What to Eat With Prediabetes
By Wilfong Nutrition LLC | Austin, Texas
A prediabetes diagnosis often comes with a handout, a recommendation to eat less sugar, and not much else. For most people, that is not enough to understand what is actually happening in their body or what changes are most likely to make a meaningful difference.
This post covers what the research actually shows about prediabetes and nutrition, without the oversimplification that tends to follow a diagnosis. Our approach is health-centered and non-diet: we focus on the eating patterns and behaviors that support blood sugar.
What Prediabetes Is
Prediabetes is a state in which blood sugar levels are higher than normal but not yet high enough to meet the criteria for a type 2 diabetes diagnosis. It is identified through fasting glucose levels between 100 and 125 mg/dL, an HbA1c between 5.7 and 6.4 percent, or a two-hour glucose of 140 to 199 mg/dL on an oral glucose tolerance test.
Prediabetes affects an estimated 98 million adults in the United States, according to CDC data, and the majority are unaware they have it. It is also responsive to change. Research consistently shows that changes to eating patterns and movement can meaningfully reduce progression to type 2 diabetes.
The Diabetes Prevention Program, a landmark randomized controlled trial in people with prediabetes, found that both intensive lifestyle intervention and metformin meaningfully reduced the risk of developing type 2 diabetes, by 58 percent and 31 percent respectively over an average of 2.8 years. The lifestyle intervention in that study was not a rigid diet. It focused on sustainable changes to eating patterns and activity.
A common question after diagnosis is whether prediabetes can be reversed. For some people, blood sugar returns to a normal range; for others, it stays steady or progresses despite real effort. That range of outcomes is normal and reflects many factors, including genetics, age, and other health conditions, not just food choices. Nutrition, movement, and medication when appropriate can all support healthy blood sugar, and a registered dietitian can help you find what fits your life.
What to Eat With Prediabetes: Why Restrictive Diets Are Not the Answer
Carbohydrates often get blamed first after a prediabetes diagnosis, but treating all carbohydrates as problematic is not supported by the evidence.
Research shows that the types of carbohydrates you eat and your overall dietary pattern matter more than carbohydrate quantity alone. Whole grains, legumes, fruits, and vegetables, all of which contain carbohydrates, are associated with improved metabolic health outcomes, not worsened ones.
Highly restrictive diets also tend not to be sustainable. And sustainability is one of the most important predictors of long-term blood sugar management. A dietary approach someone can maintain for years is more effective than a strict approach they abandon within months.
What the Evidence Supports
Some of the research below comes from studies in type 2 diabetes and general populations, where the meal-response mechanisms are well established and reasonably apply to prediabetes.
Fiber. Soluble fiber slows glucose absorption and improves insulin sensitivity. Foods high in soluble fiber include oats, legumes, apples, and barley. Research consistently associates higher fiber intake with better glycemic outcomes.
Protein at meals. Eating protein alongside carbohydrates slows digestion and lowers the blood sugar response to a meal. It also supports satiety. Protein is one of several factors that support muscle mass, along with resistance activity, and muscle is the body's main site for clearing glucose from the blood.
The Role of Movement
Physical activity improves insulin sensitivity independently of dietary changes. Brisk walking and resistance activity both contribute, and they work through different mechanisms than food does. The Diabetes Prevention Program found that 150 minutes of moderate activity per week was a key component of the intervention that reduced diabetes progression.
Movement does not need to be formal exercise. Walking after meals, for example, has meaningful research support for reducing post-meal blood sugar response.
If Your Provider Recommends Metformin
Some people worry that needing metformin means they failed at the nutrition piece, or that being offered it at diagnosis means their efforts will not matter. Neither is true.
Metformin and nutrition are different tools that often work together. In the Diabetes Prevention Program, both reduced progression to type 2 diabetes, and many people benefit from combining them. Whether metformin is right for you depends on your labs, your risk factors, and your full health picture, which is a conversation between you and your prescribing provider.
If you are prescribed metformin, the nutrition work still matters. Eating patterns that support stable blood sugar, satiety, and overall health are valuable whether or not medication is part of your picture.
How a Dietitian Approaches Prediabetes
A registered dietitian starts with your actual life, not a template, understanding your current eating patterns, food preferences, and schedule, then building from there.
At Wilfong Nutrition, prediabetes counseling is individualized. We do not eliminate food groups or assign calorie targets. We help you understand what your body needs and how to meet those needs in a way that is realistic to sustain.
This approach draws on intuitive eating, a non-diet framework with a substantial research base for improving the relationship with food and supporting overall health. It can be part of care for blood sugar concerns when tailored with a qualified dietitian. You can read more in our beginner's guide to intuitive eating.
If you are in Texas and would like to talk through nutrition support for prediabetes, we work with clients via telehealth across the state and in person in Austin. We are in-network with Blue Cross Blue Shield, Aetna, Cigna, United, and Curative.
Get in touch with our team to ask about availability and insurance coverage.
