Welcome back, health champions!👋

Every January, the American Diabetes Association drops what's essentially the bible for diabetes and prediabetes care. These are the evidence-based standards your doctor uses to decide your treatment plan.

The 2026 edition recently landed, and there are some genuinely surprising updates. In today's Health Guide, we're breaking down 10 key insights from the new ADA Standards of Care that could change how you think about prediabetes prevention.

Thank you to everyone who took the survey—your insights were incredibly valuable. Congratulations to“DSP the Determined”(nickname for privacy), our randomly selected Amazon gift card winner🎉

BEST FINDS
Cold month, warm meals—without the blood-sugar rollercoaster. This week’s picks are all about cozy flavors + fiber + protein (aka the trio that tends to keep cravings calmer and energy steadier). Spicy Greens, Roasted Red Pepper Shakshuka — spicy, cozy skillet eggs + greens. Add chickpeas for extra staying power. Cheesy Eggplant Rollatini — all the Italian comfort, but veggie-forward (great leftovers). Whole Wheat Penne w/ Mushrooms + Kale — comfort pasta, upgraded. Add beans or chicken to boost protein. Moroccan-Spiced Cod + Carrot Ribbons — big flavor, light feel; weeknight-easy. Southwest Breakfast Tostadas (Black Beans + Spinach) — savory, fiber-packed breakfast that actually keeps you full. Power Oats Mug Muffin — warm “baked” breakfast in minutes. Top with nut butter + berries.

10 Prediabetes Insights from the 2026 ADA Standards of Care

Think of the American Diabetes Association's Standards of Care in Diabetes as the instruction manual your doctor follows. Published every January in Diabetes Care, these guidelines synthesize the latest research and ensure that whether you're seeing a doctor in California or Maine, you're getting the same evidence-based treatment.

We've pulled out 10 actionable insights for prediabetes from the 2026 Standards of Care in Diabetes.

1. Sleep Quality Matters as Much as Diet and Exercise for Prediabetes

The 2026 guidelines now recognize sleep as a critical metabolic factor—right up there with diet and exercise.

The numbers are striking. Poor sleep quality increases your diabetes risk. Both short sleep (under 6 hours) and long sleep (over 9 hours) bump your risk up by 50%.

And: Your chronotype matters. "Evening people"—those who naturally stay up late and wake up late—have 2.5 times higher odds of developing diabetes compared to "morning people," even when they get the same amount of sleep.

What to do: Aim for at least 7 hours of sleep nightly and keep consistent sleep-wake times. If you're struggling with sleep, ask your doctor about screening for sleep disorders. Read: Eat your way to better sleep..

2. Prediabetes Weight Loss Target: The 7-10% Weight Loss "Sweet Spot"

You've probably heard that losing 5% of your body weight helps with prediabetes. The new guidelines specify a (higher) better target: 7-10% weight loss provides greater metabolic benefit.

The data backs this up. Every kilogram (2.2 pounds) lost reduces your progression risk by 16% over 3 years. For someone who's had gestational diabetes, each 1-unit BMI increase above your preconception baseline raises type 2 diabetes risk by 18%.

3. Metformin for Prediabetes: Who Should Take It in 2026?

Metformin isn't for everyone with prediabetes—but for certain people, it can be effective.

The guidelines continue to identify who benefits most from metformin for diabetes prevention:

• Ages 25-59 with BMI ≥35 kg/m²

• Fasting glucose ≥110 mg/dL (≥6 mmol/L)

• A1C ≥6.0% (≥42 mmol/mol)

• History of gestational diabetes

What's new in 2026: The guidelines now include two additional recommendations for metformin use beyond traditional diabetes prevention: people treated with PI3Kα inhibitors (cancer therapy) or high-dose glucocorticoids—for proactive prevention of drug-induced hyperglycemia.

Note: Long-term data shows lifestyle intervention adds 3.5 years of diabetes-free survival, while metformin adds 2.5 years.

What to do: Work with your physician to assess whether metformin is appropriate for you, considering your individual risk factors, age, other health conditions, medication tolerance, and lifestyle intervention preferences.

4. Metformin and Vitamin B12 Deficiency: What You Need to Monitor

If you're taking metformin long-term (more than 4 years), particularly at higher doses (≥1,500 mg/day), you need periodic vitamin B12 monitoring.

Why? Metformin can cause B12 deficiency, which leads to anemia and peripheral neuropathy—symptoms that might be mistaken for diabetic complications.

What to do: Request annual B12 testing if you're on metformin long-term, especially if you follow a vegan diet or have had gastric surgery.

5. Can You Reverse Prediabetes? What Research Shows About Regression

In our research deep dive two weeks ago, we discussed that achieving normal glucose regulation—even temporarily—provides long-term benefits.

At 30-year follow-up, people who regressed from prediabetes to normal glucose tolerance had significantly lower cardiovascular and microvascular disease risk. Even those who stayed in the prediabetes stage without progressing did better than those who developed diabetes.

What to do: Don't get discouraged by glucose fluctuations. Every period of improved glucose control provides lasting protection.

6. Best Diet for Prediabetes: Mediterranean or Low-Carb

There's no "perfect" diet for preventing diabetes. The guidelines explicitly state there's no ideal macronutrient ratio. Both Mediterranean and low-carbohydrate eating patterns prevent diabetes effectively.

What matters more is overall food quality—emphasizing whole grains, legumes, nuts, fruits, and vegetables while minimizing refined and processed foods.

What to do: Choose the eating pattern you can sustain long-term rather than forcing yourself into a specific diet dogma.

7. Prediabetes and Sitting: Why Breaking Up Sedentary Time Lowers Blood Sugar

Beyond the standard recommendation of 150 minutes per week of moderate activity, simply breaking up prolonged sitting lowers postprandial glucose levels.

The guidelines note that interrupting sedentary time—even without formal exercise—provides metabolic benefits.

What to do: Set a timer to stand and move for 2-3 minutes every 30-60 minutes during prolonged sitting.

8. Technology-Assisted Diabetes Prevention Programs Can Work

CDC-certified smartphone apps, web-based programs, and telehealth delivery of diabetes prevention programs can be as effective as in-person programs.

These may be particularly valuable if you face barriers to attending in-person sessions.

9. Prediabetes and Heart Disease: Why Cardiovascular Screening Matters Now

Here's something many people miss: Prediabetes itself increases cardiovascular disease and mortality risk—not just future diabetes risk.

The guidelines recommend screening for and treating cardiovascular risk factors like hypertension and dyslipidemia during the prediabetes stage, not waiting for a diabetes diagnosis.

What to do: Make sure you're being screened for blood pressure and lipid abnormalities, and discuss cardiovascular risk reduction strategies beyond glucose management.

10. When to Start Prediabetes Treatment: Age, Timing, and What Works

When Does the Good Stuff Happen?

The biggest impact occurs during the first 3 years of intervention. Those early changes set you up for long-term benefits that persist for decades.

What If It's Been a While Since Diagnosis?

Many ask: "I was diagnosed years ago—is it too late?" The answer is no. Lifestyle interventions provide benefit regardless of how long you've had prediabetes.

Does Age Matter?

Interventions work at all ages—whether you're 35 or 65, lifestyle changes and metformin show clear benefits.

However, if you're over 70, shift your focus. Rather than aggressively preventing diabetes progression, emphasize quality of life. In practical terms: if you're over 70, work with your doctor to focus on feeling good and maintaining function—rather than fixating on the prediabetes label itself.

The Bottom Line

The overarching message from the 2026 ADA Standards of Care: Prediabetes is highly responsive to intervention. Earlier action produces greater benefit. And multiple pathways—lifestyle changes, medication, sleep optimization—work synergistically.

Have questions? We got answers. Email [email protected]