Prevention and Management of Prediabetes

Diagnosis and Referral

• Patients with impaired fasting glucose (IFG) of 5.6-6.9 mmol/L (100-125 mg/dL) should be referred to an intensive diet and physical activity behavioral counseling program targeting loss of 7% of body weight and increasing moderate-intensity physical activity to at least 150 minutes per week, as recommended by the American Diabetes Association 1, 2, 3
• To confirm the diagnosis, consider repeating the fasting glucose test and additional testing such as A1C or 2-hour plasma glucose during a 75g oral glucose tolerance test (OGTT) 2
• The diagnostic criteria for prediabetes include an A1C of 5.7-6.4%, Fasting Plasma Glucose (IFG) of 100-125 mg/dL, or 2-hour Plasma Glucose during 75-g OGTT (IGT) of 140-199 mg/dL, as recommended by the American Diabetes Association 2, 4

Lifestyle Modification

• The weight loss goal is 7-10% of body weight, particularly during the first 6 months, with a calorie reduction of 500-1,000 calories/day below maintenance requirements, as recommended by the American Diabetes Association 5
• At least 150 minutes per week of moderate-intensity physical activity, such as brisk walking, is recommended, along with any evidence-based eating pattern, including Mediterranean style, intermittent fasting, or low carbohydrate diets 1, 5
• Refer to a diabetes prevention program, which should be covered by third-party payers, as recommended by the American Diabetes Association 1, 5

Pharmacological Therapy

• Metformin should be considered in high-risk individuals with IFG who have a BMI > 35 kg/m², age < 60 years, or history of gestational diabetes in women, as recommended by the American Diabetes Association 1
• Metformin has the strongest evidence base and demonstrated long-term safety as pharmacological therapy for diabetes prevention, with a 58% reduction in diabetes development after 3 years, as shown in intensive lifestyle modification programs 1

Monitoring and Follow-up

• Monitor for progression to diabetes at least annually, and for cardiovascular disease risk factors, such as lipid abnormalities, hypertension, and smoking cessation, as recommended by the American Diabetes Association 1, 6
• Patients coded with R73.03 (Prediabetes) should receive at least annual monitoring for progression to diabetes, referral to intensive diet and physical activity behavioral counseling, and consideration of metformin therapy for high-risk individuals, as recommended by the American Diabetes Association 2, 1
• The primary code R73.03 (Prediabetes) should be used for patients with impaired fasting glucose, impaired glucose tolerance, borderline diabetes, or prediabetes, and diabetes codes (E08-E13) should not be used for prediabetic conditions, according to the American Diabetes Association 2
• For pregnant women with prediabetes, the primary diagnosis should be R73.03 (Prediabetes) and a secondary diagnosis of Z33.1 (Pregnant state, incidental) should be used, as recommended by the American College of Obstetricians and Gynecologists 7

2, 4