Diagnosis and Management of Prediabetes A Review

IMPORTANCE Prediabetes, an intermediate stage between normal glucose regulation and diabetes, affects 1 in 3 adults in the US and approximately 720 million individuals worldwide. OBSERVATIONS Prediabetes is defined by a fasting glucose level of 100 to 125mg/dL, a glucose level of 140 to 199mg/dL measured 2 hours after a 75-g oral glucose load, or glycated hemoglobin level (HbA(1C)) of 5.7% to 6.4% or 6.0% to 6.4%. In the US, approximately 10% of people with prediabetes progress to having diabetes each year. Ameta-analysis found that prediabetes at baselinewas associated with increased mortality and increased cardiovascular event rates (excess absolute risk, 7.36 per 10000 person-years for mortality and 8.75 per 10000 person-years for cardiovascular disease during 6.6 years). Intensive lifestyle modification, consisting of calorie restriction, increased physical activity (>= 150 min/wk), self-monitoring, and motivational support, decreased the incidence of diabetes by 6.2 cases per 100 person-years during a 3-year period. Metformin decreased the risk of diabetes among individuals with prediabetes by 3.2 cases per 100 person-years during 3 years. Metformin is most effective forwomen with prior gestational diabetes and for individuals younger than 60 years with body mass index of 35 or greater, fasting plasma glucose level of 110mg/dL or higher, or HbA(1c) level of 6.0% or higher. CONCLUSIONS AND RELEVANCE Prediabetes is associated with increased risk of diabetes, cardiovascular events, and mortality. First-line therapy for prediabetes is lifestyle modification that includes weight loss and exercise or metformin. Lifestyle modification is associated with a larger benefit than metformin.

Automated summary

Prediabetes, an intermediate stage between normal glucose regulation and diabetes, affects 1 in 3 adults in the US and approximately 720 million individuals worldwide. Lifestyle modification, including weight loss and exercise, is the first-line therapy for prediabetes and has a larger benefit than metformin.