Approaching pre-diabetes

As the global epidemic of type 2 diabetes continues to rise, the time has come to revisit our approach to pre-diabetes. Recently, much ado has been made about screening, diagnosis, pathophysiology and clinical interventions in pre-diabetes, and all for good reason as the key to reversing the diabetes epidemic likely lies therein. The somewhat controversial term "pre-diabetes" represents collective dysglycemic states intermediate between normal glucose regulation (NGR) and diabetes. Not all people with pre-diabetes will develop diabetes, but the majority will. In fact, up to 70% of those with pre-diabetes may acquire the disease over their lifetime. Furthermore, even when overt diabetes is delayed or prevented, both micro- and macrovascular disease appears more prevalent in those with pre-diabetes compared to their normoglycemic peers. Hence, there is growing consensus that NGR should be the goal for people with pre-diabetes. Nevertheless, there is much to consider in that pursuit. Herein, we provide an update on the global burden of pre-diabetes, its underlying pathophysiology and discuss clinical considerations in these individuals at high risk of developing diabetes.