Two million Australians currently have pre-diabetes. Most of them have no idea.
Pre-diabetes produces no symptoms. It doesn’t hurt. It doesn’t announce itself. It shows up quietly in a blood test — and if no one thinks to look, it can sit undetected for years while steadily nudging the body toward type 2 diabetes and serious cardiovascular disease.
Here is what makes this genuinely important: when targeted to those at risk of type 2 diabetes, around 58% of cases may be prevented or delayed through early detection and intervention. More than half of type 2 diabetes cases are potentially preventable — if pre-diabetes is caught and acted on in time.
This guide explains exactly what pre-diabetes is, how it’s diagnosed, who is at risk in Australia, and — most importantly — what you and your GP can do about it.
What Is Pre-Diabetes?
Pre-diabetes is a state of elevated blood glucose that is above normal but not yet high enough to be diagnosed as type 2 diabetes. It sits in a clinical grey zone — the body’s glucose regulation is clearly impaired, but the threshold for a diabetes diagnosis hasn’t been crossed.
Pre-diabetes includes impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and/or elevated glycated haemoglobin (HbA1c). These three conditions represent slightly different patterns of glucose dysregulation, but they all mean the same thing practically: your blood sugar is running higher than it should, your body isn’t processing glucose efficiently, and without action, you are on a trajectory toward type 2 diabetes.
Pre-diabetes happens when the cells in your body stop responding normally to insulin, so the pancreas starts making more insulin to compensate. This state is called insulin resistance, and it is the underlying mechanism shared by both pre-diabetes and type 2 diabetes. Over time, the pancreas can no longer keep up with the demand — and blood glucose rises into the diabetic range.
The good news is that this process is not inevitable. Pre-diabetes is reversible. And a GP is the best person to help you reverse it.
How Common Is Pre-Diabetes in Australia?
The numbers are striking. Pre-diabetes affects nearly 1 in 6 Australian adults — more than 2 million individuals over the age of 25 years. Without intervention, approximately 1 in 3 will develop type 2 diabetes within ten years.
About 1 in 10 people with pre-diabetes develops type 2 diabetes each year. Across the country, this contributes to a diabetes epidemic that is already enormous: an estimated 1 in 20 Australians — just over 1.3 million people — were living with diagnosed diabetes as of 2021.
What makes pre-diabetes particularly pressing in communities like Sunshine in Melbourne’s west is the multicultural dimension of risk. Research published in the Medical Journal of Australia confirms that type 2 diabetes incidence has increased in Australia among those born in Asia, North Africa and the Middle East, and the Pacific Islands — communities that make up a significant proportion of Sunshine’s population. People from these backgrounds often develop insulin resistance and diabetes at lower body weights than Caucasians, which means standard weight-based risk thresholds can underestimate risk for many patients in our area.
Beyond ethnicity, pre-diabetes is substantially underdiagnosed across all demographics. Another 1 in 6 Australians older than 25 years are likely to have pre-diabetes — yet the vast majority remain unaware because it causes no symptoms and is only detected through blood testing.
Does Pre-Diabetes Cause Any Symptoms?
This is the critical point that makes pre-diabetes so dangerous as a public health problem.
Pre-diabetes rarely has signs or symptoms. The most common way to diagnose pre-diabetes is to see your GP and have a fasting glucose, HbA1c, or Glucose Tolerance Test (GTT) completed.
You cannot feel pre-diabetes. There is no pain, no fatigue signal specific to glucose dysregulation, no obvious physical sign. The body is coping — just barely — and that coping feels like nothing from the inside. Some people experience very subtle, non-specific symptoms that in retrospect may be connected — slightly more fatigue than expected, occasional thirst, difficulty losing weight despite reasonable effort — but these are easy to attribute to other causes and do not reliably flag pre-diabetes.
This is exactly why the AUSDRISK tool and blood testing through your GP are so important. If you are waiting to feel unwell before checking your blood glucose, you will likely wait too long.
What Are the Risk Factors for Pre-Diabetes in Australia?
Pre-diabetes shares the same risk factor profile as type 2 diabetes. Some of these factors are fixed; others are modifiable. Understanding where you sit helps your GP decide how urgently to screen and how aggressively to intervene.
Non-Modifiable Risk Factors
Age — risk increases steadily with age. Adults over 45 are at significantly higher risk, though pre-diabetes is increasingly being diagnosed in younger Australians, including those in their 20s and 30s with obesity or other risk factors.
Family history — having a parent, sibling, or close relative with type 2 diabetes meaningfully elevates your risk. Genetics plays a real role in insulin sensitivity and pancreatic function.
Ethnicity — people of Aboriginal and Torres Strait Islander, Pacific Islander, South-East Asian, South Asian, Middle Eastern, and East African backgrounds are at higher risk of pre-diabetes and type 2 diabetes, often at younger ages and lower body weights than Caucasian Australians. Risk thresholds in standard guidelines may need to be interpreted with this in mind.
Previous gestational diabetes — women who developed diabetes during pregnancy have a significantly elevated risk of developing pre-diabetes and type 2 diabetes later in life. This risk persists for decades after the pregnancy.
History of polycystic ovary syndrome (PCOS) — insulin resistance is a core feature of PCOS, making women with this condition significantly more likely to develop pre-diabetes.
Modifiable Risk Factors
Excess body weight — particularly around the abdomen — visceral fat (fat stored around the organs, as opposed to subcutaneous fat under the skin) is metabolically active and directly drives insulin resistance. Waist circumference is a useful indicator: risk increases significantly above 94 cm for men and 80 cm for women.
Physical inactivity — muscle tissue is one of the most important sites of glucose uptake in the body. When muscles are regularly used through physical activity, they become more sensitive to insulin. A sedentary lifestyle reduces this sensitivity over time.
Unhealthy diet — diets high in refined carbohydrates, added sugars, saturated fat, and highly processed foods contribute to insulin resistance and weight gain. Regularly consuming high-glycaemic index foods spikes blood glucose repeatedly, placing ongoing stress on the insulin-producing cells of the pancreas.
High blood pressure — hypertension and pre-diabetes are closely linked, often appearing together as part of metabolic syndrome. If you already have high blood pressure, your GP should be considering blood glucose screening alongside blood pressure management.
Abnormal cholesterol or triglycerides — elevated triglycerides and low HDL cholesterol (the “good” cholesterol) are associated with insulin resistance and increase pre-diabetes risk.
Smoking — smoking is associated with increased insulin resistance and is an independent risk factor for type 2 diabetes.
Sleep disorders — poor or disrupted sleep — particularly obstructive sleep apnoea — significantly impairs glucose metabolism and insulin sensitivity. This is a frequently overlooked pathway to pre-diabetes.
Stress — chronic psychological stress elevates cortisol, which raises blood glucose and contributes to insulin resistance over time.
How Is Pre-Diabetes Diagnosed? Understanding the Tests
Pre-diabetes can include impaired fasting glucose, impaired glucose tolerance, and elevated HbA1c. Each is detected by a different blood test, and your GP will choose which to use based on your circumstances.
The AUSDRISK Tool: Should You Even Be Tested?
Before arranging blood tests, your GP may use the Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) — a brief questionnaire that calculates your risk of developing type 2 diabetes over the next 5 years based on factors including age, weight, waist circumference, family history, ethnicity, physical activity, and diet.
An AUSDRISK score of 12 or above indicates high risk and warrants blood glucose testing. The tool is available online (at diabetesaustralia.com.au) and takes about two minutes to complete. It can be a useful first step before a GP appointment to help you understand your own risk level.
HbA1c (Glycated Haemoglobin)
HbA1c is a measure of chronic glycaemia — the degree of glycation reflects the mean plasma glucose over the life of the red blood cell, approximately three months. It can be taken at any time of day without fasting, which makes it the most practical first-line screening test.
For pre-diabetes (what Australian guidelines call “high-risk HbA1c”), the relevant range is 41–47 mmol/mol (5.9–6.4%). A result at or above 48 mmol/mol (6.5%) indicates type 2 diabetes.
Fasting Plasma Glucose (FPG)
This test requires at least 8 hours without eating before the blood draw. A fasting glucose between 5.5–6.9 mmol/L indicates impaired fasting glucose (pre-diabetes). A result of 7.0 mmol/L or above on two separate occasions indicates type 2 diabetes.
Oral Glucose Tolerance Test (OGTT)
If your fasting blood glucose test is high, your GP may arrange a GTT, which looks at both a fasting reading and then a one and two-hour reading after a glucose drink to see your body’s response to it. This test takes up to three hours and involves three blood samples. It is the most comprehensive assessment of glucose regulation and is considered the gold standard for diagnosing impaired glucose tolerance.
A 2-hour glucose result between 7.8–11.0 mmol/L indicates impaired glucose tolerance (pre-diabetes). A result of 11.1 mmol/L or above indicates type 2 diabetes.
Pre-Diabetes Diagnostic Thresholds at a Glance
| Test | Normal | Pre-Diabetes | Type 2 Diabetes |
|---|---|---|---|
| HbA1c | Below 41 mmol/mol | 41–47 mmol/mol | 48 mmol/mol or above |
| Fasting glucose | Below 5.5 mmol/L | 5.5–6.9 mmol/L | 7.0 mmol/L or above |
| 2-hour glucose (OGTT) | Below 7.8 mmol/L | 7.8–11.0 mmol/L | 11.1 mmol/L or above |
How Serious Is Pre-Diabetes? Is It Really That Urgent?
It’s a reasonable question. Pre-diabetes isn’t diabetes. You might feel completely fine. So how worried should you actually be?
The honest answer: without intervention, approximately 1 in 3 people with pre-diabetes will develop type 2 diabetes within ten years. That’s a substantial risk — comparable to many conditions we take seriously and treat proactively.
But the consequences of pre-diabetes extend beyond the risk of progression to diabetes. Pre-diabetes is independently associated with an increased risk of metabolic syndrome and cardiovascular disease. Even before blood glucose reaches the diabetic threshold, the elevated glucose and insulin resistance associated with pre-diabetes begin damaging blood vessels, raising cardiovascular risk.
This means that pre-diabetes is not simply a warning light for future diabetes — it is already affecting your body’s long-term health. Acting now doesn’t just reduce your chance of getting type 2 diabetes. It actively reduces your cardiovascular risk profile right now.
The flip side of this is genuinely good news: when targeted to those at risk of type 2 diabetes, around 58% of cases may be prevented or delayed, and early detection and intervention may significantly reduce the risk of complications. This is not a condition where you’re simply delaying the inevitable. For many people, meaningful lifestyle change can genuinely shift the trajectory — and a GP-led plan is the most effective way to make that happen.
How to Stop Pre-Diabetes Becoming Type 2: The Evidence-Based Approach
This is where the clinical evidence is reassuring and specific. We know what works. The challenge is doing it consistently — and that’s where your GP and a structured support plan make the difference.
1. Weight Loss — Even Modest Amounts
Weight loss is the single most powerful intervention for reversing pre-diabetes. Individuals should aim to lose weight — 5–10% of body mass — using realistic and sustainable dietary approaches.
For a person weighing 90 kg, that is 4.5–9 kg. This is not a dramatic transformation. It is a realistic, achievable target — and the evidence consistently shows that even small reductions in body weight significantly improve insulin sensitivity, reduce blood glucose, and lower the risk of progressing to type 2 diabetes.
The mechanism is direct: excess visceral fat (particularly around the abdomen) actively impairs insulin signalling. Reducing it allows insulin to work more effectively, and blood glucose levels fall accordingly. Some people who achieve 10% or greater weight loss see their blood glucose return entirely to the normal range.
2. Dietary Changes
There is no single “pre-diabetes diet” — but there are well-evidenced principles that consistently support blood glucose control.
Reduce refined carbohydrates and added sugars — these are the foods that cause the greatest and most rapid spikes in blood glucose. White bread, white rice, sugary drinks, lollies, biscuits, pastries, and highly processed snack foods all drive glucose dysregulation. Replacing them with lower glycaemic index (GI) alternatives — whole grains, legumes, non-starchy vegetables — produces smaller, slower glucose rises that are easier for the body to manage.
Increase fibre — dietary fibre slows carbohydrate digestion and glucose absorption, blunting post-meal blood glucose spikes. Aim for at least 25–30g of fibre per day from vegetables, legumes, whole grains, fruit, nuts, and seeds.
Choose healthy fats — replacing saturated fats (found in processed meats, full-fat dairy, pastries, and fried foods) with unsaturated fats (olive oil, avocado, nuts, oily fish) supports insulin sensitivity and cardiovascular health simultaneously.
Watch portion sizes — even healthy foods can drive weight gain and elevated blood glucose when eaten in excess. Understanding portions is often more practical than strict calorie counting for long-term dietary change.
Limit alcohol — alcohol affects blood glucose significantly, contributes to weight gain, and can mask the symptoms of blood glucose dysregulation in people taking certain medications.
Your GP can refer you to a Medicare-subsidised dietitian through your Chronic Disease Management Plan for personalised dietary guidance tailored to your cultural preferences, lifestyle, and medical situation.
3. Regular Physical Activity
Exercise directly improves insulin sensitivity — muscle contractions stimulate glucose uptake independent of insulin, and regular training makes muscle tissue more responsive to insulin’s signals. Intensive lifestyle intervention including regular physical activity of 150 minutes per week has been shown to reduce progression to type 2 diabetes in multiple studies globally.
150 minutes per week across most days works out to about 30 minutes of moderate-intensity activity most days. This does not have to mean going to a gym. Brisk walking, swimming, cycling, dancing, or any activity that raises your heart rate and makes you breathe a little harder all count.
Resistance training (weights or bodyweight exercises) also improves insulin sensitivity and should be included at least twice a week alongside aerobic activity. Building and maintaining muscle mass is particularly important as we age, when muscle tissue naturally declines and insulin resistance tends to increase.
Your GP can refer you to an exercise physiologist through your Chronic Disease Management Plan for a structured, personalised program that is safe for your current fitness level and health status.
4. The Life! Program — Victoria’s Free Pre-Diabetes Support
If you live in Victoria, there is a free, evidence-based program specifically designed for people at high risk of type 2 diabetes or heart disease.
The Life! Program is a telephone or group-based health coaching program run by Diabetes Victoria. It provides structured support for making the lifestyle changes that reduce the risk of type 2 diabetes — including dietary guidance, physical activity support, and ongoing health coaching over 12 months.
To be eligible, you need a high AUSDRISK score (12 or above) or a confirmed diagnosis of pre-diabetes. Your GP can refer you, or you can self-refer at lifeprogram.org.au or by calling 13 RISK (13 7475).
The Life! Program is free, evidence-based, and tailored to Melbourne’s multicultural communities — including support in languages other than English. For eligible patients in Sunshine, this is one of the most practical and accessible pre-diabetes prevention resources available.
5. Address Other Risk Factors
Treating pre-diabetes in isolation misses the bigger picture. Your GP will help you address the full set of risk factors simultaneously:
High blood pressure — hypertension and pre-diabetes frequently coexist and compound each other’s cardiovascular risk. Blood pressure management is an integral part of a pre-diabetes plan.
Abnormal cholesterol — elevated triglycerides and low HDL are both common in people with pre-diabetes and increase cardiovascular risk. Dietary changes and, where needed, medication address this alongside blood glucose.
Sleep apnoea — if you are experiencing disrupted sleep, excessive daytime sleepiness, or your partner has noticed you stopping breathing at night, discuss sleep apnoea screening with your GP. Treating sleep apnoea can meaningfully improve glucose metabolism.
Smoking — cessation support is a standard part of pre-diabetes management. Your GP can prescribe cessation medications and connect you with quitline support (Quitline: 13 QUIT / 13 78 48).
Stress and mental health — chronic stress raises cortisol, which raises blood glucose. If stress or mental health is a contributing factor in your lifestyle, your GP can discuss this and refer you for psychological support through a Mental Health Care Plan.
6. Medication — When Lifestyle Isn’t Enough
For most people with pre-diabetes, lifestyle change is the primary and preferred intervention. Medication is not routinely recommended as first-line treatment in Australian guidelines.
However, metformin therapy has been shown to prevent the progression to type 2 diabetes and may be considered in specific circumstances — particularly for people who cannot achieve sufficient lifestyle change, who have a very high progression risk, or who have other conditions (such as PCOS) where metformin provides additional benefit.
This is a decision made collaboratively between you and your GP based on your full clinical picture. If you are interested in whether medication might be appropriate for your situation, it is worth raising at your next appointment.
What Your GP Does at a Pre-Diabetes Consultation
Your GP’s role in pre-diabetes management goes well beyond handing you a blood test result. A thorough pre-diabetes consultation includes:
Confirming the diagnosis — reviewing your blood test results in the context of your full history, ruling out secondary causes of glucose elevation, and clarifying which pattern of pre-diabetes you have (impaired fasting glucose, impaired glucose tolerance, or elevated HbA1c).
Calculating your absolute cardiovascular risk — using the Australian CVD Risk Calculator to assess your 5-year risk of a heart attack or stroke, which shapes the urgency of intervention.
Creating a management plan — if you have pre-diabetes alongside other chronic conditions (high blood pressure, abnormal cholesterol, obesity), your GP can create a Chronic Disease Management Plan that coordinates your care and gives you access to up to 5 Medicare-subsidised allied health visits per year — including dietitian, exercise physiologist, and diabetes educator services.
Referring to the Life! Program — for eligible Victorian patients, this is a direct referral your GP can make at the appointment.
Scheduling follow-up blood testing — typically HbA1c or fasting glucose every 6–12 months to monitor your progress and catch any movement toward type 2 diabetes early.
Providing ongoing motivation and accountability — research consistently shows that people who have regular GP check-ins achieve significantly better outcomes in lifestyle-based health programs than those managing alone. Your GP is a partner in this process, not just a test-orderer.
Can Pre-Diabetes Be Reversed?
Yes — and this is worth emphasising clearly, because many people hear “pre-diabetes” and assume that diabetes is inevitable.
It is not. There is good evidence to implement intensive, structured lifestyle interventions for individuals with impaired glucose tolerance — and the evidence shows that bringing HbA1c and fasting glucose back into the normal range is achievable for a significant proportion of people with pre-diabetes.
The landmark Diabetes Prevention Program study found that intensive lifestyle intervention reduced the development of type 2 diabetes by 58% compared to placebo over 3 years — an effect larger than the drug metformin alone. Similar results have been replicated in Australian and international trials consistently since.
The key words are “intensive” and “sustained.” Small changes maintained consistently over time produce cumulative improvements in insulin sensitivity. The body responds to being treated well — and it often responds faster than people expect. Many patients see meaningful improvements in blood glucose within 3 months of genuine dietary and activity change.
Who Should Be Screened for Pre-Diabetes?
Based on Australian clinical guidelines, your GP should consider blood glucose testing if you:
- Are 45 years or older (general population screening)
- Are 35 years or older with a risk factor (overweight, family history, ethnicity, previous gestational diabetes, PCOS, hypertension, or high cholesterol)
- Have an AUSDRISK score of 12 or above at any age
- Have signs of insulin resistance (acanthosis nigricans — dark, velvety patches of skin at the neck or armpits — is a visible sign)
- Have existing cardiovascular disease, hypertension, or dyslipidaemia
- Had gestational diabetes in a previous pregnancy
- Have been diagnosed with PCOS
- Are of Aboriginal and Torres Strait Islander, Pacific Islander, South-East Asian, South Asian, or Middle Eastern background (screen earlier and more frequently)
If you’re unsure whether you should be screened, complete the AUSDRISK questionnaire online or ask your GP at your next visit.
Frequently Asked Questions
What is the difference between pre-diabetes and type 2 diabetes? Pre-diabetes means your blood glucose is elevated above normal but has not yet reached the threshold for a type 2 diabetes diagnosis. With pre-diabetes, the body is showing early insulin resistance — but is still managing to keep glucose below the diabetic range. Type 2 diabetes is diagnosed when fasting glucose reaches 7.0 mmol/L or above, HbA1c reaches 48 mmol/mol or above, or 2-hour glucose reaches 11.1 mmol/L or above on testing. The critical distinction is that pre-diabetes is often reversible with lifestyle change; type 2 diabetes is a chronic condition requiring ongoing management.
What does pre-diabetes feel like? Pre-diabetes typically causes no symptoms at all. This is why it goes undetected so frequently. It is identified through blood testing — either as part of a routine health check or after a high AUSDRISK score triggers screening. Some people later reflect that they had vague fatigue or difficulty losing weight, but these are non-specific and not reliable indicators.
Can pre-diabetes be reversed with diet and exercise? Yes — for many people, meaningful dietary change, regular physical activity, and modest weight loss can bring blood glucose back into the normal range. This is most achievable early, when the insulin-producing cells of the pancreas are still functioning well. The Diabetes Prevention Program showed a 58% reduction in diabetes progression with intensive lifestyle intervention. The earlier you act, the greater the opportunity for reversal.
How is pre-diabetes diagnosed in Australia? Pre-diabetes is diagnosed through blood testing arranged by your GP. The main tests are HbA1c (which does not require fasting), fasting plasma glucose (requiring 8 hours without eating), and the oral glucose tolerance test (OGTT), which is the most comprehensive. Your GP may also use the AUSDRISK tool to assess whether blood testing is warranted.
What is the Life! Program and am I eligible? The Life! Program is a free, 12-month telephone or group-based health coaching program run by Diabetes Victoria for people at high risk of type 2 diabetes or heart disease. Eligibility includes a high AUSDRISK score (12 or above) or a confirmed pre-diabetes diagnosis. It provides structured support for dietary change, physical activity, and lifestyle modification. You can be referred by your GP or self-refer at lifeprogram.org.au or by calling 13 RISK (13 7475).
How often should blood glucose be checked if I have pre-diabetes? Your GP will advise based on your specific result and risk profile, but typically HbA1c or fasting glucose is retested every 6–12 months. This allows your GP to track whether your lifestyle changes are working, catch any worsening early, and adjust your management plan accordingly. The frequency may increase if your results are borderline or if you have other complicating risk factors.
Does pre-diabetes mean I will definitely get type 2 diabetes? No. Pre-diabetes is a strong risk factor for type 2 diabetes, but it is not a fixed destiny. Without intervention, approximately 1 in 3 people with pre-diabetes develop type 2 diabetes within 10 years. With meaningful lifestyle change, this risk can be cut by more than half. Pre-diabetes is the best possible time to intervene — when the opportunity for reversal is greatest.
The Bottom Line
Two million Australians have pre-diabetes right now. Most don’t know it, because it causes no symptoms and is only found through blood testing. And without action, a significant proportion of them will develop type 2 diabetes — a chronic, serious, lifelong condition that carries substantial health and quality-of-life consequences.
But here is what the evidence is clear about: pre-diabetes is one of the most preventable conditions in medicine. Modest weight loss, regular physical activity, dietary change, and GP-led monitoring can stop type 2 diabetes in its tracks for the majority of people who start early.
If you have risk factors — if you are over 45, carry weight around your middle, have a family history, have had gestational diabetes, or have a background that places you at higher risk — talk to your GP. A blood test and a brief consultation could identify something that, addressed now, changes the course of your health for the next decade.
At Central Health Clinic in Sunshine, our GPs provide pre-diabetes screening, AUSDRISK assessment, blood glucose testing, Chronic Disease Management Plans, referrals to the Life! Program, and connections to dietitians and exercise physiologists. If you’re concerned about your diabetes risk, book an appointment today.
