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

If your last lab report showed an A1C in the 5.7% to 6.4% range, you probably heard the word prediabetes and a lot of general advice.

The label sounds scary, but prediabetes is one of the most changeable diagnoses in medicine. It is also one of the most common reasons people come to our physician-led practice asking about a GLP-1 medication.

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% and 6.4%, or if your fasting plasma glucose results are between 100 and 125 mg/dL. An oral glucose tolerance test is another way to catch it.

More than 2 in 5 American adults have prediabetes, and 8 in 10 adults with prediabetes don't know they have it. Prediabetes increases a person's risk of developing type 2 diabetes, heart disease, and stroke.

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

Why prediabetes happens: insulin resistance

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 rises after you eat, your pancreas releases insulin.

Insulin lowers blood glucose and keeps 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. While the pancreas keeps up, blood sugar stays roughly normal. Eventually it can't, and glucose creeps up. That is 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. Your gut releases GLP-1 in response to food. GLP-1 helps maintain 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.

Weight loss is a second mechanism. 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. Losing fat mass reduces this inflammation and improves metabolic health.

Tirzepatide acts on two receptors. Semaglutide targets only GLP-1 receptors. Tirzepatide acts on both GLP-1 and GIP receptors, which gives a more pronounced effect on insulin sensitivity, blood sugar control, and weight loss. We compare them further on our medications page and in our tirzepatide and semaglutide overviews.

What the research shows about lowering diabetes risk

The strongest evidence for preventing type 2 diabetes comes from the NIH Diabetes Prevention Program (DPP). It 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.

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 effective tools for achieving and sustaining meaningful weight loss alongside diet and activity.

A 2025 systematic review in an endocrinology journal assessed whether these medications slow or prevent the progression from prediabetes to diabetes, and whether early intervention lowers the risk.

GLP-1 medications can support the weight loss and blood-sugar improvements that research has repeatedly tied to lower diabetes risk. They do not guarantee you won't develop diabetes. They work best with nutrition and movement.

In our practice

Patients with prediabetes often tell us they've "tried everything" and feel stuck. Insulin resistance and appetite signals are often working against their efforts. Dr. Tran Le, MD, DABOM, leads TOM Weight Loss. She is triple board-certified in Obesity Medicine, Addiction Medicine, and Occupational and Environmental Medicine. When we treat prediabetes, we look at the whole metabolic picture.

We track more than one marker in follow-up labs. Different tests don't always identify the same patients, and some people have a normal fasting glucose but an A1C in the prediabetes range. We also protect muscle as you lose weight, since muscle itself helps blood sugar. Medication helps, and habits you can keep up sustain the result.

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. See how it works for the process.

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, 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), then plan the long term with your physician. Some people taper. Others continue.

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 is in the prediabetes range, act before it becomes something bigger. Start a consultation and we'll build a plan around your labs and your goals. (This article is educational and isn't a substitute for personal medical advice.)