Perspectives on Diabetes Care

Framing a Message About Risk: Use and Perceptions of the Term "Prediabetes"

Jul 2, 2025, 10:53 AM

ADCES Research Committee Perspectives: Liseli Mulala, PhD, MPH, RPh, CDCES, reviews this article from the June 2025 issue of The Science of Diabetes Self-Management and Care journal. 

This is a very interesting article about healthcare providers use of the term pre-diabetes. As a pharmacist and diabetes educator I often use the term and use the American Diabetes Association(ADA) specified criteria  of A1c 5.7-6.4% or Fasting Plasma Glucose 100mg/dl(5.6mmol/l) to 125 mg/dl (6.9mmol/l) or 2h PG during 75-g OGTT 140mg/dl(7.8mmol/l to 199mg/dl(11.0mmol/l) to define when I use the term. According to the article of the 97 individuals in the healthcare field surveyed the ADA is mentioned as a reference as well as the World Health Organization (WHO) and National Institute of Health and Care Excellence (NICE). The ADA, WHO and NICE all have slightly different criteria for prediabetes which can confuse the issue.  

When I counsel, I ask my patients what they understand the term to mean when I discuss it with them. In addition, I share best practices recommendations to prevent progression to diabetes (150 minutes a week of exercise and reduce carbohydrates and increase non-starchy vegetable consumption). I also provide plain language handouts with specifics about these recommendations. In this article discussing the results of the survey showed that established criteria for definition are not used by all practitioners consistently. Those surveyed expressed a need for a consistent global criterion.  The fact is that the ADA, WHO, NICE and the International Diabetes Federation (IDF) all have slightly different measurements to define prediabetes or intermediate hyperglycemia as it is known some other parts of the world. The healthcare providers ranged in use of the term prediabetes from Almost never 20%, Sometimes 16%, Often 26% and Very Often 23%. Those who used the term sometimes, fairly often and very often were more likely to perceive that the term prediabetes was likely to encourage patients to change behaviors to prevent progression to diabetes. 

Those who believed the term is well defined are more likely to use the term fairly often. Those who believed prediabetes should have a globally established definition were more likely to use the term fairly often and very often.  I agree whole heartedly with the conclusion of the authors that discussions should be had in practices and institutions as to what the definition should be and which criteria to use. A definitive global diagnosis of prediabetes or intermediate hyperglycemia with concrete action steps could lead to more consistent use and be an effective tool in type 2 diabetes prevention here in the United States and around the world.