult a physician. Yes, blood glucose levels can be reduced to within ‘normal’ range (below the diagnostic criterion) with good diet, exercise, lifestyle, and some medications. What and how to do it depends on the person and the setting, so physician guidance can be very valuable.”

Lawrence Fisher, Ph.D., ABPP
Professor Emeritus
University of California, San Francisco

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“Although genetics contribute in large part to the development of prediabetes/diabetes, and we cannot change our genetics, prediabetes has been successfully reversed through modifying the contributing factors that we can change. According to scientific studies that have been done, the one most important thing that teens and their parents can do to start reversing it is “lifestyle modification”, or in other words, changing the things we have control over. 

The two components of this are making good food choices, and increasing physical activity levels. Making good food choices is complex, and there is no one single best plan. Each person should make a plan that works best for their personal lifestyle, schedule, and tastes. Meeting with a registered dietitian or nutrition education is one great way to start making a plan. Likewise, there is no one single best plan for physical activity, but certainly we know that the more strenuous the physical activity, and the longer/more frequent the activity is maintained, the better.”  

Braden G. Barnett, MD
Assistant Professor of Clinical Medicine
Division of Endocrinology, Diabetes, and Metabolism
Department of Medicine
Keck School of Medicine of the University of Southern California

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“Yes, prediabetes can be reversed. Diabetes can be prevented. 

Many important lifestyle changes can help:

1. Stop drinking sugar-sweetened beverages (sodas, juice, bubble teas, etc.)

2. Exercise—even walking 30 min a day can make a big difference”

Alka Kanaya, MD
Professor, Medicine
School of Medicine
University of California, San Francisco

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“It is reversible. The most important thing is lifestyle change: diet, exercise and especially weight loss.

Unfortunately these individuals are prone, probably genetically, to have to deal with this issue for life since any weight gain can bring out the pre-diabetes and diabetes in the future.”

Derek LeRoith MD PhD
Director of Research
Division of Endocrinology, Diabetes and Bone Diseases
Icahn School of Medicine at Mt Sinai

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“The major study that was performed to determine whether diabetes could be prevented in persons with prediabetes was the Diabetes Prevention Program (DPP). The DPP didn’t include any teens…However, in the overweight or obese adult population with prediabetes in the DPP, losing about 7% of initial weight and increasing physical activity levels by about 30 minutes per day at least 5 days per week were highly effective in preventing the development of diabetes.”

David M. Nathan, M.D.
Director, MGH Diabetes Center and Clinical Research Center
Professor of Medicine
Harvard Medical School

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“First and most important: LIFESTYLE. Good nutrition and exercise, keep the weight down. You want your body mass index (BMI) below 25. Yes; it is reversible.

Second: make sure the prediabetes isn’t preclinical type 1 diabetes. We are now seeing this in obese teens and this is more common if there is a family history of type 1 diabetes. This can only be diagnosed with a blood test for diabetes antibodies.”

Irl B. Hirsch, M.D.
Professor of Medicine
UW Medicine Diabetes Institute

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“The short answer is once you are diagnosed with diabetes, the diagnosis stays. This is not really the case with pre-diabetes.  Pre-diabetes is diagnosed by elevated glucose levels that are not yet in the frank diabetes range. Thus, you can get your glucose values into the normal range and you won’t be considered to be “pre-diabetic” anymore; as long as they stay in the normal range. 

The one most important thing is usually losing some weight. Good news is it doesn’t have to be a lot. Losing 5-7% of your starting weight can reduce your risk for developing type 2 diabetes by as much as 60%!  If you are already at a healthy weight, the next best thing is to get into some routine physical activity.” 

David G. Marrero, PhD
Director of the UA Center for Border Health Disparities
University of Arizona Health Sciences

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“Pre-diabetes is reversible with weight loss which can be achieved by diet and exercise.  The American Heart Association recommends at least 150 minutes of moderate intensity physical activity a week. That breaks down to at least 30 minutes per day, five times a week or alternate recommendation is at least 75 minutes of vigorous exercise per week.  The American Diabetic Association recommends about 1-2 pounds weight loss per week. Diet should include non starchy vegetables, minimize refined grains or added sugars. Reducing overall carbohydrate intake and increasing lean protein intake has demonstrated improvement of glycemia in patients who are pre-diabetic.”

Nida Hamiduzzaman MD FACP
Clinical Associate Professor of Medicine
USC Internal Medicine

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“Yes, the good news is that pre-diabetes in adolescents and teens is usually reversible.  Most doctors will prescribe lifestyle intervention that includes attention to a dietary regimen that avoids fast foods and sugar-sweetened beverages and food items. The doctor will likely also recommend increasing physical activity via engagement in sports or individual exercise like biking, swimming, walking, gym workouts or running. In rare instances, genetic variation may be involved in the patient symptoms, so blood glucose and insulin should be monitored on a regular basis by a physician. There are several monogenic (genetic) forms of “maturity onset diabetes of the young (MODY)” which involve reduced insulin production by the pancreatic islets, which is not usually the problem in “garden variety” pre-diabetes, so that is why continued monitoring by a physician is a good idea.”

Christopher B. Newgard, PhD
Director, Sarah W. Stedman Nutrition and Metabolism Center
Director, Duke Molecular Physiology Institute
W. David and Sarah W. Stedman Distinguished Professor
Duke Medical Alumni Association Distinguished Professor
Departments of Pharmacology & Cancer Biology and Medicine
Duke University Medical Center”

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“There have been three studies that were conducted with gold-standard scientific methods–one in the US, one in Finland and one in China, all have shown that when prediabetes is diagnosed, it can be delayed and even prevented. In the US, the study was called the Diabetes Prevention Program (DPP). I was fortunate to be one of the scientists who helped conduct the study.  

In all three studies, lifestyle changes made the biggest difference in preventing diabetes. It isn’t as easy as it sounds. The DPP recommends a weight loss of 7% of one’s baseline weight and maintenance of that weight loss and 150 minutes of moderate-intensity exercise per week (30 minutes per day of brisk walking, dancing, or any type of activity is great!).

My suggestion is for the type of exercise selected, that it be fun and realistic and start slowly if you need to. I even tell patients to start with a minute a day and increase by a minute per day over the first month. As far as weight loss, don’t deprive yourself of anything, but cutting back is the key. Making simple changes by stopping fruit juices, but having natural fruits instead, also reduces calorie intake.

Having friends or family members to team up with is very helpful for support.  In the same way, having friends and family members who act as the “Diabetes Police” and ask questions like, “Are you sure you are supposed to be eating that?”…just isn’t helpful!”

Claresa (Resa) Levetan, MD
Fellow with Distinction, American College of Endocrinology
Board Certification in Internal Medicine, Diabetes, Endocrinology & Metabolism

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“The most important action anyone with a diagnosis of pre-diabetes can do is maintain a normal body weight (i.e., avoid obesity) and allied with that is to remain active, vs. having a sedentary lifestyle (i.e., have a daily exercise schedule).”

Ronald Alfred Arky, M.D.
Daniel D. Federman, M.D. Distinguished Professor of Medicine and Medical Education
Brigham and Women’s Hospital
Harvard Medical School

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“Pre-diabetes definitely can be reversible with lifestyle changes, including changes in diet and exercise patterns. Medications can also be helpful, although lifestyle change is the most powerful tool to reverse pre-diabetes.”

Steven J. Russell M.D., Ph.D.
Associate Professor of Medicine, Harvard Medical School

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“Yes, data in humans and mice suggest prediabetes can often be reversed or diabetes delayed if two lifestyle changes are made: 1. Decrease in weight, and even maintaining a decrease of only 5-7% or so, is very beneficial, and 2. Increased aerobic exercise, to at least 3 times a week for 40 minutes each, for example. These two changes are very important in my opinion, from what we know now. Accomplishing these two goals will usually have a major positive impact on health. Of course, healthier food choices that eliminate processed foods are also advised.”

Michael P. Czech, PhD
Isadore and Fannie Foxman Professor
Program in Molecular Medicine
University of Massachusetts Medical School

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Addressing pre-diabetes as defined this way, A1C in 5.7-6.4 range:
Hemoglobin A1C blood test
less than 5.6 = normal
5.7-6.4 = Prediabetes
6.5 = higher Diabetes

“Your doctor may have screened you for diabetes if there is a strong family history and/or if you are overweight or obese. Pre-Diabetes is a condition that places you at increased risk for diabetes.This can absolutely be reversed with lifestyle changes. It is important to reevaluate the foods and drinks consumed and reduce the carbs (i.e. bread, rice, pasta, potatoes) and sugars in your diet. Reduce the sugary drinks and soda and increase water intake. A dietician or nutritionist can help you in making healthier food choices. Increase your activity level and exercise more. If you are considered overweight or obese, reducing your weight in a healthy way will also be beneficial in reducing your risk of developing diabetes.  Lifestyle changes are key.”

Renee M. Poole MD, MMM, FAAFP
Clinical Assistant Professor
Department of Family Medicine
Keck Medicine of USC

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“Yes – attain and maintain a healthy weight through lifestyle changes – diet and exercises. Also get regular assessment of blood glucose levels.”

Thomas A Buchanan, MD
Professor of Medicine
Vice Dean for Research
Director of the CTSI
Co-Director, Diabetes and Obesity Research Institute
Endocrine Division Chief in the Department of Medicine

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“The best thing to do to avoid diabetes is to exercise regularly and keep your weight in the normal range.”

Jerrold M. Olefsky, M.D.
Professor of Medicine
Associate Dean for Scientific Affairs
University of California, San Diego

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“In adults there are clinical trials that show the benefits of regular exercise and modest weight loss reduce the risk to develop diabetes. A drug called metformin was also helpful in some study participants. There are no similar trials in teens, but observational data indicate that a healthy lifestyle with both regular physical exercise and a nutrition plan that includes weight control and even modest weight loss are likely to be effective in teens.”

Byron J Hoogwerf, MD, FACP, FACE
Endocrinology, Diabetes & Metabolism

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“For most but not all individuals, teens or adults, with pre-diabetes, there is a good chance of reversing the problem. The key is managing excess weight, eating a healthy diet while limiting calorie intake, and regular physical activity. Every little bit of weight loss for individuals with excess body weight helps. And the exercise does not have to be intense and exhaustive; sustained moderate intensity activity has important effects on insulin sensitivity and glucose measures.”

Darren K. McGuire, M.D., M.H.Sc.
Distinguished Teaching Professor; Dallas Heart Ball Chair for Research on Heart Disease in Women
Department of Internal Medicine
University of Texas Southwestern Medical Center
Director, Parkland Hospital and Health System Outpatient Cardiology clinics

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“Yes, prediabetes can be reversible!

The 2 most important things to do are to:

• Eliminate sweetened drinks and fruit juices and have fresh fruit instead of juice 

• Lose weight – for every 2 pounds of weight loss there is a 16% reduction in risk of developing diabetes and with more weight loss of 5-7% of body weight, many people revert back to having normal blood sugars.”

Linda M. Delahanty, MS, RD
Associate Professor of Medicine,
Harvard Medical School
Director of Nutrition and Behavioral Research
Massachusetts General Hospital Diabetes Center

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“Yes – if you prediabetes, it can reversed. The one most important thing teens and their parents can do is to make sure that their weight is ideal for their age and height. I really wanted to give you three important things teens and their parents can do to reverse prediabetes: healthy diet, exercise and aim to get the weight to the ideal range for age and height. Pediatricians have growth and weight curves to provide guidance on weight.” 

Umesh Masharani, M.B., M.D.
Professor of Clinical Medicine
Division of Endocrinology
Department of Medicine
University of California, San Francisco

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“First, it can be reversible in some cases by changing dietary habits and physical activity. I recommend a good Endocrinologist to evaluate each case and in my case we always use a well versed registered nutritionist because changing dietary habits requires help. The parents and siblings have to participate as well.

Good nutrition is for all of us.  A good balancee diet is key to good health.  But if you have an overweight/obese person with or without the diagnosis of diabetes caloric restriction and food composition based on lipids, BP, etc., becomes very important.

Changing habits is not easy, so follow up is crucial. In summary, focus on controlling all abnormalities usually seen in the metabolic syndrome: glucose, weight, lipids and blood pressure.”

Jaime Davidson, MD, F.A.C.P., F.A.C.E.
Clinical Professor of Medicine
Division of Endocrinology, Diabetes and Metabolism
University of Texas, Southwestern Medical Center
President WorldWIDE Diabetes

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“Absolutely, pre-diabetes is a reversible condition! The most effective intervention to reverse pre-diabetes is weight loss. Even a small amount of weight loss helps improve your health!”

Ildiko Lingvay, MD, MPH, MSCS
Professor of Medicine
Department of Internal Medicine/ Division of Endocrinology
Department of Population and Data Sciences
Medical Director, Office of Clinical Trial Management (OCTM)
UT Southwestern Medical Center at Dallas, Texas

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“Live a healthy life (moving, losing weight) and have a medical team check your progress and status of other risk factors – there is more than sugar! Also blood pressure, lipids, etc. matter.

Weight loss and eating less is crucial. There are till now no magic diets, although evidence is growing that cutting carbs helps in reducing hunger and that artificially sweetened foods drive hunger for sugar. That is a thing to keep in mind when preparing foods. Discussing with dietitians and coaches can help and can keep you motivated.

Walk, don’t drive. Stand, don’t sit ?”

Chantal Mathieu, MD, PhD
Professor of Internal Medicine
Program Director of Biomedical Sciences
Catholic University of Leuven, Belgium
Chair of Endocrinology at the University Hospital Gasthuisberg Leuven

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“The best way to prevent further progression is to get down to your ideal body weight and do regular exercise. ‘Reversing’ is not the best word..(see more about why in Dr. Edelman’s article here https://tcoyd.org/2020/01/can-type-2-diabetes-be-reversed/). ‘Remission’ is the best word because it can always come back. ‘Reversing’ may be misinterpreted as meaning ‘cure’.”

Steven Edelman MD
Professor Of Medicine
University Of California San Diego
Veterans Affairs Medical Center
Founder and Director Taking Control Of Your Diabetes 501 (c)3

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“Yes, pre-diabetes can be reversible for teens.  Regular exercise of at least 1-hour per day and a low-carb diet, high in vegetables and unsaturated fats (such as nuts, seeds, avocado, olive oil, etc.) can help to reverse pre-diabetes.  This is easier said than done, and takes time, commitment, effort and resources for the whole family! Finally, a label of pre-diabetes does not define you and should not scare you. Hopefully it will motivate you to great health and wellness!  Establishing a healthy lifestyle as a teenager can lead to a lifetime of great health and a life well lived!

Daniel DeSalvo, M.D.
Assistant Professor of Pediatrics
Director of Strategic Collaboration
Diabetes Clinic CPT Co-Director
Section of Pediatric Diabetes & Endocrinology
Baylor College of Medicine/Texas Children’s Hospital

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“Yes it is reversible. Do not leave your physical activity and nutrition to chance.”

Gregory Taylor, MD
Clinical Associate Professor of Medicine (Practitioner), USC
Medical Director of the Keck Signature Care Program

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“I would definitely not say pre-diabetes is reversible. The reason I wouldn’t say that is that someone who is at risk for diabetes is always at risk for diabetes, and it can be deceiving to say that they can “reverse” pre-diabetes. They may be able to lower their blood glucose levels, which is a very good thing! While their risk for type 2 diabetes doesn’t go away, the good news is that people with pre-diabetes can lower their risk for developing full-blown diabetes, or at least delay developing type 2 diabetes by getting and/or staying active and making balanced food choices. So again, while pre-diabetes is not reversible, people can live well and make the best possible choices to reduce their risk for and/or delay getting type 2 diabetes.”

Jane K. Dickinson, RN, PhD, CDE
Program Director/Lecturer
Diabetes Education and Management
Teachers College Columbia University

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“Excluding T1DM is essential in teens with hyperglycemia. Presentation and evidence of auto-immune disease as well as islet antibodies are important to differentiate T1DM from T2DM. 

For teens with pre or early T2DM lifestyle change (nutrition counseling and exercise) is the most important interventions.”

Bernard Zinman OC, MDCM, FRCPC, FACP
Stephen and Suzie Pustil Diabetes Research Scientist
Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital
Professor of Medicine, University of Toronto

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“Yes, pre-diabetes and diabetes in teens is definitely potentially reversible if it is type 2 diabetes. Type 1 diabetes is not usually reversible. The most important thing kids and parents can do to start reversing it is to promote healthy weight loss through calorie restriction and regular physical exercise.”

James de Lemos, M.D.
Professor of medicine
Sweetheart Ball-Kern Wildenthal, MD, PhD Distinguished Chair in Cardiology
University of Texas Southwestern Medical Center
Cardiology Service Chief and CCU Director at Parkland Memorial Hospital

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“Pre-diabetes usually occurs with Type 2 diabetes. Type 2 diabetes is related to body weight and exercise. Yes it is reversible. So the key things are to achieve your ideal body weight and begin a consistent exercise program. Often people have what is called insulin resistance, which means they make the insulin that reduces serum blood glucose levels. Because of the insulin resistance, the target organs are not sensitized to the insulin so it is not effective even though insulin is being made. Even if you don’t eat sugar, your own liver can synthesize glucose. The bottom line is weight reduction and exercise.” 

Dane K. Wukich MD
Professor and Chair
Dr. Charles F. Gregory Distinguished Chair in Orthopaedic Surgery
University of Texas Southwestern Medical Center

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“By far the most important thing for teens diagnosed with prediabetes and even those not so diagnosed is to not become overweight.  Maintain a normal weight through proper diet and exercise. Overweight teens should try to lose weight to get to a normal body weight but avoid overdoing diets and not slip into something called “anorexia nervosa,” which is to become underweight.”

Mark E. Molitch, M.D.
Professor Emeritus
Division of Endocrinology, Metabolism & MolecularMedicine
Department of Medicine
Northwestern University Feinberg School of Medicine

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“Prediabetes can be reversed in a lot of people. Since it is frequently associated with obesity, control of weight by exercise and diet is the most important thing to do.”

Jerry P. Palmer, M.D.
Professor, Medicine
Associate Director, Diabetes Research Center
University of Washington Medical Center
Division of Metabolism, Endocrinology and Nutrition

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“Firstly, I don’t like or use the term, ‘reverse’ because that’s not in reality what is possible. Nor is “cure.” The most accurate term is “remission.” To date two organizations, American Diabetes Association and Diabetes UK, have defined this term. It’s my understanding that ADA, possibly along with other international orgs, are developing a publication that will be published later this year. These orgs define remission, “as glucose levels that are in the normal or prediabetes range with no use of glucose-lowering medications for up to one year.” (1,2) For sure a critical factor for teens is to attempt to get to and, even more importantly, stay at a healthy body weight. Weight loss and keeping pounds off does seem to be very important. Teens and their families need to find a healthy way of eating that fits into their lifestyle long term. Additionally, teens and their families can get and stay physically active. Physical activity is an insulin sensitizer. It achieves other goals as well – can help keep lost pounds off, reduces stress, burns calories, lowers blood pressure, improves lipids and more.”

1. Buse JB, Caprio S, Cefalu WT, et al. How do we define cure of diabetes. Diabetes Care. 2009;32(11):2133-2135.
2. Diabetes UK. Diabetes remission. https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/type2-diabetes-remission

Hope Warshaw, MMSc, RD, CDE, is the author of books published by ADA and has been a diabetes care provider for nearly 40 years. 

Website: https://www.hopewarshaw.com/

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“Pre-diabetes can clearly be reversed (as can early type 2 diabetes) in most cases. In general, weight loss is the key (there are some people who become pre-diabetic and even diabetic despite being quite lean, but this is less common). Losing weight and sustaining weight loss is very difficult, though, as we have very few effective interventions to help with this, and our biology tens to try to prevent us from losing weight.”    

Martin G Myers, Jr, MD, PhD
Marilyn H Vincent Professor of Diabetes Research
Departments of Internal Medicine and Molecular and Integrative Physiology
Director, MDiabetes
Director, Michigan Diabetes Research Center
University of Michigan Medical School

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“Kids with pre-diabetes (the precursor to type 2 diabetes) can help to improve their glucose metabolism so that the blood sugars return to the normal range. The most important pre-diabetes treatment in kids is weight loss through lifestyle modification for the entire family. This means that everyone in the household commits to eating healthy foods and getting more physical activity. “

Michelle Van Name, MD
Assistant Professor of Pediatrics (Endocrinology)
Yale School of Medicine

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“Yes, prediabetes and even early, mild type 2 diabetes can be reversible. The great majority of people with these conditions, especially teenagers, are overweight or obese. If these individuals can lose weight (not so easy to do), their too high blood glucose levels, by which prediabetes and diabetes are diagnosed, will be reduced and may no longer fulfill these diagnostic criteria.  

The only way to lose weight is to eat less calories than our bodies use up. To lose one pound of fat requires us to eat 3500 calories less than we use. Over whatever period of time that occurs, we will lose one pound of fat. Exercise is helpful because it helps us use up more calories but increased exercise by itself doesn’t usually make us lose weight. It requires eating less calories than we use. Crash diets don’t work over the long haul; we need to change our ongoing eating habits.”

Mayer Davidson, M.D.
Professor, Medicine
Charles Drew University
and David Geffen School of Medicine at UCLA
Past President of the American Diabetes Association

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“YES… diabetes and prediabetes are reversible. But one has to act Fast and Early. Early screening, especially if overweight or obese, should be done for kids whose parents are diabetics because early diagnosis means early reversal of the disease, especially if one acts fast.

Medical Nutrition Therapy and Physical activity are the keys to reversing diabetes. Lifestyle therapy is very important in both preventing and reversing the disease and should be implemented from the very start.

Weight loss should be a priority for the overweight at risk of developing diabetes or those with prediabetes. Studies have shown that 15% weight loss is enough to remove excess fat that is stored in the liver and pancreas and to reverse the progression of prediabetes to diabetes.

The best advice to kids whose parents have diabetes is to stay fit, eat right and be active to prevent becoming overweight and over the long term develop diabetes.”

Gerry H Tan, MD, FACP, FACE, FPCP, FPSEDM
Professor of Medicine III, Cebu Doctors’ University College of Medicine
Chairman, Division of Endocrinology, Diabetes and Metabolism
Department of Medicine

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“My answer based on evidence (1) (2) is that with sufficient weight loss, about 7-10% of current weight, we know that diabetes was delayed or prevented. As weight loss was maintained, glucose levels and insulin resistance was reduced. The terminology used is ‘remission’ rather than ‘reverse’.” 

Robin Nwankwo, MPH, RDN, CDE
Clinical Research Coordinator
Diabetes Educator
University of Michigan Medical School

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“Prediabetes is a term used to identify individuals who are at increased risk for developing diabetes later in life.  The diagnosis of prediabetes (according to ADA criteria) can be based on any one of the following three criteria: (1) HbA1c 5.7-6.4% inclusive; (2) fasting plasma glucose concentration = 100-125 mg/dl (Impaired Fasting Glucose or IFG); (3) 2-hour plasma glucose concentration during OGTT = 140-199 mg/dl (Impaired Glucose Tolerance or IGT).  

Unfortunately, there is considerable discordance amongst these three tests in establishing the diagnosis of prediabetes, i.e. many individuals with IGT do not have IFG and vice versa and the HbA1c identifies individuals with IGT or IFG or IGT/IFG.  However, all 3 criteria identify individuals at increased risk (4-10% per year depending on the ethnic back and presence/severity of obesity).

The effective treatment for prediabetes is weight loss and the achievement of ideal body weight (BMI < 25 kg/m2). Exercise (30 minutes/day, 5 days/week) also is effective and should be combined with weight loss.  There are no drugs approved by the FDA for the treatment of prediabetes, although in adults metformin, pioglitazone, and glucagon-like peptide 1 receptor agonists all have been shown to be effective. However, in children only the GLP-1 RA liraglutide has been improved for the treatment of diabetes (not prediabetes). Children with prediabetes should be seen by an endocrinologist/diabetologist to formulate an individualized treatment plan.”

Ralph A. DeFronzo, MD
Profesor of Medicine
Chief, Diabetes Division
UT Health San Antonio

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“Yes, teens diagnosed with pre-diabetes, can incorporate healthy lifestyle modifications into their daily routine and prevent the progression to T2DM.

What is the one most important thing teens and their parents can do to start reversing it?

Identify one small change that they can work towards with their parents as a family (i.e. eat on smaller plates, limit late night eating, drink water with every meal, etc…).  Once they can maintain that goal for a week, continue the first change and incorporate another one into the daily routine.”

Olga Gupta, M.D.
Assistant Professor
UT Southwestern Medical Center
Pediatric Endocrinology

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“Prediabetes is a grey area between normal glucose and diabetes. When the fasting glucose is between 100-125 mg/dl, this is considered prediabetes (>126 or greater is diabetes). During a 2-hour glucose test in which the body is challenged by a sugar load, a blood glucose of 140-199 is also diagnostic of prediabetes (>200 is diabetes). Lastly, a hemoglobin A1c or Hb1c, which measures the glycosylation (attachment of sugar) to the red blood cell, between 5.7 and 6.4 defines prediabetes (> 6.5 is diabetes).

Prediabetes is a reversible condition, but in about 30% of cases progresses toward overt type 2 diabetes within 2 years. Therefore, it is very important that adolescents at high risk for prediabetes (affected by overweight or obesity, showing acanthosis nigricans, family history of type 2 diabetes etc.) are screened for the disease.

Dietary changes and physical activity are the key factors to reverse this condition. Diet modification may be a simple change such as giving up sweetened beverages, eating smaller portions at dinner, or not snacking after dinner. Also, any increase in physical activity helps improve prediabetes. Either type of change promotes weight loss, the first-line treatment for prediabetes. In fact, a modest weight loss of 7% body weight is often enough weight loss to revert back to normal glucose status.”

Nicola Santoro, MD, PhD
Assistant Professor of Pediatrics (Endocrinology)

and

Mary Savoye, RD
Associate Director, Pediatric Obesity and Director, Bright Bodies Program http://www.brightbodies.org/program.html
Registered Dietitian and Certified Diabetes Educator
Associate Director, Pediatric Obesity & Bright Bodies Weight Management Program for Children
Yale School of Medicine

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“Hyperglycemia (or an abnormal elevation in blood [plasma] glucose) is the hallmark and the criteria for making a diagnosis of diabetes and pre-diabetes. There are various ways to measure glucose exposure (fasting plasma glucose, glycosylated hemoglobin, oral glucose tolerance test) in order to make a diagnosis of diabetes or pre-diabetes, and each of these methods has its advantages and disadvantages. Glucose levels rise over time as a consequence of insufficient insulin production from the beta cells (the cells in the Islets of Langerhans that manufacture and secrete insulin). The gradual loss of insulin secretion is thought to be partly genetically medicated (you inherit the predisposition) and greatly influenced by the environment, and specifically what you eat, how much activity you engage in and where in your body does weight (fat) accumulate.

In teens with pre-diabetes, there is almost always a combination of insulin resistance and loss of beta cell function that result in the rise in blood glucose that is diagnosed as pre-diabetes and if it progresses, type 2 diabetes. While we do not fully understand what damages the beta cell, many scientists have shown that what we eat can have a profound effect on the health of our organs, including the pancreas. It is thought that elevated levels of fatty acids in the setting of chronic inflammation might be affecting both beta cell health and increasing the body’s resistance to the effect of insulin (called insulin resistance). The higher the insulin resistance the more insulin is needed in circulation to drive glucose from the bloodstream into cells and organs where it can be used (or stored) for energy. Both fatty acid levels and chronic inflammation can be addressed through dietary and lifestyle modifications. The Diabetes Prevention Program (which was done in adults) showed that in people with pre-diabetes, 150 minutes of moderate physical activity per week along with losing around 5% of body weight greatly reduced the chance of developing type 2 diabetes. And while most of the benefit from this intervention is thought to be due to decreasing insulin resistance (lowering the body’s need for insulin), there might also be a healthy impact of diet, reducing fatty acids in circulation and decreasing inflammation in the body on the health of the beta cell.

The first step in trying to reverse a condition like pre-diabetes is to want to tackle this, not as an individual, but as a family unit. The habits, environment and conditions that led to the development of pre-diabetes have probably been present for many years and are probably ingrained in the everyday activities and psyche of those affected. Getting help in identifying what those habits and conditions might be and working out a systematic, reasonable, achievable plan for substituting them with healthier alternatives is the first step. From a nutrition standpoint for example, trying to eliminate processed foods in favor of whole foods, substituting animal-based products for plant-based products, increasing intake of produce high in antioxidant properties are some of the steps that can be taken over time. Increasing physical activity (both aerobic and strength training) and trying to work towards a healthier body weight are also important aspects of prevention. Addressing the many stressors and distractors in today’s overstimulated, overwhelming and overconnected (yet personally disconnected) world through meditation or mindfulness, stress relieving activities, meaningful social connections and interactions are yet other steps to take. But all of this requires time, patience, dedication, support and personal engagement from family and friends, as well as knowledge, problem solving skills and an experienced “coach” (many health professionals are trained to provide such support) to guide you and your family through this life journey. And while at the start all of this might seem overwhelming and beyond reach, if you take the journey one step at a time, accompanied by those around you that love and care for you, the process will lead to a healthier, happier, more productive and fulfilling life.”

Luigi Meneghini, M.D., M.B.A.,
Professor, Internal Medicine
University of Texas Southwestern Medical Center
Division of Endocrinology
Executive Director, Parkland Health and Hospital System Global Diabetes Program

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Each patient might be a different case and they should follow their endocrinologist’s advice and recommendations. There is a great section at the end of this article that will cover all the questions regarding recommendations and treatments.

Pere Puigserver, Ph.D.
Professor of Cell Biology at Harvard Medical School and Dana-Farber Cancer Institute

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1. “Firstly, remember not all pre-diabetes progresses to type 2 diabetes, and some regresses spontaneously. However, over time, most progress to type 2 diabetes.
2. We don’t like to talk about “preventing diabetes” we prefer to say “delaying”
3. The one most important thing? That’s tough. Honestly, I would say: don’t panic and do find fun, long-term friends who enjoy living a healthy, low-stress life. As a clinician I love the resources available through the American College of Lifestyle Medicine..the new Culinary Medicine Program (https://culinarymedicine.org/) would be great to offer to your members.”

Elizabeth Beale, MD
Assistant Professor of Clinical Medicine
Endocrinology, Diabetes and Metabolism
Keck School of Medicine, USC