Implications of Rising Prediabetes Prevalence

Given the burden of type 2 diabetes and its complications, much attention has been given to prevention, beginning with identifying at-risk individuals prior to diagnosis. This has led to the designation of “prediabetes,” which is an intermediate form of dysglycemia on a spectrum ranging from normal to overt diabetes. The American Diabetes Association defines prediabetes as a fasting glucose of 100 to <126 mg/dL (impaired fasting glucose [IFG]), a 2-h plasma glucose of 140 to <200 mg/dL after a 75-g oral glucose tolerance test (impaired glucose tolerance [IGT]), or HbA1c 5.7% (39 mmol/mol) to <6.5% (48 mmol/mol) (1). Fasting glucose ≥100 mg/dL portends an increased risk of diabetes (2,3), cardiovascular disease (CVD) in women (2), and mortality (4). HbA1c levels 5.5% (37 mmol/mol) to <6.5% (48 mmol/mol) are associated with an increased risk of diabetes and CVD compared with levels <5.5% (37 mmol/mol) even after adjustment for fasting glucose and key CVD risk factors (3). Because of these associated risks, surveillance of prediabetes allows better prediction of diabetes trends and of the resources that will be required to treat rising diabetes. In the current issue of Diabetes Care , Bullard et al. (5) review secular trends in U.S. prediabetes prevalence using National Health and Nutrition Examination Surveys (NHANES) data from 1999 to 2010. Prediabetes was defined as HbA1c 5.7% (39 mmol/mol) to <6.5% (48 mmol/mol) or fasting glucose 100 to < 126 mg/dL; oral glucose tolerance tests (OGTTs) were not used. Participants completed a household interview followed by physical examination at mobile centers. A total of 19,182 participants ages ≥12 years were included in …