November is Diabetes Awareness Month. Honestly, most awareness campaigns wash right past us. This one earns a pause, though.
Here’s why. Roughly 80 million American adults have prediabetes and haven’t been told. [1] Meanwhile, prediabetes causes no symptoms whatsoever.
So consider this your nudge. Fortunately, one simple blood test tells you a great deal.
Key takeaways
- Age 35 is the backstop, not the starting line. Many women qualify far earlier.
- Prediabetes produces no symptoms, so testing is the only way to find it.
- An A1c between 5.7% and 6.4% means prediabetes.
- Diabetes affects your heart, kidneys, eyes, and nerves — and women lose more heart protection than men do.
- Lifestyle change cut the odds of developing diabetes by 58%, and that benefit lasted decades. [2]
Age 35 is the backstop, not the starting line
Most women assume screening starts somewhere in their forties. Actually, the guidance is broader than that number suggests.
Everyone gets tested by 35. The American Diabetes Association recommends testing no later than age 35 for all adults, regardless of weight or risk factors. [3] After a normal result, repeating every three years is reasonable — sooner if your weight or health changes. [3]
Many women qualify earlier. With overweight or obesity plus one risk factor, age stops mattering entirely. [3] A 31-year-old with PCOS qualifies today, and so does a 29-year-old with a family history.
So work backward from your risk factors rather than forward from your birthday.
Risk factors that move up your timeline:
- A parent or sibling with type 2 diabetes
- High blood pressure
- Low HDL cholesterol, or high triglycerides
- A history of gestational diabetes
- Polycystic ovary syndrome (PCOS)
- Physical inactivity [3]
Background matters too. Diabetes occurs more often in American Indian, Alaska Native, Asian American, Black, Hispanic, and Native Hawaiian or Pacific Islander women. Consequently, earlier screening deserves consideration in these groups.
Medications count. Statins, thiazide water pills, and some HIV medications all raise blood sugar, so screening deserves consideration if you take them. [3] Additionally, second-generation antipsychotics call for a stricter schedule: testing at the start, again at 12 to 16 weeks, and yearly afterward. [3]
Curious why midlife specifically raises your risk? [Our article on insulin resistance after 40] walks through the hormone and muscle changes behind it.
Why this screening matters more than it sounds
“Borderline” sounds harmless. Unfortunately, high blood sugar works quietly, and it works on your blood vessels.
Here’s the simplest way to understand it. Extra sugar in your bloodstream slowly damages the lining of your blood vessels — both the large ones feeding your heart and brain, and the tiny ones feeding your kidneys, eyes, and nerves. Consequently, diabetes rarely causes one problem. It causes several, in different places, over years.
Reading this next part isn’t fun. However, it explains why one unremarkable blood test earns a whole awareness month.
Your heart and brain
This is the big one, and it’s the piece most women never hear.
Diabetes roughly doubles the risk of heart attack and stroke. Furthermore, women lose more ground than men do: compared with men who have diabetes, women face a 52% higher relative risk of coronary heart disease and a 44% higher risk of dying from it. Meanwhile, the natural heart protection younger women usually enjoy largely disappears.
Timing shifts too. Without diabetes, a woman’s heart risk stays low until her sixties. With it, that same level of risk can arrive twenty to thirty years earlier.
Even the prediabetes stage counts. In one large study, prediabetes was linked to higher cardiovascular risk in women, though not significantly in men.
Your kidneys
Your kidneys filter blood through millions of tiny vessels, so they’re vulnerable early.
Kidney disease develops in roughly 20% to 40% of people with diabetes. Additionally, nearly 40% of Americans on dialysis or awaiting a transplant have type 2 diabetes.
Early kidney damage causes no symptoms whatsoever. Therefore, a yearly urine test and a blood test catch it long before you’d notice anything. Encouragingly, several modern medications now slow that damage meaningfully.
Your eyes
High blood sugar damages the small vessels in your retina, the light-sensing layer at the back of your eye.
About 10% of adults with type 2 diabetes have severe vision difficulty or blindness. Notably, early damage causes no blurriness at all, which is exactly why yearly dilated eye exams matter.
Your nerves and feet
Nerve damage usually starts in the feet, and it’s common. It shows up as numbness, tingling, burning pain, or unsteadiness when you walk.
Numbness is actually riskier than pain, because a blister or cut can go unnoticed until it becomes a serious wound. That pathway explains a hard statistic: diabetes remains a leading cause of lower-limb amputation in American adults. Fortunately, a simple yearly foot check catches most of this early.
Nerve damage isn’t limited to your feet, either. It can affect digestion, bladder function, and sexual comfort — topics women rarely raise, and providers rarely ask about.
Why catching it early changes everything
Two facts make the case.
Damage can begin before diagnosis. Nearly one-third of people already have a complication on the day they’re diagnosed with diabetes. [1] So this isn’t a problem that waits politely.
Early control pays off for decades. In long-term follow-up of major trials, people who controlled blood sugar well early on had fewer eye and kidney complications, fewer heart attacks, and lower death rates measured twenty years later. Researchers call this the legacy effect.
And risk climbs steeply, not evenly. An A1c between 5.5% and 6.0% carries a five-year diabetes risk of 9% to 25%. Meanwhile, an A1c of 6.0% to 6.5% carries a five-year risk of 25% to 50%. [4] So where you land within the range genuinely matters.
Please hear the point behind all of this, though. These outcomes describe diabetes left unaddressed for years — not a single borderline lab result. Screening exists precisely so you never reach that chapter.
| What it affects | What can happen | How it gets caught |
|---|---|---|
| Heart and brain | Heart attack, stroke, heart failure | Blood pressure, cholesterol, and risk assessment |
| Kidneys | Reduced filtering, eventually dialysis | Yearly urine and blood test |
| Eyes | Vision loss, and rarely blindness | Yearly dilated eye exam |
| Nerves and feet | Numbness, pain, wounds, amputation | Yearly foot exam |
Which test should you ask for?
Three tests work, and each looks at something slightly different. [3]
A1c shows your average blood sugar over roughly three months. Best of all, it needs no fasting.
Fasting blood sugar captures one morning moment after an overnight fast.
Two-hour glucose test shows how your body handles a sugar drink.
What the numbers mean
| Test | Normal | Prediabetes | Diabetes |
|---|---|---|---|
| A1c | Below 5.7% | 5.7% to 6.4% | 6.5% or higher |
| Fasting blood sugar | Below 100 mg/dL | 100 to 125 mg/dL | 126 mg/dL or higher |
| Two-hour glucose test | Below 140 mg/dL | 140 to 199 mg/dL | 200 mg/dL or higher |
Two practical caveats matter here. [3] First, A1c can read inaccurately with anemia, low iron, kidney disease, or certain inherited blood traits. Second, before a two-hour test, eat normally — at least 150 grams of carbohydrate daily for three days. Otherwise your result may look falsely abnormal. [3]
Also worth knowing: the three tests often disagree, and all three line up in only about 4% of cases. [4] Consequently, one normal result doesn’t always settle the question, and your provider may repeat or combine them.
The genuinely good news: this stage responds
Here’s the part awareness campaigns underplay. Prediabetes is not a countdown clock.
Lifestyle change works, and it works well. In the landmark Diabetes Prevention Program, participants aimed for 7% weight loss plus 150 minutes of walking weekly. As a result, they cut their risk of developing diabetes by 58% over three years. [2]
The benefit lasted decades. Twenty-one years later, that group still showed significantly fewer cases, corresponding to 3.5 additional diabetes-free years. [2] Similar programs abroad showed lasting results too, including a 39% reduction at thirty years. [2]
Movement helped on its own. Participants who hit 150 minutes weekly without reaching the weight goal still lowered their risk by 44%. [2] So progress doesn’t only depend on the scale.
One honest caveat, though: major heart events weren’t significantly lower at 21 years, likely because nearly everyone in the study eventually took cholesterol and blood pressure medication. [2] Diabetes prevention is therefore one important piece of heart protection, not the whole plan.
What that looks like in practice
- Move 150 minutes a week. Brisk walking counts. Spread it across at least three days, ten minutes at a minimum per session. [2]
- Add strength training. Muscle is where your body parks sugar. Up to 75 minutes of it counts toward your weekly total. [2]
- Choose a Mediterranean or DASH-style pattern. Both carry strong evidence, and neither requires eliminating whole food groups.
- Aim for 7% weight loss, if that fits your situation. For a 180-pound woman, that’s roughly 13 pounds, at a pace of one to two pounds weekly. [2]
- Protect your sleep, and address ongoing stress. Both affect blood sugar directly.
- Ask about a structured prevention program. The National DPP is proven, and many insurers cover it. [2]
Medication helps some women too, including metformin and the newer GLP-1 medications.
Myth versus fact
Myth: I’d feel it if my blood sugar were high.
Fact: Prediabetes typically causes no symptoms at all. Testing finds it; feelings don’t.
Myth: I’m too young to worry about this.
Fact: With overweight or obesity plus one risk factor, screening applies at any age. [3]
Myth: My doctor would have tested me if I needed it.
Fact: Screening gets missed constantly. Roughly 80 million American adults have undiagnosed prediabetes. [1]
Myth: Prediabetes always turns into diabetes.
Fact: It doesn’t. Structured lifestyle change cut progression by 58%. [2]
Myth: One normal result means I’m set.
Fact: Retesting every three years is recommended, and sooner if your health changes. [3]
Your November checklist
- Review the risk factor list above, then note any that apply to you.
- Check whether you’re due. Testing starts by 35, or earlier with risk factors.
- Ask for an A1c at your next visit. Conveniently, no fasting is required.
- Bring your family history, your pregnancy history, and your full medication list.
- If your result lands in the prediabetes range, request a cardiovascular check too.
- Read [what insulin resistance actually is] so the result makes sense.
Frequently asked questions
At what age should women start diabetes screening?
By 35 for everyone. However, screening applies at any age with overweight or obesity plus one risk factor. [3]
I’m 32 with PCOS. Should I be tested?
Quite possibly, yes. PCOS counts as a risk factor, so age alone shouldn’t rule you out. [3]
Why is diabetes harder on women’s hearts?
Women with diabetes face a higher relative risk of coronary heart disease and cardiac death than men with diabetes. Additionally, the heart protection younger women typically have largely disappears.
Would I notice kidney or eye damage early?
Usually not. Both develop silently at first, which is exactly why yearly screening tests exist.
Can prediabetes be reversed?
Often, yes. Structured lifestyle change cut progression by 58%, and many participants returned to normal blood sugar. [2]
Do I need to lose weight for this to work?
Not necessarily. Reaching 150 minutes of activity weekly lowered risk by 44%, even without weight loss. [2]
Do I need to fast?
Not for an A1c. Both the fasting test and the two-hour test do require preparation, though. [3]
I had gestational diabetes 15 years ago. Does that still count?
Yes. That history keeps raising your risk decades later, so ongoing screening matters. [3]
A closing thought
Awareness months can feel like noise. This one points at something useful, though: a five-minute test and a genuinely open window.
You deserve a visit that looks at the whole picture — your numbers, your hormones, your history, and your actual life.
This November, book a preventive health review and get your baseline.
(Telehealth appointments are currently available for patients located in Arizona and New York.)
This information is educational and not a substitute for personalized medical care.
REFERENCES
- American Diabetes Association Professional Practice Committee. 2. Diagnosis and Classification of Diabetes: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1).
- American Diabetes Association Professional Practice Committee. 3. Prevention or Delay of Diabetes and Associated Comorbidities: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1).
- American Diabetes Association Professional Practice Committee. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1).
- US Preventive Services Task Force, Davidson KW, Barry MJ, et al. Screening for prediabetes and type 2 diabetes: US Preventive Services Task Force recommendation statement. JAMA. 2021;326(8):736-743.
- Echouffo-Tcheugui JB, Perreault L, Ji L, Dagogo-Jack S. Diagnosis and management of prediabetes: a review. JAMA. 2023;329(14):1206-1216.
- Bowen ME, Lingvay I, Meneghini L, et al. Derivation and validation of D-RISK: an electronic health record–driven risk score to detect undiagnosed dysglycemia in clinical practice. Diabetes Care. 2025.
- Kalyani RR, Neumiller JJ, Maruthur NM, Wexler DJ. Diagnosis and treatment of type 2 diabetes in adults: a review. JAMA. 2025.
- Yaow CYL, Chong B, Chin YH, et al. Higher risk of adverse cardiovascular outcomes in females with type 2 diabetes mellitus: an umbrella review of systematic reviews. Eur J Prev Cardiol. 2023.
- Yoshida Y, Chen Z, Fonseca VA, Mauvais-Jarvis F. Sex differences in cardiovascular risk associated with prediabetes and undiagnosed diabetes. Am J Prev Med. 2023.
- Cho L, Davis M, Elgendy I, et al. Summary of updated recommendations for primary prevention of cardiovascular disease in women: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(20):2602-2618.
- Ballotari P, Venturelli F, Greci M, Giorgi Rossi P, Manicardi V. Sex differences in the effect of type 2 diabetes on major cardiovascular diseases: results from a population-based study in Italy. Int J Endocrinol. 2016.
- Das SR, Bonaca MP, Creager MA, et al. Management of peripheral artery disease in adults with diabetes: 2025 ACC scientific statement. J Am Coll Cardiol. 2025.
- Horton WB, Barrett EJ. Microvascular dysfunction in diabetes mellitus and cardiometabolic disease. Endocr Rev. 2021.
- Samson SL, Vellanki P, Blonde L, et al. American Association of Clinical Endocrinology consensus statement: algorithm for management of adults with type 2 diabetes — 2026 update. Endocr Pract. 2026.