Prediabetes and What It Means: The Epidemiological Evidence

Area of Science:

• Endocrinology
• Metabolic Diseases
• Public Health

Background:

• Prediabetes is a prevalent intermediate stage between normal blood glucose and type 2 diabetes.
• It disproportionately affects older adults and obese individuals.
• Current clinical practice uses five distinct definitions based on HbA1c, fasting glucose, and 2-hour glucose levels.

Purpose of the Study:

• To highlight the challenges posed by the lack of a unified definition for prediabetes.
• To underscore the varying risks of complications associated with different prediabetes definitions.
• To emphasize the need for consensus on prediabetes definition for effective intervention and policy development.

Main Methods:

• Review of current prediabetes diagnostic criteria (HbA1c, fasting glucose, 2-hour glucose).
• Analysis of complication risks associated with different definitions.
• Evaluation of evidence for lifestyle and pharmacologic interventions in prediabetes management.

Main Results:

• Five different definitions for prediabetes exist, leading to ambiguity in diagnosis and risk assessment.
• The risk of complications, including progression to diabetes, cardiovascular disease, and mortality, varies based on the definition used.
• Interventions like lifestyle changes and metformin are proven effective but underutilized due to definitional inconsistencies.

Conclusions:

• A lack of consensus on prediabetes definition hinders effective screening, diagnosis, and treatment.
• Establishing standardized definitions is a priority to guide clinical practice and insurance coverage.
• Consensus definitions will facilitate wider implementation of cost-effective interventions, improving patient outcomes and reducing healthcare burden.