Preface

It is currently estimated that 57 million people (1 in 4 adults) in the Unites States have prediabetes, many of whom will develop diabetes in ensuing years unless significant modifications in lifestyle occur, including diet, weight loss, and exercise. Furthermore, a small but significant number may already be at risk for developing vascular disease. Hence, prediabetes constitutes a major international public health concern that threatens to increase dramatically given the growing prevalence of worldwide obesity. Prediabetes is also associatedwith considerable financial expenditure with higher rates of medical visits for hypertension, metabolic and renal complications, and general medical conditions. The national annual medical cost of prediabetes has been estimated to exceed $25 billion. Since it therefore impacts considerably an already burdened healthcare system, the recently passed Affordable Care Act is opportune, as it addresses the critical need for preventive approaches to this epidemic. A major factor contributing to the difficulty in ascertaining who has prediabetes pertains to the way it, as diabetes per se, has been defined. As discussed in greater detail in this issue, the diagnosis of prediabetes hasbeenpredicated on absolute criteria defined by blood glucose measurements, which is one of the reasons the American Diabetes Association adopted a range of HbA1c values as a basis for identifying those at risk for developing diabetes. However, as neither glucose nor HbA1c determinations may be sufficiently sensitive to diagnose early metabolic abnormalities precisely, the practitioner requires considerable judgment in assessing these subtle conditions. Thus, defining prediabetes categorically by relatively arbitrary threshold criteria may inadvertently lead to the failure to diagnose individuals with lower glucose levels who may still be at risk for progression to diabetes or cardiovascular disease. Rather than viewing the evolving disease process as a continuum, the traditional dichotomous approach to definingmetabolic entitiesmost likely addresses only a small segment of a much larger problem and hence underestimates the considerable prevalence of this condition. One potential approach for overcoming the uncertainty associated with absolute diagnostic criteria is the use of a “personalized profile,” which would