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Shi DN, Jia F, Wang ZR, Wang Y, Xi YR, Wang X, Li WF. Prediabetes: Epidemiology, diagnosis, and management. World J Diabetes 2026; 17(11): 125494 [DOI: 10.4239/wjd.125494]
World J Diabetes. Nov 15, 2026; 17(11): 125494 Published online Nov 15, 2026. doi: 10.4239/wjd.125494
Prediabetes: Epidemiology, diagnosis, and management
Dan-Ni Shi, Fan Jia, Zhi-Ru Wang, Yi Wang, Yue-Ran Xi, Xuan Wang, Wei-Feng Li
Dan-Ni Shi, Fan Jia, Zhi-Ru Wang, Yi Wang, Yue-Ran Xi, Medical College, Jiangsu Medical College, Yancheng 224005, Jiangsu Province, China
Xuan Wang, College of Traditional Chinese Medicine, Jiangsu Medical College, Yancheng 224005, Jiangsu Province, China
Wei-Feng Li, Department of Pediatrics, Yancheng Traditional Chinese Medicine Hospital, Yancheng 224000, Jiangsu Province, China
Co-first authors: Dan-Ni Shi and Fan Jia.
Co-corresponding authors: Xuan Wang and Wei-Feng Li.
Author contributions: Shi DN and Jia F were responsible for the conception of the review, literature search, data interpretation, and drafting of the manuscript, they contributed equally to this article, they are the co-first authors of this manuscript; Wang ZR, Wang Y, and Xi YR contributed to literature collection, analysis, and manuscript revision; Wang X and Li WF contributed to the conception and design of the review, provided critical revisions, and supervised the overall preparation of the manuscript, they contributed equally to this article, they are the co-corresponding authors of this manuscript; and all authors have read and approved the final manuscript.
AI contribution statement: No artificial intelligence (AI) tools were used in the preparation, analysis, or writing of this manuscript. All aspects of the manuscript were performed by the authors.
Supported by the National Natural Science Foundation of China, No. 82405567 and No. 82505663; the Jiangsu Province Young Scientific and Technological Talents Promotion Plan, No. JSTJ-2025-890; and the Applied Basic Research Program of Yancheng, No. YCBK2025031.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Xuan Wang, MD, Associate Professor, College of Traditional Chinese Medicine, Jiangsu Medical College, No. 283 Jiefang South Road, Yancheng 224005, Jiangsu Province, China. wangxuan1669@163.com
Received: July 13, 2026 Revised: August 11, 2026 Accepted: September 20, 2026 Published online: November 15, 2026 Processing time: 117 Days and 4.2 Hours
Abstract
Prediabetes describes impaired glucose regulation below the diagnostic threshold for diabetes and represents an important stage for prevention. In 2024, an estimated 635 million adults worldwide had impaired glucose tolerance and 488 million had impaired fasting glucose, indicating a large at-risk population. Prediabetes increases the risk of type 2 diabetes and cardiometabolic complications, but this risk varies across individuals. Diagnosis is mainly based on fasting plasma glucose, the oral glucose tolerance test, and glycated hemoglobin, which assess different aspects of glucose metabolism and do not identify identical populations. This narrative review summarizes the definition, epidemiology, screening, diagnosis, and management of prediabetes. Lifestyle intervention, particularly dietary modification and regular physical activity, remains the main approach. Pharmacological treatment may be considered for selected high-risk individuals, including those with obesity, marked dysglycemia, or a history of gestational diabetes. Metabolic and bariatric surgery may reduce diabetes risk in patients with obesity who meet surgical indications, but it is not a general treatment for prediabetes. Better risk stratification, individualized intervention, and long-term follow-up are needed to improve diabetes prevention and cardiometabolic outcomes.
Core Tip: Prediabetes is a heterogeneous dysglycemic state with variable risk of progression to type 2 diabetes. Fasting plasma glucose, oral glucose tolerance testing, and glycated hemoglobin identify partly different populations, making risk stratification important. Lifestyle intervention remains the foundation of management, while pharmacological therapy and metabolic and bariatric surgery are appropriate only for selected high-risk individuals. This narrative review integrates diagnostic heterogeneity, glycemic phenotype, and intervention intensity to support more individualized diabetes prevention.
