Prediabetes: Epidemiology, diagnosis, and management

Table 2 Comparison of selected guideline recommendations for prediabetes screening and pharmacological prevention

Guideline	Screening recommendation	Prediabetes/high-risk criteria	Pharmacological prevention
ADA 2026	Screen from age 35; earlier with overweight/obesity plus risk factors	FPG 5.6-6.9 mmol/L; 2-hour OGTT 7.8-11.0 mmol/L; HbA1c 5.7%-6.4%	Consider metformin in selected high-risk adults (age 25-59, BMI ≥ 35 kg/m2, higher glycemia, or previous GDM)
USPSTF 2021[118]	Adults aged 35-70 years with overweight/obesity	Prediabetes by FPG, HbA1c, or OGTT	Offer/refer to effective preventive interventions; metformin may benefit selected high-risk groups
NICE PH38[119]	Risk assessment, then FPG or HbA1c in people at increased risk	FPG 5.5-6.9 mmol/L or HbA1c 6.0%-6.4%	Consider metformin if lifestyle intervention is ineffective or not feasible, especially BMI > 35 kg/m2

ADA: American Diabetes Association; USPSTF: United States Preventive Services Task Force; NICE: National Institute for Health and Care Excellence; FPG: Fasting plasma glucose; OGTT: Oral glucose tolerance test; HbA1c: Glycated hemoglobin; BMI: Body mass index; GDM: Gestational diabetes mellitus.