ISSN 1662-4009 (online)

ESPE Yearbook of Paediatric Endocrinology (2022) 19 12.5 | DOI: 10.1530/ey.19.12.5


Trends in endocrinology and metabolism. 2022;33(1):4-7. doi: 10.1016/j.tem.2021.10.007

Brief Summary: In this perspective, the authors propose to remove the term prediabetes and shift the paradigm to include current glycemic thresholds for prediabetes as diabetes.

Comment: In 2001, a group of experts defined the term prediabetes to raise awareness of the increasing epidemic of individuals with obesity who had a slight elevation in blood glucose levels. Initially, there was opposition to this term, and it was considered “scaremongering”. Although the term was eventually accepted, its definition has changed over time, and there is no consensus regarding the criteria for identifying individuals at the highest risk of progressing to overt diabetes.

Currently, the definition of prediabetes comprises heterogeneous tests of impaired fasting glucose, impaired tolerance to oral glucose, and elevated HbA1c, for identifying individuals at high risk of developing diabetes within five years. Furthermore, the cutoffs of abnormal fasting glucose differ; for example, the World Health Organization (WHO) criterion is 110 to 125 mg/dl and the ADA is 100 to 125 mg/dl.

In this paper, the authors state that current thresholds for diagnosing diabetes are outdated and do not represent advances in disease understanding or the ability to impact its course. They argue that prediabetes is associated with micro- and macrovascular complications, and that lower diabetes diagnostic criteria should be established. This will enable clinicians to prescribe approved antidiabetic agents for more patients. Importantly, early treatment could improve health by mitigating serious complications.

Of note, the definition of T2DM has also changed over the years. In 1985, WHO defined diabetes by either a fasting plasma glucose concentration of ~140 mg/dl or a glucose concentration of ~200 mg/dl at 2 h after an oral glucose challenge. In 1997, new recommendations classified diabetes mellitus by a lower cutoff for fasting plasma glucose, of 126 mg/dl. According to the current paper, diabetes should be defined by a fasting glucose concentration above 100 mg/dl.

Expanding the definition of diabetes would have major financial consequences for companies that conduct lab tests, drug companies, device and app developers, clinics, physicians, hospitals, insurance companies and state-funded health provision. Currently, no drugs have been explicitly approved for prediabetes, meaning that we are limited to prescribing diabetes drugs or other medications ‘off-label’ to treat it. Nevertheless, drug companies are testing dozens of drugs aimed at prediabetes in the hope of tapping a potential worldwide market of hundreds of millions of people. On the other hand, others view that many individuals with prediabetes would be better off untreated (See 10.1126/science.aax2208).

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