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June 7, 2026Diabetes

People who met broader definitions of prediabetes had much lower diabetes incidence rates and greater estimated NNT to prevent a case of diabetes than did those who met DPP criteria.

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Why the study?

Do different definitions of prediabetes affect the estimated diabetes incidence and NNT for prevention interventions in US adults?

Population

US adults ≥25 years old from 2005-2016 NHANES data and three US longitudinal cohorts

Comparison

Different prediabetes definitions vs Normoglycemia

Design

Cohort

Authors

EAElsa Vazquez ArreolaRHRobert L. HansonWKWilliam Knowler

Discussion

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Overview

Extrapolating the benefits of diabetes prevention interventions from the DPP trial to the broader prediabetes population may be unwarranted due to lower baseline incidence rates and higher NNT.

Key Points

  • This analysis estimates the impact of various prediabetes definitions on diabetes incidence and prevention intervention outcomes.
  • Defined four groups using ADA criteria and NHANES data from 2005-2016.
  • Compared diabetes incidence rates and hazard ratios among groups in three longitudinal cohorts.
  • Calculated numbers needed to treat to prevent one diabetes case in three years by a hypothetical intervention.
  • Prediabetes group P had an estimated prevalence of 56.1% (~98.8 million), significantly higher than normoglycemia.
  • DPP criteria showed the highest hazard ratio and rate difference, indicating greater diabetes risk.
  • Broader definitions result in greater numbers needed to treat compared to DPP, questioning the extrapolation of DPP benefits.

Structured PICO

Do different definitions of prediabetes affect the estimated diabetes incidence and NNT for prevention interventions in US adults?

P
Population
US adults ≥25 years old from 2005-2016 NHANES data and three US longitudinal cohorts
I
Intervention
Different prediabetes definitions (ADA criteria, modified National DPP eligibility criteria, modified DPP trial inclusion criteria)
C
Comparator
Normoglycemia
O
Outcome
Diabetes incidence rate differences (RD) and hazard ratios (HR)hard clinical

Extrapolating the benefits of diabetes prevention interventions from the DPP trial to the broader prediabetes population may be unwarranted due to lower baseline incidence rates and higher NNT.

Cite This Study

Arreola et al. (2026) studied this question.

synapsesocial.com/papers/6a250c507def13d035e1c5b4https://doi.org/10.2337/db26-2221-p
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