Prediabetes Care in Southlake, TX

Prediabetes is the last stage where you can genuinely change the outcome, and it is the stage most often handled with a shrug and a suggestion to eat better. We treat it as an active diagnosis with a workup, a plan, a recheck date and a specific target.

Getting the number right

We diagnose on A1c, fasting glucose, or a two-hour glucose tolerance test.

A1c can read falsely low or high with anemia, sickle cell trait, chronic kidney disease, recent blood loss or recent transfusion. If your number does not match the rest of your picture, we confirm it a different way rather than acting on a bad result. Sickle cell trait in particular affects a meaningful share of Black patients and is a well documented source of misleading A1c values.

At the same visit we check lipids, liver enzymes and blood pressure, because insulin resistance rarely arrives alone.

What we look for alongside it

Fatty liver shows up constantly in this group and almost nobody is told about it. Elevated ALT with insulin resistance is the usual signature, and it is largely reversible at this stage. See fatty liver disease.

The triglyceride and HDL pattern, high triglycerides with low HDL, is the fingerprint of insulin resistance on a lipid panel, and it often appears before glucose moves at all.

In women, a history of gestational diabetes or polycystic ovary syndrome raises risk substantially and moves screening earlier.

What actually moves the number

The strongest evidence here comes from structured lifestyle programs, and the effect size is larger than any drug we have.

• Losing 5 to 7 percent of body weight. Not more. That threshold is where the risk curve bends, and aiming for 40 pounds when 14 would do is how people quit.
• 150 minutes a week of moderate activity. Walking counts. Ten-minute pieces count. Resistance training twice a week adds meaningfully, because muscle is where glucose goes.
• Cutting liquid sugar first. The highest-yield single change for most people and the least painful, because calories in liquid form do not register as food.
• Protecting sleep. Short sleep and untreated apnea both worsen insulin resistance directly and measurably.

We can refer you to a recognized Diabetes Prevention Program, which Medicare and many commercial plans cover.

Medication

Metformin is not automatic here, but it is reasonable for younger patients, those with a BMI over 35, women with a history of gestational diabetes, and anyone whose A1c keeps rising despite genuine effort.

If weight is the main driver, our medical weight management program is often the more effective route, and the newer weight medications reduce progression to diabetes substantially.

The recheck is the point

You leave with an A1c recheck scheduled, usually at six or twelve months, and with the specific target written down.

Prediabetes without a follow-up date is just a line in a chart. Half the value of this diagnosis is that somebody looks again.

If your number crosses the threshold, our approach to type 2 diabetes management picks up from here without you having to start over. Weight is the strongest lever and is covered on our obesity page.

This is followed through our chronic condition management program. Read more about our primary care Southlake practice.