"Prediabetes": Are There Problems With This Label? Yes, the Label Creates Further Problems!

Area of Science:

• Endocrinology
• Metabolic Disorders
• Public Health

Background:

• The American Diabetes Association defines prediabetes using intermediate hyperglycemia thresholds (fasting glucose, 2-h postload glucose, or HbA1c).
• Recent changes have lowered the cut points for identifying prediabetes, particularly fasting glucose levels.

Purpose of the Study:

• To present a Point-Counterpoint debate on the current definition and cut points for prediabetes.
• To explore the implications of revised prediabetes criteria on risk identification, intervention, and healthcare capacity.

Main Methods:

• This content is based on expert arguments presented in a Point-Counterpoint format.
• Arguments are presented by Dr. Yudkin (critiquing the definition) and Dr. Cefalu (defending the definition).

Main Results:

• Arguments suggest the lower cut points identify individuals at higher cardiovascular disease risk and allow for earlier intervention.
• Counterarguments highlight that the current definition may obscure subcategory differences, complicate outcome interpretation, and overwhelm healthcare systems.

Conclusions:

• There is no consensus on the current definition of prediabetes and its associated cut points.
• Ongoing controversy exists regarding the utility of glycemic metrics beyond HbA1c for assessing diabetes complication risk.