Prediabetes is one of the most common health conditions linked to heart disease, and affects approximately 88 million—more than one in three—American adults, according to the Centers for Disease Control and Prevention. In fact, the American Heart Association states that those diagnosed with prediabetes are more likely to develop type 2 diabetes within 10 years, along with being at a higher risk for heart attack or stroke.

But what exactly is prediabetes, and what can you do to lower your risk for developing type 2 diabetes?

Prediabetes is defined as having higher-than-normal blood glucose levels and is considered a precursor to type 2 diabetes, according to the American Diabetes Association. “Most often, the progression from prediabetes to diabetes takes many years, so getting your HgbA1c—also referred to as A1c—checked every three years would find diabetes in its earliest stages,” says Sarah R. Rettinger, M.D., an endocrinologist at Providence Saint John’s Health Center in Santa Monica, CA.

A1c is a measure of the patient’s average blood sugars over the previous three months, Dr. Rettinger explains. The ADA determines an A1c reading of less than 5.7 percent to be in the normal range. A reading between 5.7 percent and 6.4 percent falls in the prediabetes range, while a reading of 6.5 percent and higher indicates diabetes.

“It gives much more information than simply getting a few blood sugars, and it is useful as an initial baseline as the patient gets treated,” she says.

Rettinger adds that three other tests can properly diagnose prediabetes and diabetes. The first is a fasting plasma glucose, which requires repeat testing for confirmation. The second is an oral glucose tolerance test, which is rarely used outside of pregnancy. This test involves drinking a high-carbohydrate drink and checking blood sugar every hour for three hours. The last is the random, or casual, plasma glucose test, which also requires repeat testing for confirmation.

Diabetes Signs And Risk Factors

If blood sugar levels are only slighted elevated, it’s likely that a patient will not experience any symptoms, Rettinger says.

“This explains why it’s important to have A1c checked every year,” she suggests. “However, by the time patients have higher blood sugars, they may feel thirsty, hungry, and may be urinating excessively. And some patients lose weight without making any changes in their diet and exercise.”

Risk factors for prediabetes and type 2 diabetes include:

• Being age 45 or older
• Being of Black, Hispanic/Latino, American Indian, Asian American, or Pacific Islander descent
• Family history: “Patients with a first degree relative (like a mother, father, or sibling) with type 2 diabetes have a two- to three-fold risk of developing diabetes,” Rettinger says.
• Obesity: “Data from the Nurses’ Health Study (NHS) demonstrated an approximately 100-fold increased risk of incident diabetes over 14 years in nurses whose baseline BMI was greater than 35 kg/m2 compared with those with BMI less than 22 kg/m2,” Rettinger says.
• Fat distribution: “In obese patients, it matters where the fat tissue is,” Rettinger explains. “The risk of type 2 diabetes is highest in patients who have ‘male’ type fat distribution—a large waist or abdominal obesity. The ‘female’ fat distribution— on the buttocks and thighs— is not as likely to be associated with type 2 diabetes.”
• Physical inactivity: “This includes long periods of sitting or TV watching, even without weight gain,” Rettinger states.
• A previous diagnosis of high blood pressure, high cholesterol, and/or polycystic ovary syndrome
• A previous diagnosis of gestational diabetes

Preventative Measures That Can Help You Avoid Diabetes

The following six wellness strategies may help keep your blood sugar levels balanced and lower your risk for developing prediabetes or type 2 diabetes in the future.

1. Shed Weight

Dr. Rettinger offers these three words: intensive lifestyle change.

“This is a behavioral modification program aimed at a low-fat diet, along with exercising for 150 minutes per week, with the goal of reducing weight by seven percent,” she states. “However, we would only recommend this for patients who are overweight or obese.”

Read More: A Guide To Diet And Exercise, And Supplements For People Over 50

One study published in the Journal of The American Dietetic Association entitled Look AHEAD (Action for Health in Diabetes) found that the adults who participated in this type of lifestyle intervention program lost an average of nine percent of their weight within one year, as well as showed improvement in blood glucose, blood pressure, and blood cholesterol levels.

2. Consume Carbs Carefully

Your carbohydrate intake has a direct impact on your blood glucose, says Jackie Newgent, R.D.N., chef, nutritionist, and author of The Clean & Simple Diabetes Cookbook. “While carbohydrate goals need to be individualized, aiming for a maximum of 45 grams of total carbohydrates per meal may be a good general goal, unless you need more carbs to fuel a higher activity level,” she states.

3. Regulate Your Diet

Say goodbye to skipping meals. “Eating more consistently-sized meals, rather than going without breakfast and consuming a big dinner every night, can help better manage blood glucose levels,” Newgent says.

A 2017 study published in the Korean Journal of Family Practice discovered that irregular eating patterns in non-diabetic adults increased the risk of impaired fasting glucose. These results led the authors to conclude that consistent eating patterns throughout the day may contribute to the prevention of type 2 diabetes.

4. Eat More Plant-Based Foods

Newgent points to research that suggests following a plant-based eating style can help people with type 2 diabetes better manage their A1c levels, total cholesterol, and weight. According to one study published in the Journal of Geriatric Cardiology, a whole-food, plant-based diet (fresh fruits and vegetables, legumes, whole grains, nuts, with minimal or no amounts of animal products and processed foods) was deemed as highly beneficial for possibly preventing and treating type 2 diabetes.

“Going ‘halfsies’—or filling half of each plate or bowl with non-starchy veggies—is one of the easiest approaches to eating more plant-based,” Newgent advises.

5. Try Fat-Swapping

All fats are not equal. In fact, some fatty foods can be your friend.

Newgent suggests getting creative in the kitchen and replacing foods high in saturated fats (butter, heavy cream, bacon, and ribs) with delectable options that are rich in healthful, unsaturated fats, such as avocados, extra-virgin olive oil, seeds, nuts, and salmon.

“Making these healthy swaps may help play a role in lowering A1c,” she adds. “So instead of spreading whole grain toast with butter, smear on mashed avocado.”

6. Boost Your Soluble Fiber

“Soluble fiber can have a notable, beneficial impact on blood glucose levels by slowing the absorption of sugar,” Newgent explains. A study published in the journal Experimental and Therapeutic Medicine examined the blood tests of 117 adults living with type 2 diabetes, and found that volunteers who regularly ate foods high in soluble fiber—including dry beans, oats, barely, sunflower seeds, and flaxseeds—had significant improvements in blood glucose levels, insulin resistance, and metabolic profiles.

Read More: Fiber Is Especially Important For These Three Groups Of People

“As a bonus, if that soluble fiber is coupled with protein, such as in the pairing of oats and yogurt, it can help you feel more satiated,” Newgent adds.