Can you prevent diabetes if it runs in the family?

With a family history, your risk is real, but far from inevitable.

Written by Dr Nilay Desai

Diabetes prevention: If diabetes runs in your family but your blood sugars are currently normal, you’re in a powerful prevention window. Genetics load the gun; lifestyle and timely screening decide whether it fires. This guide explains what “normal” really means, how often to test, and the few habits that, when consistently applied, have the greatest impact.

First: what counts as “normal” sugar?

Clinically, normal glycaemia means:

A1c < 5.7%
Fasting plasma glucose < 100 mg/dL
2-hour OGTT < 140 mg/dL after 75 g glucose

These thresholds are from the ADA’s current Standards of Care.

How often should you test for diabetes if it is in the family?

Age-based screening: Most adults should begin screening by age 35. If your initial test is normal, rescreen about every 3 years; test sooner if weight or risk factors change.
Risk-based (South Asian focus): Because South Asians develop diabetes at lower BMIs, treat BMI =23 kg/m² as “overweight” for risk and screen earlier/more often even if you’re slim elsewhere.
If you’ve ever had gestational diabetes, test every 3 years lifelong, even if sugars are currently normal.

Also Read | Our Expert Article: Dr Nikita Chaturvedi on family history and heart risk

The prevention playbook (what actually works)

1. Lose ~7% of current body weight (and keep it off)

The landmark Diabetes Prevention Program (DPP) showed a 58% reduction in diabetes risk with lifestyle change targeting =7% weight loss; metformin reduced risk by 31%, but lifestyle outperformed medication. Example: if you’re 78 kg, aim to lose about 5–6 kg over 6 months.

2. Move with intent, every week

Match the DPP (Diabetes Prevention Program) / (American Diabetes Association) ADA target: =150 minutes/week of moderate activity (e.g., brisk walking) plus 2–3 days/week of resistance training; avoid >2 consecutive inactive days. These patterns improve insulin sensitivity even before weight changes.

3. Eat for steady glucose, not perfection

You don’t need a rigid diet. Two evidence-based patterns:

DPP-style calorie control with fibre-rich staples (dal, sabzi, leafy greens, whole grains), fewer refined carbs, and portion-aware roti/rice.
Mediterranean-style plate with calorie reduction and regular activity, recent randomised data (PREDIMED-Plus) showed about 31% lower diabetes incidence over 6 years versus diet alone.
Practical Indian swaps: add one fist of salad/leafy veg to lunch and dinner, pick whole grains (phulka/jowar/bajra) more often than refined options, limit sugar-sweetened beverages, and push protein into each meal (curd, paneer, lentils, eggs, fish).

4. Sleep, stress, and routines matter

The ADA emphasises behavioural supports, sleep regularity, stress management, problem-solving, and social support because they make weight and activity goals stick. Target 7–9 hours of consistent sleep; treat loud snoring/daytime sleepiness (possible OSA) since it worsens insulin resistance.

5. Know when medication enters the chat

You don’t need a pill if your sugars are normal. If future tests show prediabetes, your doctor may consider metformin in higher-risk individuals (younger than 60, BMI =35 kg/m², or women with prior gestational diabetes)—in addition to lifestyle measures.

A simple, doctor-approved 90-day plan

Weeks 1–2: Foundations

Log baseline: weight, waist, step count, and 3 days of meals.
Walk 30 minutes on 5 days/week (or 3×10 minutes).
Add protein to breakfast; remove one sugary drink or dessert.

Weeks 3–6: Build

Progress to 45–50 minutes walking most days; start 2 short strength sessions (bodyweight squats, push-ups against a wall, resistance band rows).
Plate rule at lunch/dinner: ½ vegetables, ¼ protein, ¼ whole grains.

Weeks 7–12: Consolidate

Hit the full 150 minutes/week + 2–3 strength days.
Aim for ~7% weight loss from your start weight if you have excess weight; if already lean, prioritise fitness and waist reduction.
Keep one weekly “audit”: sleep times, late-night snacking, weekend overeating.

When to retest and what to track

Glucose/A1c: If today’s tests are normal, repeat about every 3 years (earlier if BMI =23 for South Asians, weight gain, new blood-pressure or lipid issues, or pregnancy).
Weight & waist: Monthly.
Blood pressure & lipids: At least annually; managing cardiometabolic risk is part of diabetes prevention. (Aligned with ADA prevention standards.)

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With a family history, your risk is real, but far from inevitable. Prioritise a 7% weight-loss target, 150 minutes/week of activity plus strength training, and a high-fibre, minimally processed plate. Screen on time (earlier if South Asian BMI =23), and reserve metformin only if you cross into prediabetes and meet high-risk criteria. These few moves, done consistently, are the difference between “at risk” and “doing well for decades.”

Medical disclaimer: This article is for general education and does not replace a personal consultation. Screening schedules, activity targets, and medications must be individualised by your doctor.