What did the STEP trials show about prediabetes?
They showed that most people with prediabetes reached normal blood sugar while on semaglutide. In STEP 1, 43.7% of the adults enrolled had prediabetes at baseline, and none had diabetes. After 68 weeks of weekly semaglutide 2.4 mg plus lifestyle counseling, 84.1% of those with prediabetes had reverted to normal blood sugar, against 47.8% in the placebo group.
The same trial found an average A1C drop of 0.45 percentage points with semaglutide versus 0.15 with placebo across all participants, whose average starting A1C was 5.7%. That sounds small, but for someone sitting at 5.9% or 6.0%, it is the difference between one category and the next.
What does “reversal” mean on an A1C report?
It means your A1C falls below the prediabetes line. MedlinePlus lists the cutoffs most labs use:
| A1C result | Category |
|---|---|
| Below 5.7% | Normal |
| 5.7% to 6.4% | Prediabetes |
| 6.5% or higher | Diabetes |
An A1C reflects your average blood sugar over roughly the past two to three months, so one good week does not move it. Reversal is a lab category, not a permanent state. The insulin resistance that pushed your number up is still there to some degree, which is why the NIDDK frames prediabetes as something you can prevent or reverse with steps you keep taking, such as losing 5% to 7% of your starting weight.
Fasting glucose and fasting insulin add detail. Our A1C test page for men covers when the A1C can mislead, such as with anemia or recent blood loss.
What happens to the result after you stop?
This is where planning matters. The STEP 1 trial extension followed 327 participants for a year after treatment, including lifestyle support, ended at week 68.
| Participants with prediabetes at baseline | Semaglutide | Placebo |
|---|---|---|
| Normal blood sugar at week 68, on treatment | 93.6% | 41.5% |
| Normal blood sugar at week 120, one year off | 43.3% | 34.0% |
Over that year the semaglutide group regained about two-thirds of the weight they had lost, and most cardiometabolic gains drifted back toward baseline. A small edge over placebo remained, but most of the blood sugar benefit did not outlast the medicine. The authors concluded that ongoing treatment appears to be needed to keep the improvements. We cover the rebound in detail in what happens when you stop semaglutide.
What keeps prediabetes reversed after treatment?
Keeping the weight off is the main lever. In the Diabetes Prevention Program, a lifestyle program aiming for at least 7% weight loss and 150 minutes of activity a week cut new cases of type 2 diabetes by 58% over about three years, compared with 31% for metformin.
In practice, that usually means some mix of the following, agreed with your provider before any dose change:
- A maintenance plan for the medicine, whether that is continuing, lowering the dose or a slow step-down
- Strength training at least twice a week to hold on to the muscle that clears glucose
- Protein at each meal and fewer refined carbohydrates and sugary drinks
- An A1C recheck a few months after any change, so drift is caught early
Related question: can testosterone therapy do the same?
Low testosterone and insulin resistance often travel together in men, so the question comes up. Testosterone therapy is a treatment for diagnosed testosterone deficiency, not a blood sugar medicine, and the evidence is different. Our page on whether TRT can reverse prediabetes walks through it, and the prediabetes guide for men covers screening and treatment choices side by side.
How Ultimate Male approaches prediabetes
A prediabetes result is a reason to look closer, not a reason to start a medicine automatically. At our San Gabriel and Downey clinics, the visit starts with on-site labs, including A1C and fasting glucose, then a one-on-one consultation with a PA-C or MD that covers your weight history, waist, sleep and family history of diabetes.
If semaglutide or tirzepatide fits, it becomes part of a medical weight loss plan with check-ins and repeat A1C testing, and the plan for coming off is discussed from the start rather than after the last dose. If it does not fit, you leave with a clear target and the numbers to track. You can begin with a free 10-minute call or book online.
