AKT · Endocrine/Diabetes & glucoselow yield

Prediabetes (impaired glucose regulation)

Intermediate hyperglycaemia (impaired fasting glucose / impaired glucose tolerance)

Overview

Intermediate hyperglycaemia below diabetic thresholds — HbA1c 42–47 mmol/mol (6.0–6.4%), impaired fasting glucose or impaired glucose tolerance. A high-risk state for progression to T2DM and CVD; the intervention is intensive lifestyle change ± metformin.

Recognise

Asymptomatic; identified on screening (HbA1c 42–47, IFG, or IGT on OGTT)
Risk factors: obesity, inactivity, family history, high-risk ethnicity, prior gestational diabetes, PCOS

Red flags

Progression to diabetic-range HbA1c → diagnose and manage as T2DM

Differentials & how to tell them apart

Type 2 diabetesHbA1c ≥48 / fasting ≥7 / 2-h ≥11.1

Stress hyperglycaemiatransient, during acute illness — recheck when well

Investigations

HbA1c 42–47 mmol/mol, or fasting glucose 6.1–6.9 (IFG), or 2-h OGTT 7.8–11.0 (IGT). Annual review.

Management

Intensive lifestyle change (± metformin if progressing)

1Refer to a diabetes-prevention programme; weight loss, diet and activity. Annual HbA1c.Gate: Consider metformin if blood glucose is rising despite lifestyle change, particularly in younger/higher-risk people
2Re-test annually; manage cardiovascular risk factors (BP, lipids).

Intensive lifestyle / NHS Diabetes Prevention Programme — first-line — diet, weight loss, activity

Metformin — consider if HbA1c rises despite lifestyle, esp. higher-risk

Key points

A modifiable warning state — lifestyle prevents ~half of progressions. PCOS and prior gestational diabetes are key flags.

Monitor & prognosis

Annual HbA1c; CV risk factors.

Reversible/preventable with lifestyle.

Source: NICE NG (prevention); CKS