Pre-Diabetes
NICE Public health guideline [PH38] Type 2 diabetes: prevention in people at high risk. Last updated: Sep 2017.
Important disclaimer on terminology:
NICE guideline uses the formal clinical term ‘high-risk of type 2 diabetes‘ to describe the clinical state commonly referred to as ‘pre-diabetes’
The 2026 UKMLA content map uses the term ‘pre-diabetes’, therefore this article would be using the term ‘pre-diabetes’, which corresponds to ‘high-risk of type 2 diabetes’ used in PH38.
Definition
Pre-diabetes is formally defined by:
- Fasting plasma glucose of 5.5-6.9 mmol/L, OR
- HbA1c of 42-47 mmol/mol (6.0-6.4 %)
The guideline also recognises that impaired glucose regulation as “risk factor for future diabetes” – i.e. pre-diabetes. This clinical umbrella term includes:
- Impaired fasting glucose: fasting plasma glucose 6.1-6.9 mmol/L
- Impaired glucose tolerance: 2-our post OGTT 7.8-11.1 mmol/L
For reference, the following cut-offs are used to diagnose diabetes mellitus:
| Fasting plasma glucose | ≥7.0 mmol/L |
| Random plasma glucose | ≥11.1 mmol/L |
| 2-hour post-oral glucose tolerance test | |
| HbA1c | ≥48 mmol/mol (6.5%) – can only be used to diagnose type II diabetes but not type I |
Management
The following management is to prevent or delay the onset of type II diabetes.
| Category | Recommended management |
|---|---|
| Structured programme | Refer to a quality-assured structured intensive lifestyle-change programme |
| Lifestyle |
|
| Pharmacological management | Metformin should be offered based on clinical judgement:
Orlistat should be considered if:
|
| Monitoring and review | At least once yearly follow-up to perform:
|