Divergence in prediabetes guidelines – A global perspective

Abstract

The global landscape of prediabetes diagnostic guidelines varies significantly, reflecting diverse healthcare priorities, population characteristics, and resource availability. Major international organisations, including the World Health Organisation (WHO), European Association for the Study of Diabetes (EASD), Italian Society of Diabetes (SID), American Diabetes Association (ADA), International Diabetes Federation (IDF), Diabetes UK, and Chinese Diabetes Society (CDS), adopt differing criteria for defining and diagnosing prediabetes. These discrepancies arise from variations in diagnostic tests—oral glucose tolerance test (OGTT), fasting plasma glucose (FPG), and glycated haemoglobin (HbA1c)—as well as differences in prevalence estimates, screening policies, and healthcare infrastructure. Ethnic variability in glucose metabolism further complicates standardisation, as some diagnostic tools, such as HbA1c, perform differently across populations. Additionally, individuals diagnosed via different criteria exhibit distinct metabolic risks and may respond differently to interventions. This heterogeneity poses challenges for global research, policy-making, and equitable access to care. While complete international harmonisation may be impractical, emerging diagnostic approaches, such as the 1-hour plasma glucose (1-h PG) test, offer a promising step toward improving diagnostic consistency. A hybrid model integrating universal standards with population-specific adaptations may offer a more effective global strategy for prediabetes identification and prevention.