Divergence in prediabetes guidelines - A global perspective.

Area of Science:

• Endocrinology
• Public Health
• Clinical Diagnostics

Background:

• Global prediabetes diagnostic guidelines exhibit significant variation.
• Discrepancies stem from diverse healthcare priorities, population characteristics, and resource availability.
• International organizations like WHO, EASD, ADA, and IDF use differing criteria.

Purpose of the Study:

• To analyze the heterogeneity in global prediabetes diagnostic guidelines.
• To identify challenges posed by these discrepancies for research, policy, and care.
• To explore potential solutions for improved diagnostic consistency.

Main Methods:

• Comparative analysis of diagnostic criteria from major international organizations (WHO, EASD, SID, ADA, IDF, Diabetes UK, CDS).
• Evaluation of diagnostic tests including oral glucose tolerance test (OGTT), fasting plasma glucose (FPG), and glycated haemoglobin (HbA1c).
• Consideration of ethnic variability in glucose metabolism and its impact on diagnostic tools.

Main Results:

• Significant differences exist in prediabetes definitions and diagnostic criteria across major global health organizations.
• Variations in diagnostic tests (OGTT, FPG, HbA1c), prevalence estimates, and screening policies contribute to discrepancies.
• Ethnic variability impacts the performance of diagnostic tools like HbA1c, complicating standardization.

Conclusions:

• Heterogeneity in prediabetes diagnosis challenges global research, policy-making, and equitable healthcare access.
• Emerging approaches like the 1-hour plasma glucose (1-h PG) test show promise for diagnostic consistency.
• A hybrid model integrating universal standards with population-specific adaptations may enhance global prediabetes identification and prevention strategies.