The End of Prediabetes? Understanding the Proposed Stages of Type 2 Diabetes
For decades, the term prediabetes has been used to describe blood glucose levels that are elevated above normal, but not yet high enough to meet the criteria for type 2 diabetes. However, a growing group of international diabetes experts is now questioning whether the term itself may contribute to clinical inertia and delayed treatment.
In a recent commentary published in The Lancet Diabetes & Endocrinology, diabetes researchers proposed replacing the term prediabetes with a formal three-stage classification system. The goal is to better reflect the progressive nature of diabetes and encourage earlier intervention to reduce long-term complications.
So what could this mean for patients, clinicians, and the future of diabetes care?
When “Prediabetes” Delays Action
The concern is that the word prediabetes may unintentionally minimize risk. To many patients and clinicians, the term can sound more like a warning sign than an active disease process.
I know I’ve seen this firsthand in my own practice. Often, I feel like I’m breaking the news to someone who, based on their clinical trajectory and risk profile, should have already been made aware of both their diagnosis and the likelihood of disease progression.
Blood Glucose and Risk Exist on a Continuum
Research has consistently shown that both impaired fasting glucose and glucose tolerance are associated with increased risk for:
- Cardiovascular disease
- Chronic kidney disease
- Early-onset dementia
- Certain cancers, including colorectal, breast, and pancreatic cancer
Blood glucose also appears to have a continuous relationship with adverse health outcomes. In other words, risk increases progressively as glucose rises, even before someone meets the current diagnostic threshold for type 2 diabetes.
The Proposed Three-Stage Classification for Type 2 Diabetes
The proposed framework would classify type 2 diabetes into stages rather than separating “prediabetes” from diabetes altogether.
Stage 1 Type 2 Diabetes
A gradual increase in fasting plasma glucose that still remains within the currently defined normal range (ie. <100 mg/dL).
Stage 2 Type 2 Diabetes
Glucose levels above normal but below the current threshold for type 2 diabetes. This stage would include:
- Impaired fasting glucose (IFG)
- Impaired glucose tolerance (IGT)
- A1C of 5.7% to 6.4%
Experts also propose subdividing this category into:
- Stage 2a: slower progression
- Stage 2b: faster progression
Stage 3 Type 2 Diabetes
Overt type 2 diabetes, including individuals who may initially be managed without insulin therapy.
Why Diabetes Staging Could Change Treatment Pathways
One of the major implications of staging type 2 diabetes is regulatory recognition.
Currently, there is no FDA or European Medicines Agency approval pathway specifically for treating prediabetes. Although medications such as metformin, pioglitazone, and GLP-1 receptor agonists have demonstrated benefits in delaying progression to type 2 diabetes and reducing cardiovascular risk, none are formally approved for prediabetes management.
A staging model that redefines early dysglycemia as part of the disease continuum could:
- Encourage earlier intervention
- Reduce long-term complications
- Improve insurance reimbursement for treatment, including DSMES and medical nutrition therapy (MNT)
- Shift the focus toward prevention and earlier risk reduction rather than waiting for overt disease progression
Not All Experts Agree on the Change
Some experts caution that changing terminology may create confusion for clinicians and patients.
Former American Diabetes Association leader M. Sue Kirkman, MD, noted that while the concept is scientifically interesting, the public already broadly understands the term prediabetes. She questioned whether telling someone they have “stage 2 type 2 diabetes” would motivate behavior change more effectively than current terminology.
Others also point out an important distinction from type 1 diabetes staging. Not everyone with elevated glucose levels will inevitably progress to overt type 2 diabetes.
A Shift Toward Earlier Action
Regardless of whether the terminology changes, this conversation reflects a broader shift already happening in diabetes care. We need to move toward earlier identification, earlier intervention, and more proactive risk reduction.
As our understanding of cardiometabolic disease continues to evolve, many experts believe we will increasingly view type 2 diabetes as a progressive continuum that deserves attention long before complications develop.
I also hope this shift encourages both patients and clinicians to view care from Diabetes Care and Education Specialists as a proactive investment in long-term health and well-being, rather than something reserved only for later-stage disease management.
- Goodbye, prediabetes, hello, type 2 diabetes stages? Medscape. Accessed May 26, 2026. https://www.medscape.com/viewarticle/goodbye-prediabetes-hello-type-2-diabetes-stages-2026a1000a0r
- Shah V, Battelino T, Bergenstal R et al. Staging prediabetes and type 2 diabetes: the time to start is now. Lancet Diabetes Endocrinol. 2026;14(1):8-10.
- Levitzky YS, Pencina MJ, D’Agostino RB, et al. Impact of impaired fasting glucose on cardiovascular disease. Journal of the American College of Cardiology. 2008;51(3):264-270. doi:10.1016/j.jacc.2007.09.038
- Tabák AG, Herder C, Rathmann W, Brunner EJ, Kivimäki M. Prediabetes: a high-risk state for diabetes development. Lancet. 2012;379(9833):2279-2290.
- Ackermann RT, Dorans KS, Formagini T, O’Brien MJ. Prevention of type 2 diabetes in adults. In: Lawrence JM, Casagrande SS, Herman WH, Wexler DJ, Cefalu WT, eds. Diabetes in America. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); 2023. Accessed May 26, 2026. http://www.ncbi.nlm.nih.gov/books/NBK619261/
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Let me help you develop patient-centered diabetes care and education that integrates seamlessly into clinical care. Book a discovery call to explore how we might work together.
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