Table 1.

Recommendations for treatment of patients with pre-diabetes by the American Diabetes Association, American Heart Association and American College of Endocrinology

	American Diabetes Association (21)	American Heart Association (4)*	American College of Endocrinology (22)
Lifestyle	Weight loss of 5–10% bodyweight and ∼30 min/daymoderate-intensity physical activity	Weight loss of 7–10% body weightwithin 6–12 months ≥ 30 min/day moderate-intensity exercise Reduced intake of saturated fat(< 7% of total calories),trans fat, and dietary cholesterol(< 200 mg/dl); totalfat 25–35% of total calories;reduced intake of simple sugars	30–60 min moderate-intensityphysical activity/day at least 5 times/week Low-fat diet with adequate fibre
Glucose	Metformin in patients with IFG and IGTand any risk factors for diabetes†		Addition of drug therapy(e.g. acarbose, metformin) in patientswith MetS, worsening glycaemia, CVD,NA fatty liver disease, history ofgestational diabetes or PCOS
Blood pressure		BP < 140/90 mmHg BP medication(s) as needed to achieve goal BP	BP < 130/80 mmHg ACEI or ARB as first-line agent
Lipids		Depending on risk, LDL-C < 130,< 100 or < 70 mg/dl; non-HDL-C < 160,< 130 or < 100 mg/dl Lipid-lowering drug therapy with possibleaddition of fibrate or nicotinic acid	LDL-C: < 100 mg/dl Non-HDL-C: < 130 mg/dl ApoB: < 90 mg/dl
Prothrombotic state		Depending on risk, consider low-dose aspirintherapy or clopidogrel whenaspirin is contraindicated	Aspirin in therapy unless patient isat increased risk of GI, intracranialor other haemorrhagic condition

ACEI, angiotensin converting-enzyme inhibitor; ApoB, apolipoprotein B; ARB, angiotensin receptor blocker; BP, blood pressure; GI, gastrointestinal; HDL-C, high-density lipoprotein cholesterol; IFG, impaired fasting glucose; IGT, impaired glucose tolerance; LDL-C, low-density lipoprotein cholesterol; MetS, metabolic syndrome; NA, non-alcoholic; PCOS, polycystic ovary syndrome.

^*American Heart Association guidelines pertain to patients with the metabolic syndrome, defined as any three of the following features: elevated waist circumference [≥ 102 cm (≥ 40 inches) in men or ≥ 88 cm (≥ 35 inches) in women], elevated triglycerides [≥ 150 mg/dl (1.7 mmol/l)] or drug treatment for elevated triglycerides, reduced HDL-C [< 40 mg/dl (< 1.03 mmol/l) in men or < 50 mg/dl (< 1.3 mmol/l)] in women or drug treatment for reduced HDL-C, elevated blood pressure (≥ 130/85 mmHg or antihypertensive drug treatment), elevated fasting glucose (≥ 100 mg/dl) or drug treatment for elevated glucose. †Risk factors for diabetes = age < 60 years, body mass index ≥ 35 kg/m², family history of diabetes in first-degree relatives, elevated triglycerides, reduced HDL-C, hypertension, glycosylated haemoglobin > 6.0%.