Diagnostic criteria for prediabetes

Abstract

The diagnosis of prediabetes is an area of ​​considerable controversy in contemporary medicine due to discrepancies in diagnostic criteria, its predictive value, and its clinical and public health implications. One of the main sources of debate is the variability among international organizations (ADA, WHO, IDF). This difference significantly distorts the estimated prevalence of prediabetes, raising concerns about overdiagnosis.

Another controversy lies in the use of different diagnostic methods: fasting glucose, oral glucose tolerance test (OGTT), and glycated hemoglobin (HbA1c). These methods identify partially overlapping, but not equivalent, populations, meaning that the same individual can be classified differently depending on the test used. Furthermore, HbA1c has limitations in certain populations (e.g., anemia, kidney disease, or ethnic variations), which calls into question its accuracy in some contexts.

Similarly, the OGTT and the interpretation of single fasting glucose values ​​face difficulties and limitations. There is also debate about the clinical significance of prediabetes. Although it is associated with an increased risk of developing type 2 diabetes and cardiovascular disease, not all individuals progress to overt disease, and some even spontaneously revert to normoglycemia.

This raises questions about the medicalization of an intermediate condition and the potential for unnecessary anxiety or burden for patients. Finally, the usefulness of the diagnosis as an intervention tool is discussed. While lifestyle changes have proven effective, large-scale implementation is complex, and the use of preventive pharmacotherapy remains controversial. Taken together, these uncertainties reflect the need for more personalized and absolute risk-based approaches.