57 million Americans are believed to have what's called pre-diabetes.
These are patients with higher than normal glucose levels and other signs that put them at risk for developing diabetes.
Until now, there's been no solid advice on how to treat them.
A panel of experts has come up with a gameplan so pre-diabetic patients can lower their risk before it's too late.
24 million Americans have diabetes. More than twice that many are considered at risk and experts say many don't know it.
In testing blood sugar levels, there's a 25 to 60 point gap depending on the test between what's considered normal and what's clearly diabetic.
That gap is what doctors call pre-diabetes.
Dr. Philip Levy of the University of Arizona College of Medicine says "somebody with pre-diabetes usually has absolutely no symptoms, and they may not even know they're at risk."
People with elevated glucose face a higher risk of heart disease, sometimes just as much as those with diabetes.
They also risk blindness, kidney failure, amputation, and death.
Dr. Daniel Einhorn, Vice-President of the American Association of Clinical Endocrinologists, says "if you don't do anything, there's gonna be a huge price to pay. And it's completely in your hands."
The American College of Endocrinology brought together experts to study pre-diabetes.
Here's what they suggest.
Doctors should consider drugs to lower glucose, cholesterol and blood pressure. Asprin is recommended. But mostly, focus on lifestyle changes: lose weight (just 5% or 10% lowers your risk), stick to a low-fat, low-salt diet, and get 30 to 60 minutes of exercise five days a week.
Dr. Daniel Einhorn says "when you don't hurt, when you're not suffering, when it's early that's the time that you can hit a home run."
Doctors don't know how many pre-diabetic patients will develop diabetes but they do know small changes can make a big difference.