Prediabetes to normalcy: 58-year-old client restores metabolic health

Fact checked – 7 min read

Between May 2025 and October 2025, I had been working (and still am) with a 58-year-old male in Gibraltar who at baseline weighed 125kg / BMI 44.8, bodyfat ~30-36%. His blood work (data published with prior client consent) displayed considerable insulin resistance and dysglycemia, and his HbA1c suggested he was prediabetic (5.9%). I have worked successfully with many other prediabetics, type II diabetics, and one type 1 diabetic.

I am a strong proponent of an evidenced-based data-driven approach to my client’s health, and five months later upon re-testing his blood work, without the use of weight loss drugs, he achieved measurable improvements across several key metabolic domains: HbA1c, fasting insulin, fasting glucose, insulin sensitivity, insulin resistance, body weight, body mass index (BMI), and waist-to-hip ratio (WHR). Together, these changes reveal a transition from a high-risk metabolic profile toward a much healthier, lower-risk state. It is highly likely these changes occurred much sooner but he was unable to test earlier.

Glycemic control (HbA1c and Fasting glucose)
HbA1c, or glycated hemoglobin, is a blood test that measures the average blood sugar levels over the past 2–3 months, a gold-standard marker of blood glucose control. He reduced his HbA1c by 5.1% over 5 months. Studies show that each 1% drop in HbA1c is associated with a 20–30% lower risk of microvascular complications, such as eye (retinopathy), kidney (nephropathy), and nerve damage (neuropathy). These shifts moved him out of the prediabetic range (≥ 5.7%) and back into the normal glycemic zone (Fig.1), as well as a modest improvement on his fasting blood glucose (Fig.2). This degree of improvement often results from dietary and lifestyle modulation, weight loss, and enhanced insulin sensitivity. Research suggests that even small HbA1c reductions of 0.3% can substantially lower risk of type 2 diabetes onset and cardiovascular complications (1, 2), reduce short-term risks of cognitive decline, longer-term risks of Alzheimer’s disease.

Insulin sensitivity
Fasting insulin: ↓ from 10 → 5.6 mU/L
A roughly 45 % reduction in fasting insulin (Fig.3) and marked improvements in calculated insulin sensitivity (Fig.4) and insulin resistance (Fig.4), strongly suggested restored insulin and blood glucose homeostasis, one of the most powerful indicators of metabolic rejuvenation. Insulin resistance is arguably the biggest risk factor for cardiovascular disease and often even more predictive than high cholesterol or obesity alone, whilst elevated fasting insulin is a hallmark of metabolic syndrome, linked with hypertension, dyslipidemia, fatty liver, and future diabetes risk (3). Lower insulin levels mean the body is now managing blood sugar with far less effort, reducing strain on pancreatic β-cells, which could considerably reduce short-term risks of acute pancreatitis, and longer-term risks of pancreatic cancer.

Body weight and central adiposity
Weight: ↓ from 125 → 113 kg (-12 kg total)
Waist-to-hip ratio (WHR): ↓ from 1.10 → 1.07
Losing nearly 10 % of body weight (fig.5) over five months is clinically meaningful. Research shows that a 5–10 % reduction in total body weight can markedly improve glucose metabolism, blood pressure, and lipid profiles (4).The modest fall in WHR (Fig.6) indicates decreased visceral fat, the metabolically active abdominal fat most associated with inflammation and insulin resistance. Even small improvements in WHR correlate with lower risk of cardiovascular disease and all-cause mortality (5). His blood pressure however remained relatively stable and well controlled compared to baseline (114/78 mm/Hg), surprising given this client was considerably overweight and obese at baseline (125kg / BMI 44.8).

From class III to class I: What a 10-point BMI drop really means for long-term health
Between May and October 2025, this 58-year-old male reduced his BMI (Fig.7) from 44.8 kg/m² to 34.9 kg/m², a 22% reduction that represents a transition from Class III (severe) to Class I obesity. This degree of change in only five months is not merely cosmetic; it is clinically transformative, reshaping the metabolic, cardiovascular, and hormonal environment of the body.

Why BMI Still Matters
BMI is a simple calculation of weight relative to height used to categorise underweight, normal, overweight, or obesity at a population level, but has some limitations. WHR is often superior because it is more personalised and nuanced, describing fat distribution, particularly abdominal fat, which is a stronger predictor of heart disease, diabetes, and metabolic risk than BMI, which doesn’t distinguish between muscle and fat or indicate where fat is stored. Despite these shortcomings, a BMI at this level (44.8) of obesity remains highly predictive of metabolic diseases (Fig.8), cardiovascular risk, and mortality (6). A BMI of 44.8 kg/m² places an individual firmly in the high-risk category for type 2 diabetes, hypertension, dyslipidaemia, Metabolic-associated fatty liver disease (MAFLD), mood and sleep apnea (2). Bringing BMI down to 34.9 kg/m² meaningfully reduces the physiological strain on the musculoskeletal system (bones & joints), cardiovascular system, whilst markedly improving insulin sensitivity and lipid metabolism, as well as potentially reducing GHA healthcare costs and resource burden.

Short-term health impacts
Within months, these changes likely produced:
– Improved energy, due to more stable glucose and insulin levels.
– Reduced risk of high blood pressure, lower triglycerides, common secondary benefits of lower body weight.
– Enhanced endothelial function, lowering short-term cardiovascular strain.
– Reduced risks of cognitive decline

Long-term risk reduction
Sustaining these results could yield profound long-term dividends:
– Type 2 diabetes risk: markedly reduced (~58%) as per Diabetes Prevention Program data (7).
– Cardiovascular risk: decreased via better lipid and inflammatory profiles.
– Liver health: reduced likelihood of MAFLD.
– Neurological: reduced risks of Alzheimer’s disease.
– Longevity and quality of life: improved metabolic flexibility and lower chronic disease burden.
– QRISK3: 10-year risk assessment of a cardiovascular event places him at lowest risk category of 7.6% (highly unlikely)

The bigger picture
There are many more blood work markers I could have highlighted that evidences progress in other aspects of this client’s metabolic health, but didn’t want to make this blog post excessively convoluted. What’s matters here is not only the numerical changes but the robust directional consistency, every metric shifted the ‘needle’ favourably in the right direction. This pattern points unequivdbly to systemic improvements in metabolic function, rather than isolated changes. For a 58-year-old male, these gains potentially rejuvenate his DNA and metabolic health via epigenetic mechanisms by several years, arguably improving his quality-adjusted life years (QALY), a generic measure of disease burden, including both the quality and the quantity of life lived, evidencing how diet and lifestyle interventions remain potent tools for mid-life health renewal and long-term risk reduction.

Work in progress
However, all is not perfect and this client is not over the hill yet. His latest blood work revealed other small imbalances in need of attention, but it was important to initially work on the more urgent health concerns first and establish a solid foundation on which to achieve even more gains longer-term. It was not feasible nor realistic to target everything at once, and evidence of the benefits of my longer-term NUTRITIONAL THERAPY health programmes.

Summary
Within just five months, and quite probably much sooner due not being able to re-test earlier, this individual has transitioned from early metabolic risk to measurable protection. The reductions in HbA1c, fasting insulin, weight, BMI and WHR together mark a clinically significant improvement in metabolic health and a substantial reduction in long-term risk for diabetes, cardiometabolic and neurological diseases. Check out my NUTRITIONAL THERAPY page and let’s work together to to make meaningful changes to your health in a personalised and evidence-based manner.