Insulin resistance and pancreatic β-cell dysfunction are the key initiating physiological events for T2D, with complex pathways involving genetics and environmental factors. Prediabetes, however, is not normally recognised as a distinct disease entity, often being described as ‘borderline diabetes’. Fasting glucose levels, 2-hour post-challenge glucose testing, or HbA1c levels are used to assess prediabetes, but there are no agreed diagnostic blood levels.2,3

The AACE believes further scientific research might eventually lead to prediabetes being reclassified from a pre-disease to a true disease state. Having a distinct prediabetes diagnosis would help improve health outcomes by identifying people at greater risk, it says, as potentially 70% of people with prediabetes have a lifetime risk of moving into T2D.2

Prediabetes is also associated with CVD factors: a third of people with prediabetes have hypertension, half have dyslipidaemia (disturbances in fat metabolism affecting blood lipid concentrations), and around a quarter use tobacco. An estimated 6% have a 10-year cardiovascular event risk.2