Is a non-pregnant individual with a Fasting Blood Sugar (FBS) level of 111.72 mg/dL and a slightly elevated 1-hour glucose level during a 75g Oral Glucose Tolerance Test (OGTT) considered to have prediabetes?

Prediabetes Diagnosis with Fasting Glucose 111.72 mg/dL and Elevated 1-Hour OGTT

Yes, this individual has prediabetes based on the fasting blood sugar of 111.72 mg/dL, which falls within the diagnostic range of 100-125 mg/dL for impaired fasting glucose (IFG). 1, 2, 3

Diagnostic Criteria Applied

Your patient meets the diagnostic threshold for prediabetes through the fasting glucose value alone:

• Fasting plasma glucose (FPG) 100-125 mg/dL = Impaired Fasting Glucose (IFG) 1, 2, 3
• Your patient's FPG of 111.72 mg/dL clearly exceeds the 100 mg/dL threshold 1, 2
• The 1-hour glucose value during a 75g OGTT is not used for diagnostic purposes in non-pregnant adults 4

What Actually Matters for Diagnosis

The American Diabetes Association uses only three time points from the 75g OGTT for diagnostic purposes in non-pregnant adults 4:

• Fasting glucose: <100 mg/dL (normal), 100-125 mg/dL (prediabetes), ≥126 mg/dL (diabetes) 1, 2
• 2-hour glucose: <140 mg/dL (normal), 140-199 mg/dL (prediabetes/IGT), ≥200 mg/dL (diabetes) 1, 2, 4
• HbA1c: <5.7% (normal), 5.7-6.4% (prediabetes), ≥6.5% (diabetes) 1, 2

The 1-hour value you mentioned is not part of standard diagnostic criteria for non-pregnant adults 4. The 1-hour glucose is only relevant in pregnancy screening protocols 5.

Confirmatory Testing Requirement

You should confirm this diagnosis with a second abnormal test result before definitively labeling this patient with prediabetes 2, 4. This is critical because:

• Fasting glucose has significant day-to-day variability of 12-15% 1
• The same person could measure 99 mg/dL one day and 110 mg/dL the next without actual metabolic change 1
• Diagnosis requires two abnormal values in the absence of unequivocal hyperglycemia 2, 4

Options for confirmatory testing include repeating the fasting glucose, obtaining an HbA1c, or using the 2-hour OGTT value if it was measured 1, 2.

Critical Context About the "100 mg/dL Threshold"

The difference between 99 and 100 mg/dL is clinically arbitrary 1. Risk for progression to diabetes and cardiovascular disease increases continuously across the entire glucose spectrum, even within the "normal" range 1, 4, 6. In fact, fasting glucose levels in the high normal range (95-99 mg/dL) are independently associated with increased cardiovascular disease risk compared to levels <80 mg/dL 6.

Clinical Implications and Next Steps

This patient faces significant health risks:

• Approximately 10% annual progression rate to diabetes 3
• Increased cardiovascular event rates with excess absolute risk of 8.75 per 10,000 person-years during 6.6 years 3
• Increased mortality risk with excess absolute risk of 7.36 per 10,000 person-years 3

First-line therapy is intensive lifestyle modification, which decreases diabetes incidence by 6.2 cases per 100 person-years over 3 years 3. This consists of:

• Calorie restriction 3
• Physical activity ≥150 minutes per week 3
• Self-monitoring and motivational support 3

Metformin is the second-line option, decreasing diabetes risk by 3.2 cases per 100 person-years over 3 years 3. Metformin is most effective for patients younger than 60 years with BMI ≥35, fasting glucose ≥110 mg/dL, or HbA1c ≥6.0% 3.

Screening Follow-Up

Annual screening is recommended for anyone with prediabetes 1, 2. This can be performed with fasting glucose, HbA1c, or OGTT 1, 2.