Prediabetes has long occupied a gray zone in clinical care, frequently identified but often under-addressed. Traditionally viewed as a precursor to type 2 diabetes 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.
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.
In an interview with HCPLive, 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, cardiovascular disease, and chronic kidney 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.
References
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. Endocr Pract. 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. Diabetol Metab Syndr. doi:10.1186/s13098-024-01371-3
