If your last lab report came back with an A1C in the 5.7% to 6.4% range, you probably heard the word prediabetes and a lot of general advice that followed. It's a scary-sounding label, but here's the reassuring part: prediabetes is one of the most changeable diagnoses in medicine. And in our physician-led practice, it's one of the most common reasons people come to us wondering whether a GLP-1 medication could help.

Let's walk through what prediabetes actually means, how GLP-1 medications fit in, and what the research does (and doesn't) suggest about treatment.

What GLP-1 for prediabetes really means

First, the numbers. Prediabetes is defined by blood sugar that's higher than normal but not yet in the diabetes range. You have prediabetes if your A1C results are between 5.7% to 6.4%, or if your fasting plasma glucose results are between 100 to 125 mg/dL. An oral glucose tolerance test is another way to catch it.

This is far more common than most people realize. More than 2 in 5 American adults have prediabetes, and 8 in 10 adults with prediabetes don't know they have it. It's also not something to shrug off: prediabetes increases a person's risk of developing type 2 diabetes, heart disease, and stroke.

Using a GLP-1 for prediabetes isn't a quick fix. It addresses the underlying problems (insulin resistance and excess weight) before they progress. Importantly, GLP-1 medications are not FDA-approved specifically to treat prediabetes, so this is an individualized clinical decision made with a physician and there is not a guaranteed outcome.

Why prediabetes happens: it's an insulin problem

The root issue is usually insulin resistance. Insulin is a hormone made by the pancreas that helps glucose in your blood enter cells in your muscle, fat, and liver, where it's used for energy. When blood glucose levels rise after you eat, your pancreas releases insulin, which then lowers blood glucose to keep it in the normal range. Over time, that system can break down. Insulin resistance is when cells in your muscles, fat, and liver don't respond well to insulin and can't easily take up glucose from your blood. As a result, your pancreas makes more insulin to help glucose enter your cells.

Excess fat tissue makes this worse. As long as the pancreas can keep up, blood sugar stays roughly normal, but eventually it can't, and glucose starts creeping up. That's the transition from prediabetes toward type 2 diabetes.

How GLP-1 medications affect blood sugar

GLP-1 medications work with a hormone your gut already makes. Released in response to nutrient ingestion, GLP-1 plays an important role in maintaining glucose homeostasis: it regulates blood glucose by stimulating glucose-dependent insulin secretion and inhibiting glucagon secretion, gastric emptying, and food intake. In plain terms, these medications help the body release insulin when it's needed, quiet the hunger signals, and slow how fast food leaves the stomach.

There's a second, powerful mechanism too: weight loss itself. Weight loss from GLP-1 medications independently improves insulin sensitivity and reduces the metabolic stress on beta cells. Adipose (fat) tissue produces inflammatory molecules that worsen insulin resistance, and losing fat mass reduces this inflammation and improves metabolic health.

Tirzepatide adds a twist. The main difference with tirzepatide is its dual receptor action. Unlike semaglutide, which targets only GLP-1 receptors, tirzepatide acts on both GLP-1 and GIP receptors. This dual mechanism results in a more pronounced effect on insulin sensitivity, blood sugar control, and weight loss. We dig into that comparison more on our medications page and in our tirzepatide and semaglutide overviews.

What the research shows about lowering diabetes risk

Here's where context matters. The single strongest piece of evidence for preventing type 2 diabetes comes from the landmark NIH Diabetes Prevention Program (DPP), which tested weight loss and activity, not GLP-1s specifically. After about 3 years, the DPP showed that participants in the lifestyle change program lowered their chances of developing type 2 diabetes by 58 percent compared with participants who took a placebo. The two major goals of that lifestyle intervention were a minimum of 7% weight loss and at least 150 minutes of physical activity similar in intensity to brisk walking.

Why does that matter for GLP-1 medications? Because another study found that weight loss was the main way to predict whether a participant in the DPP Lifestyle Change Program would have a lower risk of developing diabetes. GLP-1 medications are, among other things, effective tools for achieving and sustaining meaningful weight loss alongside diet and activity. A 2025 systematic review in a peer-reviewed endocrinology journal set out to systematically assess the effectiveness of these medications in slowing or preventing the progression of prediabetic patients into diabetics, and to determine whether early intervention can effectively mitigate the risk of developing diabetes.

A fair way to think about it: GLP-1 medications can support the weight loss and blood-sugar improvements that research has repeatedly tied to lower diabetes risk. They are not a guarantee that you personally won't develop diabetes, and they work best paired with nutrition and movement, not instead of them.

In our practice

Patients with prediabetes often tell us they've "tried everything" and feel stuck. What we usually find is that the deck was stacked against them biologically: the insulin resistance and appetite signals were fighting their best efforts. TOM Weight Loss is led by Dr. Tran Le, MD, who is triple board-certified in Obesity Medicine, Addiction Medicine, and Occupational & Environmental Medicine. When we treat prediabetes, we look at the whole metabolic picture, not just the number.

A few things we emphasize:

Screening and follow-up labs. Different test options don't always identify the same patients: some people may have a normal fasting glucose but an A1C in the prediabetes range. We track more than one marker.
Protein and muscle. Losing weight the right way means protecting muscle, which itself helps blood sugar.
Sustainable habits. Medication opens a window; lifestyle keeps it open.

Our all-inclusive memberships include the compounded medication (compounded semaglutide at $199/month or compounded tirzepatide at $249/month), and we also offer an à la carte plan for brand-name GLP-1s such as Wegovy, Ozempic, Zepbound, and Mounjaro. Note that compounded medications are not FDA-approved. Curious how the process works? See how it works.

Frequently asked questions

Can prediabetes be reversed?

Progression to type 2 diabetes is not inevitable. Type 2 diabetes can be prevented or delayed through a structured lifestyle change program that promotes weight loss, healthy eating, and increased physical activity. For many people, blood sugar can move back toward the normal range with sustained changes; medication may help you get there, but results vary from person to person.

Do I have to take a GLP-1 forever if I have prediabetes?

Not necessarily. The goal is to improve your metabolic health (through weight loss and better insulin sensitivity) and then work with your physician on a long-term plan. That plan is individualized. Some people taper; others continue. It's a conversation, not a one-size-fits-all rule.

Is metformin an option instead of a GLP-1?

Sometimes, yes. In the DPP, metformin reduced diabetes by 31%. It's an established, generic option your physician may consider depending on your labs, BMI, and history. We'll talk through what fits you.

Available across Texas and Utah

Our telehealth program serves patients throughout Texas (Houston, Dallas, Austin, San Antonio, and beyond) as well as Utah, so you can be seen from home without a long wait for an in-person appointment.

If your A1C or fasting glucose has landed you in the prediabetes range, don't wait for it to become something bigger. This is the ideal moment to act. Start a consultation and we'll build a plan around your labs, your goals, and your life. (This article is educational and isn't a substitute for personal medical advice.)

GLP-1s for Prediabetes: Can They Lower Diabetes Risk?