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Prediabetes: a new indication for GLP-1s?

International Journal of Obesity (2025)Cite this article

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Prediabetes is a condition defined by the American Diabetes Association (ADA) based on one of the following criteria: impaired fasting glucose (IFG) with fasting blood glucose (FBG) of 5.6–6.9 mmol/L (100–125 mg/dL), impaired glucose tolerance (IGT) with 2h-plasma glucose (PG) during a 75 g oral glucose tolerance test (OGTT) of 7.8–11.0 mmol/L (140–199 mg/dL), or HbA1c of 39–47 mmol/mol (5.7–6.4%). Other medical organizations have slightly different criteria for prediabetes but all agree prediabetes is prevalent worldwide [1].

In 2018, 34.5% of U.S adults had prediabetes [2] which confers a substantial risk of progression to overt type 2 diabetes (T2DM) [3]. Nearly 90% of those with prediabetes are unaware they have it [4]. The problem with this is that in those aged 45 years, the lifetime risk of progression from prediabetes to T2DM is 74.0% [4]. Better detection is certainly needed. But what can providers do when it is detected? The ADA recommendations to treat prediabetes include lifestyle and the medication metformin, although it is not approved by the Food and Drug Administration (FDA) for prediabetes [5]. Is this enough for a condition that is associated with an increased risk for all cause mortality and cardiovascular disease?

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  1. Brigham and Women’s Hospital, Boston, MA, USA

    Caroline M. Apovian

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  1. Caroline M. Apovian
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CMA is responsible for all aspects of this manuscript.

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Correspondence to Caroline M. Apovian.

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Competing interests

In the past 36 months, CMA has participated on advisory boards for AbbVie Inc., Altimmune, Inc., Arrowhead Pharmaceuticals, Inc., BioAge, Biolinq Incorporated, Caribou Biosciences, Inc., CinFina Pharma, Inc., Covidien LP, Cowen and Company, LLC, Currax Pharmaceuticals, LLC, EPG Communication Holdings Ltd., Form Health, Inc., Fractyl Health, Inc., Keros Therapeutics, Inc., Lilly USA, LLC, L-Nutra, Inc., Mediflix Inc., NeuroBo Pharmaceuticals, Inc., Neurocrine Biosciences, Inc., NodThera Limited, Novo Nordisk, Nutrisystem, OptumRx, Inc., Pain Script Corporation, Palatin Technologies, Inc., Pursuit By You, Redesign Health Inc., ReShape Lifesciences Inc., Riverview School, Roman Health Ventures Inc., Scholar Rock, Inc., Terns, Inc., Verily Life Sciences LLC, Veru Inc., Vida Health, Inc., Wave Life Sciences, WondrHealth, Xeno Biosciences and Zyversa Therapeutics, Inc. CMA has received research funding from PCORI and GI Dynamics, Inc.

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Apovian, C.M. Prediabetes: a new indication for GLP-1s?. Int J Obes (2025). https://doi.org/10.1038/s41366-025-01930-2

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