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Predicting pre-diabetes progression: a systematic review and meta-analysis
Kate Meads1, Pranav Machiraju1, Yumeng Shi2
1The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia.
BMJ Nutrition, Prevention & Health
|August 1, 2026
Summary
Identifying patients at high risk of diabetes is crucial for early intervention. Impaired fasting glucose (IFG) combined with other tests, like HbA1c, best predicts progression from pre-diabetes to diabetes.
Area of Science:
- Endocrinology
- Metabolic Diseases
- Public Health
Background:
- Pre-diabetes significantly increases the risk of developing type 2 diabetes, a leading cause of global morbidity and mortality.
- Effective early identification of high-risk individuals is essential for timely intervention strategies.
- Current diagnostic criteria for pre-diabetes lack consensus, with no single test consistently proving most predictive of diabetes progression.
Purpose of the Study:
- To conduct a systematic review and meta-analysis to identify the most predictive biochemical tests and pre-diabetes definitions for diabetes progression.
- To compare the predictive accuracy of single versus combination biochemical testing for identifying individuals at high risk of progressing to diabetes.
Main Methods:
- A comprehensive systematic review and meta-analysis of 40 original studies published between 2006 and 2024.
- Inclusion criteria focused on adults diagnosed with pre-diabetes, excluding children, pregnant women, and those with significant comorbidities.
- Risk of bias was systematically assessed using the JBI Critical Appraisal Checklist.
Main Results:
- The impaired fasting glucose (IFG) range of 6.1–6.9 mmol/L demonstrated the highest risk of diabetes progression, with a hazard ratio (HR) of 9.0 (4.6–13.5).
- A combination of IFG (6.1–6.9 mmol/L), impaired glucose tolerance, and HbA1c (6.0%–6.4%) showed the highest annual incidence of diabetes at 15.2%.
- Generally, combination biochemical tests were associated with significantly higher rates of progression to diabetes compared to single tests.
Conclusions:
- Specific single and combination biochemical test results can significantly improve the identification of pre-diabetes patients likely to progress to diabetes.
- This review is the first to comprehensively evaluate all combinations of these biochemical tests for predicting diabetes progression.
- The findings highlight the potential for refined diagnostic criteria to guide personalized interventions for pre-diabetes management.
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