Prediabetes (Non-diabetic Hyperglycaemia)
Non-diabetic hyperglycaemia, often called prediabetes, is glucose above the usual range but below the diagnostic threshold for diabetes; it identifies increased type 2 diabetes and cardiovascular risk and is an opportunity for intensive prevention.
Definition
Non-diabetic hyperglycaemia, commonly called prediabetes, is blood glucose above the usual range but below the diagnostic threshold for diabetes. In the NICE prevention pathway it is HbA1c 42 to 47 mmol/mol or fasting plasma glucose 5.5 to 6.9 mmol/L.
First principles
Insulin resistance is compensated, then begins to fail
Muscle, liver and adipose insulin resistance initially triggers compensatory insulin secretion. Non-diabetic hyperglycaemia appears as beta-cell compensation becomes less effective but before the diagnostic threshold for diabetes is reached. Progression is not inevitable: weight, activity, sleep, medicines and social factors can all change the trajectory.
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