Managing pre-diabetes — a growing health concern

Published on 03 Jul 2017
Last Updated on 27 Jul 2021

This ACE Clinical Guidance (ACG) covers diagnosis and management of pre-diabetes, with a focus on lifestyle intervention (including diet and physical activity) and pharmacotherapy.  

First published in 2017, this ACG has been updated in 2021 to incorporate the latest evidence where relevant.

Download the ACG

Managing pre-diabetes - a growing health concern (Jul 2021) [PDF]

Dec 2023 update: practice tips in Table 4 for nitrofurantoin and fosfomycin for treatment of acute uncomplicated cystitis have been updated.

ACG recommendations

1. Pre-diabetes is asymptomatic but puts a person at high risk of developing type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD).

2. Early diagnosis, appropriate management and follow-up help to prevent or delay T2DM in persons with pre-diabetes.

3. Recommend lifestyle intervention to all persons with pre-diabetes.

4. Tailor lifestyle intervention to individual needs for sustained behavioural changes.

5. Consider metformin for persons with pre-diabetes when

   • glycaemic status does not improve despite lifestyle intervention OR

   • they are unable to adopt lifestyle intervention,

especially if the persons outlined in the two points above have a body mass index (BMI) of ≥ 23 kg/m2, are younger than 60 years of age, or are women with a history of gestational diabetes.

ACG references

Managing pre-diabetes - a growing health concern references (Jul 2021) [PDF]