Introduction: Pre-diabetes in Primary Care

Pre-diabetes is a reversible metabolic state where blood glucose is elevated above normal but below the diagnostic threshold for Type 2 Diabetes Mellitus (T2DM).

Why It Matters:

• Affects ~98 million U.S. adults

• 5–10% per year progress to T2DM if untreated

• ↑ Risk of cardiovascular disease (CVD) and microvascular complications

• Early detection allows up to 58% reduction in T2DM progression with lifestyle changes.

Diagnosis of Pre-diabetes

Pre-diabetes is diagnosed when blood glucose or HbA1c levels are above normal but below diabetes thresholds. It signals impaired glucose regulation and carries a high risk of progression to Type 2 Diabetes Mellitus (T2DM).

Key Points:

• Diagnosis is based on lab criteria: HbA1c, fasting plasma glucose (FPG), or oral glucose tolerance test (OGTT).

• Thresholds differ slightly between US (ADA) and UK/WHO guidelines.

• Diagnosis can be made with any one abnormal result, but repeat testing is advised if asymptomatic.

• Screening is recommended for at-risk individuals (e.g. age ≥45, BMI ≥25, FHx of diabetes, hypertension, PCOS).