Scott Isaacs, MD, is an Adjunct Assistant Professor of Medicine at Emory University. He currently serves as Immediate Past President of the American Association of Clinical Endocrinology (AACE).

Scott Isaacs, MD

Prediabetes Isn’t “Watch and Wait”: New Prevention Strategies

Prediabetes has long occupied a gray zone in clinical care, frequently identified but often under-addressed. Traditionally viewed as a precursor to 

 warranting monitoring rather than immediate action, this approach is increasingly being challenged by a growing recognition of the broader cardiometabolic risks associated with early dysglycemia.

Prediabetes should be accurately classified, distinguishing insulin resistance from insulin deficiency, LADA, or secondary endocrine causes.

The “watch and wait” approach is outdated; prediabetes should prompt broader cardiometabolic risk evaluation, including liver, kidney, and cardiovascular health.

Lifestyle modification remains foundational, but incremental, realistic changes and use of pharmacotherapy may be necessary for effective prevention.

Prediabetes should be framed as a reversible condition to encourage patient engagement without causing unnecessary anxiety.

Though not indicated for prediabetes, GLP-1 receptor agonists and related therapies can significantly reduce progression to type 2 diabetes and address associated comorbidities.

Emerging perspectives suggest that prediabetes is not a uniform condition, but rather a heterogeneous state with diverse underlying mechanisms, requiring a more nuanced and proactive clinical strategy. At the American Association of Clinical Endocrinology (AACE) Annual Meeting 2026, Scott Isaacs, MD, an adjunct assistant professor of medicine at Emory University and Immediate Past President of AACE, spotlighted this topic in a session on advances in prediabetes and diabetes prevention.

, he emphasized the need for more precise diagnosis and risk stratification. Rather than treating all patients with prediabetes as a single group, he argued that clinicians should evaluate for underlying differences such as insulin resistance, insulin deficiency, or secondary causes including endocrinopathies.

“Prediabetes can sometimes be thought of as a ‘watch and wait’ diagnosis, but that is the wrong way to look at it, because pre diabetes should be a wake up call for cardiometabolic risk,” Isaacs explained.

Beyond glucose abnormalities, prediabetes may signal the presence of conditions such as 

metabolic dysfunction-associated steatotic liver disease

. As such, identification of prediabetes represents an opportunity for comprehensive risk assessment and early intervention aimed at preventing downstream complications.

Lifestyle modification remains the foundation of prevention strategies, but Isaacs acknowledged the real-world challenges of sustained behavioral change. He advocated for a pragmatic approach focused on incremental improvements, such as dietary substitutions, increased physical activity, and gradual adoption of healthier eating patterns.

At the same time, he noted that lifestyle interventions alone may not be sufficient for all patients. In such cases, pharmacologic therapies can play an important adjunctive role in reducing risk and supporting weight management.

Communication is another critical component of effective prediabetes care. Isaacs highlighted the importance of framing the diagnosis in a way that motivates patients without causing undue anxiety. Emphasizing that prediabetes is a reversible condition and that progression to diabetes is not inevitable can help foster engagement and encourage proactive behavior change.

The evolving therapeutic landscape is also reshaping how clinicians approach prevention. The emergence of GLP-1 receptor agonists and related agents has introduced new opportunities to intervene earlier in the disease continuum.

While not formally approved for prediabetes, these therapies have demonstrated substantial efficacy in reducing progression to diabetes and addressing associated comorbidities, including cardiovascular risk and liver disease. As a result, clinical guidelines are increasingly incorporating these agents into prevention-focused strategies.

Editors’ note: Isaacs reports no relevant disclosures.

Samson SL, Vellanki P, Blonde L, et al. American Association of Clinical Endocrinology Consensus Statement: Algorithm for Management of Adults With Type 2 Diabetes - 2026 Update. 

. 2026;32(4):473-518. doi:10.1016/j.eprac.2026.01.006

Salamah HM, Marey A, Abugdida M, et al. Efficacy and safety of glucagon-like peptide-1 receptor agonists on prediabetes: a systematic review and meta-analysis of randomized controlled trials. 

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Isaacs explains how prediabetes care is shifting toward early intervention, risk stratification, and prevention of cardiometabolic disease, not just progression to diabetes.

Scott Isaacs, MD

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