A conceptual framework for targeting prediabetes with lifestyle, clinical, and behavioral management interventions

Prediabetes is a condition that does not fall squarely into the primary or secondary prevention domain, and therefore tends to be inadequately addressed by interventions in either health promotion or disease management. Prediabetes is defined as having an impaired fasting glucose (fasting glucose of 100-125 mg/dL), impaired glucose tolerance (two-hour postprandial glucose of 140-199 mg/dL), or both. There is substantial evidence to suggest that even at these blood glucose levels, significant risk exists for both microand macrovascular complications. This paper introduces a conceptual framework of care for prediabetes that includes both screening and the provision of up-to-date clinical therapies in conjunction with an evidence-based health coaching intervention. In combination, these modalities represent the most effective means for delaying or even preventing the onset of diabetes in a prediabetes population. This paper concludes with a brief example in which these principles are applied to a hypothetical patient.