Where is the way-out for prediabetes management?

The impact of prediabetes on cardiovascular health is a widely recognized fact. However, intervention worldwide at the community level has been challenging. Some experts believe the reason is that the term "pre-stage" is too mild, misleading the public and health authorities into underestimating the health risks to this population. To promote proactive intervention across society, there have been increasing recommendations in recent years to classify prediabetes as part of diabetes. Given the hundreds of millions of people with prediabetes, the multiplied medical burden caused by turning all of them into diabetes will be the biggest obstacle to this "renaming". How can we resolve the world-wide challenges? The new diabetes diagnostic criteria proposed by the International Diabetes Federation (IDF, one-hour blood glucose above 11.6 mmol/L) may offer us fresh ideas. It is worth considering designating the current World Health Organization (WHO) standard diabetes as diabetes (WHO) and those people with prediabetes who meet the IDF diagnostic criteria as diabetes (IDF). This approach will protect the legal health rights of the high-risk groups previously defined as prediabetes without excessively increasing the burden on the current medical payment system. Besides, great efforts should be made to educate the public to effectively improve the public's understanding of dangerous outcomes of prediabetes, and highly individualized interventions should be carried out based on the heterogeneity of the prediabetes population.