Healthy 64 year-old male with prediabetes with no significant risk factors who is very interested and active in preventing the progression to diabetes and avoiding traditional pharmacotherapy if possible. Healthy 64 year-old male with prediabetes with no significant risk factors who is very interested and active in preventing the progression to diabetes and avoiding traditional pharmacotherapy if possible.A 64 year-old male presents for a routine physical. His past medical history is significant for benign prostatic hypertrophy. He is very active, doing both cardiovascular and resistance training daily. His body-mass index (BMI) is 21. He is a non-smoker and has 1-2 glasses of red wine each week. He takes a baby aspirin a day (81mg) as well as a multivitamin and Omega 3 supplementation. His diet is well rounded with frequent servings of fruits and vegetables with little processed food. He has had some increased stress surrounding a controversy in his condominium association and may have to move as a result. His wife comments that he has had a short fuse as of late. No depressive symptoms on screening. Routine labwork shows an elevated fasting blood glucose (FBG) of 122, placing him in the category of “pre-diabetes”. The test was repeated with a FBG of 121 and a hemoglobin A1c was elevated at 6.3. Urine microalbumin was negative. A lipid profile was excellent with an LDL of 82, HDL of 43 and triglycerides of 178. 64MaleCurrently asymptomatic. No polyuria, polydipsia. No polyneuropathy, no sensory loss, no nephropathy. This is the big question! I have reviewed dietary modifications surrounding carbohydrates and referred him to a nutritionist. I have also reinforced the importance of continued exercise. With regard to his increased stress, further discussion reveals this to be more longstanding and he has agreed to individual therapy.In addition to exercise and dietary modifications, what are other modalities that have been shown to help prevent the progression of prediabetes to diabetes? What is the evidence of stress reduction in preventing the progression?