Medically reviewed by Dr Todd On, Associate Consultant, Family Physician, MBBS, GDFM, MMED (FM), MCFP (S)
Key takeaways
- Prediabetes means blood glucose is higher than normal but not yet high enough to diagnose diabetes. It usually has no symptoms.
- It is reversible for many people. Modest weight loss and moderate physical activity can potentially reverse prediabetes and its progression.
- The window is easy to miss: in a 2024 Singapore survey, nearly 70% of people with prediabetes believed they did not have diabetes.
- Prediabetes is also a signal for heart disease risk, not only diabetes.
What is prediabetes?
Prediabetes is the stage between normal glucose regulation and type 2 diabetes. It covers impaired fasting glucose (a high sugar reading after an overnight fast) and impaired glucose tolerance (a high sugar reading two hours after a 75g glucose drink). Both can be classified as prediabetes.
Recommended Reading: Prediabetes - Symptoms, blood sugar ranges, diagnosis test, diet and treatment in Singapore
How common is prediabetes in Singapore?
MOH reported in 2017 that about 430,000 Singaporeans, or 14% of those aged 18 to 69, had prediabetes. A 2024 survey of 994 participants by NUS Lloyd’s Register Foundation Institute for Public Understanding of Risk and Diabetes Singapore found a higher figure, with nearly 40% of health-screening participants showing prediabetes. These figures come from different samples and methods, so they should not be read as a trend, but both point the same way: prediabetes is common, and most people do not know that they have.
Why is this a “window of opportunity”?
Because three facts line up:
One, the risk is substantial. According to the MOH, without intervention, one in three people with prediabetes is likely to develop type 2 diabetes within eight years.
Two, the process is reversible at this stage. Lifestyle changes, with modest weight loss and moderate physical activity, can potentially reverse prediabetes and its progression to diabetes. Once diabetes is established, the goal shifts from prevention to management.
Three, the evidence for acting is strong. The Pre-DICTED Randomised Controlled Trial in Singapore recruited people between 2017 to 2021 and followed them up over 3 years to determine how effective an incentives-enhanced stepped care intervention program using lifestyle interventions for 6 months before adding on Metformin for higher risk patients. It was found that after 3 years, 34.8% of participants that underwent this intervention program developed diabetes compared to 47.3% who received normal standard care. Thus this study shows that intervening with lifestyle and medications through a structured program does effectively reduce diabetes progression from pre-diabetes.
Meanwhile, in another study, patients with type 2 diabetes or prediabetes were enrolled from the Singapore Armed Forces and offered a 3-month intervention program, the NOVI Diabetes Care management program, in addition to the usual care they received. The program included:
- an in-person initial consultation with a clinical dietitian;
- in-person review with a diabetes specialist doctor;
- 1 continuous glucose monitoring device (CGM)
- access to the mobile app for dietary intake and physical activity tracking, and communication via messaging with the dietitian and doctor; and
- context-sensitive digital health coaching over the mobile app.
At the end of the program, the patients’ mean HbA1c (3-month sugar average) decreased from 7.6% to 7.0%, showing better blood sugar control. Their weight also had a mean decrease of 3.5% from baseline weight, and average BMI decreased from 27.8 kg/m2 to 26.7 kg/m2, which helps with better sugar control and overall health.
But why do so many people miss it?
- No symptoms, so there is nothing to prompt a visit.
- A false sense of security. Among people with prediabetes in the NUS IPUR survey, nearly 70% believed they did not have diabetes, and almost half of respondents who believed they had no diabetes actually had prediabetes (41.6%) or diabetes (5.9%).
- Screening starts late. Routine screening in Singapore begins at 40, every three years. People without risk factors are usually first tested then.
- The “I’m not overweight” assumption. Asians tend to develop type 2 diabetes at lower BMIs and with more visceral fat, which is why Singapore’s guidance targets a normal BMI of under 23 kg/m².
What actually works?
Singapore’s guidance recommends lifestyle intervention for all people with prediabetes. In practice, that means five things.
- Confirm where you stand. Ask your doctor about checking your fasting glucose and, where advised, take a diabetes screening test. Risk factors such as family history, high blood pressure or excess weight justify testing at any age. Recommended reading: Screening for Diabetes in Singapore
- Aim for a realistic weight target. The care protocol suggests BMI below 23 kg/m² if you are of Asian ethnicity, or 25 kg/m² is ideal if you’re non-Asian .
- Move more, and sit less. Singapore’s guidance also emphasizes reducing sedentary behavior.
- Change the plate and the glass. Follow a healthy plate, reduce carbohydrate and fat intake, avoid sugary drinks and foods, and reduce alcohol. Stopping smoking is also advised.
- Use the support available. NOVI Health’s has several options available:
- The NOVI Glucose Improvement Program includes 1-on-1 health coaching (In-person & digital), a CGM sensor and access to the NOVI Health App to track your progress. In a month, you will see how food and activity impact your unique glucose levels using a CGM, partner with a dedicated NOVI health coach to turn that data into practical, sustainable habits, and feel empowered with personalized nutrition advice that works for your life, not a one-size-fits-all diet.
- NOVI Diabetes Care brings together medical care, nutrition, and lifestyle support in a single, structured program, fully personalized to each patient’s goals. It includes:
- 1x Doctor consult
- 1x Dietitian consult
- 1x Blood test (HbA1c)
- 1x CGM sensor
- 1 month Digital Coaching via NOVI app on your handphone
Frequently asked questions
Does prediabetes have symptoms?
No. It is usually asymptomatic, which is why testing matters.
Can prediabetes be reversed?
For many people it can be, through modest weight loss and moderate activity, although results vary and habits need to be maintained.
Can I have prediabetes if I am slim?
Yes. Asians develop type 2 diabetes at lower BMIs and with more visceral fat.
When should I get tested?
From age 40, or earlier with risk factors.
About Dr. Todd On
Dr. Todd On, an Associate Consultant and Family Physician with 16 years of experience in tertiary and community care, specializes in person-centered treatment for acute and chronic conditions. He has led quality initiatives in smoking cessation and diabetic care and is an award-winning clinical tutor at the College of Family Physicians Singapore.