Reversing prediabetes: Managing HbA1c, weight loss and lifestyle

Prediabetes is a condition in which blood glucose (sugar) levels are higher than normal but not considered type 2 diabetes. It is a precursor of type 2 diabetes.

One of the recommended lifestyle changes for managing and reversing prediabetes is weight loss as it can improve glycaemic control. When we talk about glycaemic control, we mean the body’s ability to regulate and maintain healthy blood glucose levels.

How can weight loss help? 

Weight loss can help improve glycaemic control by making cells more responsive to insulin, reducing inflammation, decreasing excessive glucose production by the liver, and enhancing the function of insulin-producing beta cells. It’s worth noting that weight loss is not always necessary or appropriate to reverse prediabetes in every individual.

For those of you that are unfamiliar, insulin plays a crucial role in maintaining normal blood glucose levels by allowing cells in the body, particularly muscle, fat, and liver cells, to absorb glucose from the bloodstream. 

Weight loss in the short-term 

It’s important to note that people with prediabetes may experience a temporary increase in their HbA1c levels (a measure of average blood glucose levels over three months) after losing weight. There are several reasons for this temporary increase. Factors like increased glucose production by the liver, temporary insulin resistance, the release of stored glucose, and changes in insulin sensitivity can contribute to this elevation. 

When you are insulin sensitive, your cells take up glucose from the bloodstream, helping to maintain stable blood glucose levels. Insulin resistance refers to the body’s cells becoming less responsive to the effects of insulin. Think of your body’s cells as doors and insulin as the key to opening those doors. When you are insulin sensitive, it’s like having a well-functioning lock and key. 

How long does it take for our HbA1c levels to change? 

It takes time for changes in diet and lifestyle to have a noticeable effect on HbA1c levels. Research, such as the Look AHEAD trial (2001), suggests that it can take up to a year for HbA1c levels to reflect the impact of diet and lifestyle changes. This shows the need for patience and a long-term mindset when adopting healthier habits to reverse prediabetes. The researchers also found that individuals who were able to maintain their weight loss over a four-year period experienced lasting improvements in their HbA1c levels. 

This finding shows the long-term advantages of weight loss in managing blood glucose levels but also emphasises the importance of allowing enough time between HbA1c tests.

In addition to weight loss, various factors can influence your long-term blood glucose levels, including but not limited to:

• poor-quality weight loss
• loss of muscle mass
• sleep deprivation
• chronic stress

Poor-quality weight loss

Poor-quality weight loss means losing weight in a way that may harm your health. Losing weight without considering nutrition or long-term sustainability can have negative effects in the long run. It can result in nutrient deficiencies, loss of muscle mass, and weight regain over time. Moreover, a diet that consists of ultra-processed foods lacking in fibre can cause big fluctuations in blood glucose levels. This can leave you feeling tired, and hungry, and impact your ability to control blood glucose levels in the long term.

Loss of muscle mass

Muscles play a vital role in keeping blood glucose levels healthy and enhancing insulin sensitivity. When your muscles are active and well-developed, they become more receptive to insulin, absorbing glucose from the bloodstream and helping to regulate blood glucose levels.

It’s important to ensure an adequate intake of protein and engage in resistance exercise to maintain muscle mass, promote insulin sensitivity, and regulate blood glucose levels. Moreover, the loss of muscle mass and strength that occurs with ageing, known as sarcopenia, can have a detrimental effect on insulin sensitivity. 

Sleep deprivation

Sleep deprivation (less than seven hours per night) is also linked to decreased insulin sensitivity. It can raise cortisol levels, a stress hormone that stimulates glucose production in the liver, resulting in higher blood glucose levels. Sleep is often overlooked as we prioritise other aspects of our lives, but it plays a vital role in reversing prediabetes and maintaining overall health.

Chronic stress

Chronic stress, whether from work or personal life, can elevate stress hormones like cortisol and epinephrine. These hormones raise blood glucose levels to provide energy during the “fight-or-flight” response. Yet, chronic stress can disrupt insulin’s ability to regulate blood glucose, potentially leading to insulin resistance. 

To summarise

In this article, we have discussed the connection between weight loss, blood glucose levels, and prediabetes management. While short-term weight loss may increase HbA1c levels infrequently in some individuals, it is beneficial for long-term glycaemic control in individuals carrying excess weight, especially when paired with a whole foods approach. 

If you have recently been informed you’re living with prediabetes, this article aims to provide you with the motivation to improve your nutrition, prioritise muscle health, and manage sleep and stress. Additionally, it offers a long-term outlook on your weight loss journey and HbA1c levels.