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In summary, patients with prediabetes have abnormal glucose regulation mediated by impaired insulin secretion and reduced insulin action, as well as an increased risk of progression to DM [18, 25, 26]. Many clinicians screen for diabetes and prediabetes using the combination of FPG and HbA1c. However, even when used together, the combined sensitivity for diagnosing DM and prediabetes is poor [41]. Therefore, omission of a 75‐g OGTT results in both misclassification and under‐diagnosis of DM and prediabetes. The following question then arises: are there clinical consequences to misclassifying diabetes as only prediabetes or prediabetes as normal glucose metabolism?

We conclude that the answer is yes. There is a clear association of increasing microvascular complications with rising glucose concentrations, and patients with prediabetes have an increased prevalence of retinopathy, nephropathy, and neuropathy compared to individuals with normal glucose metabolism [13, 14, 55, 57,59–61, 63,104–106]. There is also an increased prevalence of CVD, cardiovascular mortality, and all‐cause mortality in patients with prediabetes compared to those with normal glucose metabolism [66–68, 70].

Therefore, recognition and treatment of prediabetes is essential to minimize morbidity and mortality. Intensive lifestyle changes emphasizing weight loss and physical activity have been shown to prevent or delay progression to DM, potentially decrease microvascular complications, potentially reduce macrovascular complications, improve comorbidities, improve quality of life, reduce medical costs, and decrease mortality [1875–80]. In addition to lifestyle changes, numerous medications are also effective in preventing or delaying progression to DM including metformin, glipizide, liraglutide, insulin glargine, several thiazolidinediones, orlistat, acarbose, valsartan, and estrogen/progestin [18,82–85,87–92, 107].

The totality of available evidence suggests that prediabetes is not only a risk factor, it is in fact a disease. Perhaps the term “prediabetes” should be changed to “early diabetes” and managed as such clinically.