We appreciate the interest in our work that provided global estimates for prediabetes (1). Dr. Sathish (2) describes that there is limited research on the phenotype of isolated impaired fasting glucose and prior studies have not focused on developing lifestyle interventions specifically for this group. We agree that further research into the isolated fasting glucose phenotype would be helpful for the field. However, lifestyle interventions can have broad benefits across a range of populations (3), and we suspect that it may be similarly effective in persons with impaired fasting glucose compared with individuals meeting other definitions of prediabetes. Increasing physical activity, weight management, and dietary changes should be first-line therapy for all individuals with prediabetes.
Dr. Shinde (4) highlighted the implications of cut points for prediabetes on prevalence estimates. As highlighted in our article, there is currently no single agreed-upon definition of prediabetes and the use of five different definitions of prediabetes poses challenges for the field and clinical practice. Consensus definition(s) of prediabetes are needed.
Lastly, we thank Mohan et al. (5) for sharing their recent publication with nationally representative data for India on both impaired fasting glucose and impaired glucose tolerance (6). Few countries have original data on both prediabetes phenotypes (1). We look forward to including additional original data sources published since the 2021 IDF Diabetes Atlas, 10th edition (7). Mohan et al. highlight that impaired fasting glucose and impaired glucose tolerance classifications often do not capture the same individuals, as illustrated by the region of Southeast Asia having the highest prevalence of impaired fasting glucose and lowest prevalence of impaired glucose tolerance. This heterogeneity in prevalence has important implications for diabetes prevention planning efforts.
This collection of letters highlights that prediabetes is a heterogeneous phenotype and there are major gaps in our understanding of this condition. It remains to be seen whether prediabetes subtyping and risk stratification can better account for the heterogeneity in pathophysiology, reduce risk of progression to diabetes, and improve patient outcomes.
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Duality of Interest. E.S. is a deputy editor of Diabetes Care. No other potential conflicts of interest relevant to this article were reported.