Reframing prediabetes: A call for better risk stratification and intervention

Area of Science:

• Endocrinology
• Metabolic Disorders
• Public Health

Background:

• Prediabetes represents a critical stage in glucose metabolism, preceding type 2 diabetes.
• Diagnostic criteria for prediabetes have evolved, lacking global standardization, which impacts clinical outcomes and type 2 diabetes risk assessment.
• Current identification relies on hemoglobin A1c, fasting plasma glucose, and 2-hour plasma glucose, with most individuals meeting only one criterion.

Purpose of the Study:

• To review the current epidemiology, prognosis, and interventions for prediabetes.
• To advocate for refined risk stratification of prediabetes based on the number of glycemic criteria met.
• To prompt a reevaluation of diagnostic methods and intervention strategies for prediabetes.

Main Methods:

• Literature review of prediabetes epidemiology, prognosis, and intervention strategies.
• Analysis of current diagnostic criteria and their impact on risk stratification.
• Synthesis of evidence to propose a revised approach to prediabetes management.

Main Results:

• Individuals with prediabetes exhibit varying risks for type 2 diabetes based on meeting one, two, or all three glycemic criteria.
• Current risk stratification and intervention strategies do not adequately account for the number of prediabetes criteria met.
• There is a need to reassess the role of oral glucose tolerance testing and continuous glucose monitoring in prediabetes diagnosis.

Conclusions:

• A more precise risk stratification (elevated, high, very high risk) is needed for individuals with prediabetes.
• Intensive interventions should be prioritized for those identified as high and very high risk.
• Standardizing diagnostic criteria and reassessing testing methodologies are essential for effective prediabetes management.