Prediabetes and insulin resistance: the numbers, and what can reverse it

By the Voltra team · Updated 30 September 2026

The numbers

American Diabetes Association (ADA), Standards of Care in Diabetes 2026, Tables 2.1 and 2.2 [1]. Below the prediabetes range counts as normal, as the Saudi Ministry of Health's chart labels it [4]. In mmol/L, fasting glucose is 5.6–6.9 for prediabetes and 7.0 or more for diabetes; at two hours, 7.8–11.0 and 11.1 or more [1].

Risk doesn't start at a line. ADA says that for all three tests it is continuous: it begins below the prediabetes range and rises faster towards the top of it [1]. Fasting means no calories for at least 8 hours [1].

One high result isn't a diagnosis of diabetes. Unless blood sugar is unmistakably high, ADA requires two abnormal results, from two different tests or from the same test done twice [1], and the Saudi Ministry of Health notes that the lab tests are often repeated the next day to confirm [4].

The cut-offs also differ. ADA starts the fasting range at 100 mg/dL, while the World Health Organization and several diabetes organisations start it at 110 mg/dL (6.1 mmol/L) [1], so a fasting result of 105 is prediabetes on one scale and normal on the other. ADA also says there isn't enough evidence to use continuous glucose monitors (CGMs) to screen for or diagnose prediabetes or diabetes [1].

The Saudi Ministry of Health's chart

The Saudi Ministry of Health's infographic on blood sugar levels and what they mean sorts three tests into three bands: normal, prediabetes and high [4]. Its numbers match ADA's. Fasting: under 100 mg/dL, 100–125, and 126 or more. HbA1c: under 5.7%, 5.7–6.4%, and 6.5% or more [4]. The chart is laid out right to left, so read left to right its ranges come out reversed, as 125 - 100.

Its middle row is two hours after eating, with the same 140 and 200 cut-offs [4]. That isn't the test used for diagnosis. ADA's two-hour test measures blood sugar two hours after drinking a solution with 75 g of glucose [1], and the Ministry's own diabetes page describes the glucose tolerance test as a reading before and two hours after drinking a sugar solution [4]. A reading two hours after an ordinary meal isn't one of the tests ADA uses to diagnose prediabetes [1].

Insulin resistance: no routine test

NIDDK, part of the US National Institutes of Health, defines it: "Insulin resistance is a condition in which your body doesn’t respond to insulin the way it should." [2] It can lead to higher blood sugar, and people with insulin resistance or prediabetes usually have no symptoms [2]. The Saudi Ministry of Health describes type 2 diabetes as the body resisting the effect of insulin, or the beta cells not making enough of it [4].

What you can't do is confirm it with a standard lab test:

• NIDDK: "Health care professionals may not test for insulin resistance. The test for insulin resistance is primarily used only for research studies." [2]
• The Endocrine Society's 2017 guideline on children and teenagers recommends against measuring insulin when assessing them for obesity [5]. It adds that in adults without diabetes, fasting insulin explains no more than 5% to 50% of the differences in insulin sensitivity, that proposed cut-offs for insulin resistance vary 2.5-fold between studies, and that doctors in general practice should stop measuring fasting insulin to try to diagnose it [5].
• The 2023 international guideline on polycystic ovary syndrome (PCOS) says the insulin tests available in clinics are of limited clinical relevance and aren't recommended in routine care [6].

ADA's screening criteria bring insulin resistance in only through conditions linked to it, such as severe obesity, acanthosis nigricans and fatty liver disease (MASLD) [1] [2]. The tests that follow are the blood sugar tests above [1].

Who should get tested, and how often

ADA's 2026 standards say [1]:

• Adults of any age with overweight or obesity should be considered for testing if they have at least one other risk factor, such as a parent, sibling or child with diabetes, high blood pressure, low HDL cholesterol or high triglycerides, PCOS, physical inactivity, or a condition linked to insulin resistance. Overweight here means a BMI of 25 or more, or 23 or more for people of Asian ancestry.
• Everyone else should start screening at 35.
• If results are normal, repeat at least every 3 years, sooner if you have symptoms or your risk changes, for example with weight gain. With prediabetes, get tested every year, and ADA says it should also prompt a full check of your cardiovascular risk factors.

Our BMI guide covers the lower cut-offs some guidelines use for Middle Eastern adults. Saudi Arabia's Ministry of Health has an online prediabetes risk test; if your score is high, it reminds you that the result isn't precise and that you need a doctor's diagnostic tests [7].

What lowers the risk

NIDDK says: "People with prediabetes have a high chance of developing type 2 diabetes within 5 to 10 years." [2] It adds that not everyone with prediabetes goes on to develop it [2].

The strongest evidence on lowering that risk comes from the US Diabetes Prevention Program (DPP), published in 2002 [3]. It randomly assigned 3,234 US adults with raised fasting and post-glucose-drink blood sugar, average age 51 and average BMI 34, to a lifestyle programme, metformin or placebo [3]. The lifestyle programme's goals were at least 7% weight loss and at least 150 minutes of physical activity a week [3]. Its funders included the US National Institutes of Health and two drug companies, Bristol-Myers Squibb and Parke-Davis [3].

Over an average of 2.8 years [3]:

• The lifestyle programme cut new cases of type 2 diabetes by 58% compared with placebo, and metformin by 31% [3].
• Average weight loss was 5.6 kg with the lifestyle programme, 2.1 kg with metformin and 0.1 kg with placebo [3].
• Half the lifestyle group had reached the 7% goal by 24 weeks; 38% were at least 7% lighter at their most recent visit [3].
• For every 6.9 people who followed the lifestyle programme for three years, one case of diabetes was prevented [3].

The effect shrank but lasted. In the follow-up study, the lifestyle group's risk was still 34% lower at 10 years, 27% at 15 and 24% at 21 [8].

ADA says weight loss was the most important factor [8]. Its 2026 standards recommend that adults with overweight or obesity at high risk of type 2 diabetes join a prevention programme to lose at least 5–7% of their starting weight, through a healthy reduced-calorie eating pattern and at least 150 minutes a week of moderate activity [8]; a later analysis suggested more benefit with at least 7–10% [8]. For someone weighing 90 kg, 5–7% is 4.5 to 6.3 kg (calculated). ADA also recommends prescribing an evidence-based eating pattern, such as Mediterranean or low-carbohydrate, to people with prediabetes [8].

Activity counts on its own too. In a later analysis cited by ADA, getting at least 150 minutes a week reduced new cases of type 2 diabetes by 44%, even without reaching the weight-loss goal [8].

Two caveats. The trial wasn't designed to separate the effects of diet, activity and weight loss [3]. And ADA notes that prevention has been shown mainly in people with impaired glucose tolerance, a high two-hour result, rather than in people with only a high fasting glucose or only a high HbA1c [1].

NIDDK sums it up: "Healthy living may help prevent or reverse insulin resistance and prediabetes." [2] WHO describes impaired glucose tolerance and impaired fasting glucose as in-between states on the way from normal to diabetes: people with either are at high risk of type 2 diabetes, though it isn't inevitable, and WHO calls lifestyle change the best way to prevent or delay it [9]. Its list: reach and keep a healthy weight, at least 150 minutes of moderate activity a week, a healthy diet with less sugar and saturated fat, and no smoking [9]. See how much exercise you need a week.

How common it is in the Gulf

IDF Diabetes Atlas 2025: estimates for 2024, adults aged 20–79, age-standardised [10]. Undiagnosed is the share of people with diabetes who haven't been diagnosed. IDF counts impaired fasting glucose from 110 mg/dL, the WHO cut-off, not ADA's 100 [10]. One person can have both impaired fasting glucose and impaired glucose tolerance, so those two rows can't be added together.

IDF ranks Kuwait third in the world for diabetes in adults and puts Saudi Arabia in the top ten [10]. But these are modelled estimates, built from older national surveys listed on each country page [10], and the 11th edition was produced with support from Sanofi, Novo Nordisk and an educational grant from the Pfizer-MSD Alliance [10]. The UAE figure rests on a single survey of migrants recruited at visa-renewal centres, 81% of them men, rather than Emirati citizens [10] [11].

A separate survey, which can't be compared with the IDF figures because it covered different ages and only citizens, measured Kuwaiti adults aged 18–69 in 2014: 19.4% had prediabetes and 18.8% diabetes, 38.2% in all (calculated), which the authors called almost 40% [12]. It counted prediabetes as a fasting glucose of 6.1–6.9 mmol/L or an HbA1c of 5.7–6.4% [12]. Worldwide, WHO says the number of people with diabetes rose from 200 million in 1990 to 830 million in 2022 [9].

In Voltra

Voltra doesn't read or record blood sugar, and nothing in it diagnoses or treats diabetes. It tracks your body weight, the food you log in the Eat tab, your steps from Apple Health and your workouts, and it sets a daily calorie target from your goal. Voltra and Apple Health explains what connects.

Frequently asked

Sources

1. American Diabetes Association Professional Practice Committee for Diabetes (2026). 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026. Diabetes Care 49(Suppl 1). Tables 2.1, 2.2 and 2.5; recommendations 2.12a–c; diagnosis of prediabetes.
2. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), US National Institutes of Health (2025). Insulin Resistance & Prediabetes. Last reviewed March 2025.
3. Knowler WC, Barrett-Connor E, Fowler SE, et al.; Diabetes Prevention Program Research Group (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346(6):393–403. Abstract and full text. Funders included the NIH, Bristol-Myers Squibb and Parke-Davis; Lipha Pharmaceuticals supplied the metformin and placebo.
4. وزارة الصحة، المملكة العربية السعودية. السكري، منصة التوعية: إنفوجراف معدلات السكر في الدم ومدلولاتها. In Arabic. The infographic is undated; its values were read from the image.
5. Styne DM, Arslanian SA, Connor EL, et al.; Endocrine Society (2017). Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 102(3):709–757. Recommendation 1.7 and its evidence. The guideline covers children and adolescents.
6. Teede HJ, Tay CT, Laven JJE, et al. (2023). Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab 108(10):2447–2469. Practice point 1.9.12.
7. وزارة الصحة، المملكة العربية السعودية. اختبار خطر الإصابة بمرحلة ما قبل السكري. In Arabic.
8. American Diabetes Association Professional Practice Committee for Diabetes (2026). 3. Prevention or Delay of Diabetes and Associated Comorbidities: Standards of Care in Diabetes—2026. Diabetes Care 49(Suppl 1). Recommendations 3.3 and 3.4, and the text on the Diabetes Prevention Program.
9. منظمة الصحة العالمية (٢٠٢٤). داء السكري (صحيفة وقائع). In Arabic. 14 November 2024.
10. International Diabetes Federation (2025). IDF Diabetes Atlas, 11th edition: Saudi Arabia country page. Country pages for Saudi Arabia, Kuwait and the UAE (2024 column), the FAQ, and Figure 1.1 of the report. The 11th edition was supported by Sanofi, Novo Nordisk and a Pfizer-MSD Alliance grant.
11. Sulaiman N, Albadawi S, Abusnana S, et al. (2018). High prevalence of diabetes among migrants in the United Arab Emirates using a cross-sectional survey. Sci Rep 8(1):6862. Abstract. The only data source IDF lists for the UAE.
12. Alkandari A, Longenecker JC, Barengo NC, et al. (2018). The prevalence of pre-diabetes and diabetes in the Kuwaiti adult population in 2014. Diabetes Res Clin Pract 144:213–223. Abstract. WHO STEPS survey of Kuwaiti citizens aged 18–69.

Sources checked on 30 September 2026.

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