Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Mar 15, 2015; 6(2): 296-303
Published online Mar 15, 2015. doi: 10.4239/wjd.v6.i2.296
Prediabetes diagnosis and treatment: A review
Nidhi Bansal
Nidhi Bansal, Department of Pediatrics, Section of Pediatric Diabetes and Endocrinology, Baylor College of Medicine, Texas Children’s Hospital, Houston, TX 77030, United States
Author contributions: Bansal N solely contributed to this work.
Conflict-of-interest: Bansal N has no conflict-of-interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Nidhi Bansal, MD, MPH, Assistant Professor, Department of Pediatrics, Section of Pediatric Diabetes and Endocrinology, Baylor College of Medicine, Texas Children’s Hospital, 6701 Fannin St., Suite 1020, Houston, TX 77030, United States.
Telephone: +1-832-8244104 Fax: +1-832-8253903
Received: August 29, 2014
Peer-review started: August 30, 2014
First decision: September 30, 2014
Revised: October 10, 2014
Accepted: December 29, 2014
Article in press: December 31, 2014
Published online: March 15, 2015

Prediabetes is an intermediate state of hyperglycemia with glycemic parameters above normal but below the diabetes threshold. While, the diagnostic criteria of prediabetes are not uniform across various international professional organizations, it remains a state of high risk for developing diabetes with yearly conversion rate of 5%-10%. Observational evidence suggests as association between prediabetes and complications of diabetes such early nephropathy, small fiber neuropathy, early retinopathy and risk of macrovascular disease. Several studies have shown efficacy of lifestyle interventions with regards to diabetes prevention with a relative risk reduction of 40%-70% in adults with prediabetes. While there is increasing evidence to prove the efficacy of pharmacotherapy in prevention of diabetes in adults with prediabetes, pharmaceutical treatment options other than metformin are associated with adverse effects that limit their use for prediabetes. There are no reports of systematic evaluation of health outcomes related to prediabetes in children. The effects of pharmacotherapy of prediabetes on growth and pubertal development in children remains unknown. Secondary intervention with pharmacotherapy with metformin is advocated for high-risk individuals but criteria for such consideration benefit of early intervention, long term cost effectiveness of such interventions and the end point of therapy remain unclear. Pharmacotherapy must be used with caution in children with prediabetes. Prediabetes is a condition defined as having blood glucose levels above normal but below the defined threshold of diabetes. It is considered to be an at risk state, with high chances of developing diabetes. While, prediabetes is commonly an asymptomatic condition, there is always presence of prediabetes before the onset of diabetes. The elevation of blood sugar is a continuum and hence prediabetes can not be considered an entirely benign condition. This aim of this review is to describe the challenges associated with diagnosis of prediabetes, the possible adverse medical outcomes associated with prediabetes and the treatment options and rationale for their use in context of prediabetes.

Keywords: Impaired fasting glucose, Impaired glucose tolerance, Diabetes, Metformin, Lifestyle intervention, Prediabetes

Core tip: Prediabetes is a state of intermediate hyperglycemia. While there are several controversies about the diagnosis of prediabetes, it remains an at-risk state for development of diabetes. Several adverse health outcomes have been associated with prediabetes. This review provides a detailed description of the current literature regarding diagnosis, health consequences and treatment of prediabetes and also provides an insight for clinical management.