Most involve the reduction of added sugars and fats but there remains a lack of conclusive evidence proving the best approach.For patients with severe risk factors, prescription medication may be appropriate. This may be considered in patients for whom lifestyle therapy has failed, or is not sustainable, and who are at high-risk for developing type 2 diabetes. Metformin and acarbose help prevent the development of prediabetes, and also have a good safety profile. Evidence also supports thiazolidinediones but there are safety concerns, and data on newer agents such as GLP-1 receptor agonists, DPP4 inhibitors or meglitinides are lacking. Prognosis
The progression to type 2 diabetes mellitus is not inevitable for those with prediabetes. The progression into diabetes mellitus from prediabetes is approximately 25% over three to five years. This increases to 50% risk of progressing to diabetes over 10 years. Diabetes is a leading cause of morbidity and mortality. Effects of the disease may affect larger blood vessels (e.g., atherosclerosis within the larger arteries of the cardiovascular system) or smaller blood vessels, as seen with damage to the retina of the eye, damage to the kidney, and damage to the nerves.Prediabetes is a risk factor for mortality and there is evidence of cardiovascular disease developing prior to a diagnosis of diabetes. Epidemiology
Studies conducted from 1988 to 1994 indicated that of the total population of US in the age group 40–74 years, 34% had IFG, 15% had IGT, and 40% had prediabetes (IFG, IGT, or both).
Periodontal disease occurs when a number of anaerobic bacteria living on the tooth surface cause infections, which leads to a potentially sustained immune response. Diabetes is a type of condition in which infections are easier to get, and hyperglycemia contributes to the mechanism causing oral complications. Prevention
The American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE) have developed lifestyle intervention guidelines for preventing the onset of type 2 diabetes:

Healthy diet (a diet with limited refined carbohydrates, added sugars, trans fats, as well as limited intake of sodium and total calories)
Physical fitness (30–45 minutes of cardiovascular exercise per day, 3–5 days a week)
Weight loss by as little as 5–10 percent may have a significant impact on overall health

Management
There is evidence that prediabetes is a curable disease state. Although some drugs can delay the onset of diabetes, lifestyle modifications play a greater role in the prevention of diabetes. Intensive weight loss and lifestyle intervention, if sustained, may improve glucose tolerance substantially and prevent progression from IGT to type 2 diabetes. The Diabetes Prevention Program (DPP) study found a 16% reduction in diabetes risk for every kilogram of weight loss. Reducing weight by 7% through a low-fat diet and performing 150 minutes of exercise a week is the goal. The ADA guidelines recommend modest weight loss (5–10% body weight), moderate-intensity exercise (30 minutes daily), and smoking cessation.There are many dietary approaches that can reduce the risk of progression to diabetes.