Goodbye “Prediabetes,” Hello Type 2 Diabetes Stages? Experts Propose New Classification System

April 3, 2026

A multidisciplinary group of international diabetes specialists is proposing a seismic shift in how we define metabolic health: retiring the term “prediabetes” in favor of a three-stage classification system for type 2 diabetes (T2D). This move, outlined in a recent commentary in The Lancet Diabetes & Endocrinology, could soon label millions of people as having an early stage of a chronic disease rather than an intermediate risk state. If adopted by major health organizations, the framework aims to lower the threshold for medical intervention, expand drug approvals into earlier stages of metabolic dysfunction, and reframe risk reduction as a core part of diabetes care rather than a separate “prevention” conversation.

The End of an “Intermediate” Era

For decades, the term “prediabetes” has served as a yellow light—a warning that blood sugar levels are high, but not yet high enough for a formal diabetes diagnosis. However, many experts argue this terminology suggests a safety net that doesn’t actually exist.

“What we really want to do is to make stage 1 and stage 2 [T2D] a disease, which means you can treat it,” explained Tadej Battelino, MD, head of the Department of Endocrinology at UHC-UMC Ljubljana and a lead advocate for the proposal. Speaking to Medscape Medical News, Dr. Battelino emphasized that the current binary system—where you either “have” diabetes or you don’t—fails to capture the physiological reality of the disease.

The effort is currently led by members of the Time in Range Coalition, a project of the diaTribe Foundation. An official international consensus statement is currently under development, with multiple professional societies expected to review the framework for potential adoption.

The Proposed Three-Stage Framework

The new schema envisions type 2 diabetes as a continuous spectrum of metabolic decline. Rather than waiting for blood sugar to cross a specific “magic number,” the system categorizes patients based on the progression of the underlying disease:

• Stage 1: Fasting plasma glucose is rising but remains within the “normal” range (below 100 mg/dL). While lab tests may not flag these individuals yet, they often exhibit subtle metabolic changes, such as early insulin resistance.

• Stage 2: Glucose values are above normal but below overt T2D thresholds. This includes:

  • Impaired Fasting Glucose (IFG)

  • Impaired Glucose Tolerance (IGT)

  • HbA1c levels of 5.7%–6.4%

  • Sub-stages 2a and 2b are proposed to distinguish between those whose glucose levels are stable (“slow progressors”) and those whose levels are climbing rapidly (“fast progressors”).

• Stage 3: Overt type 2 diabetes. Stage 3a would represent cases that can be managed with non-insulin therapies, such as metformin or GLP-1 receptor agonists (e.g., Ozempic or Wegovy).

Why the Reclassification Matters

The push to ditch “prediabetes” isn’t just about semantics; it’s about access to care and perceived urgency. Research published in the Journal of Metabolic Health indicates that individuals in the current “prediabetes” range already face significantly elevated risks for cardiovascular disease, chronic kidney disease, early-onset dementia, and certain cancers.

Currently, because prediabetes is not officially classified as a “disease” by many regulatory bodies like the U.S. Food and Drug Administration (FDA), pharmaceutical companies face hurdles in getting drugs approved specifically for this population. Furthermore, insurance reimbursement for specialist visits or advanced therapies is often limited until the patient crosses into overt Stage 3 diabetes.

By shifting to a staging model—similar to how medicine classifies cancer or heart failure—clinicians hope to shift the focus toward early intervention. This approach mirrors recent changes in hypertension guidelines, which discarded “prehypertension” in favor of “Stage 1 Hypertension” to encourage earlier blood pressure management.

Expert Pushback: Caution and Nuance

Despite the potential benefits, the proposal has met with significant skepticism from some corners of the medical community. Critics worry that labeling a massive portion of the population as “diabetic” could lead to over-medicalization and unnecessary anxiety.

Sue Kirkman, MD, a prominent member of the American Diabetes Association (ADA) professional community, urges caution. “In contrast to the stages of type 1 diabetes, where progression is virtually certain, many people with stage 1 or stage 2 type 2 diabetes may never actually progress to clinical T2D,” Kirkman told Medscape.

She and others argue that the new labels might:

• Drive Stigma: Labeling someone “diabetic” earlier in life may carry social or psychological weight.

• Increase Healthcare Costs: Widespread use of expensive medications for Stage 1 or 2 patients could strain healthcare budgets.

• Create Inequities: In low-resource settings, access to the continuous glucose monitoring (CGM) or specialist care required to accurately “stage” a patient is often unavailable.

What This Means for Your Health

While the medical community debates the terminology, the underlying health advice for the public remains consistent. Whether it is called “prediabetes” or “Stage 2 T2D,” the presence of elevated glucose is a call to action.

If this staging system is adopted, patients can expect:

1. Earlier Conversations About Medication: Doctors may be more likely to discuss metformin or GLP-1 therapies alongside lifestyle changes.

2. Increased Monitoring: More frequent HbA1c testing or the use of CGMs may become standard for those in high-risk groups (e.g., those with obesity, PCOS, or a history of gestational diabetes).

3. Proactive Lifestyle Shifts: Reframing the condition as an “early stage disease” may provide the psychological motivation needed for sustained lifestyle changes.

Data continues to show that dietary patterns—specifically Mediterranean-style or controlled carbohydrate approaches—and regular physical activity remain the most effective tools for reversing early metabolic dysfunction.

The Road Ahead

The staging system is currently in a consensus-building phase. Before it becomes the global standard, researchers must validate stage-specific outcomes and develop better tools to predict who will progress quickly versus those who will remain stable for decades.

For now, the American Diabetes Association and the World Health Organization (WHO) continue to use the term prediabetes. However, the conversation has officially shifted. The medical world is increasingly viewing blood sugar not as a “pass/fail” test, but as a sliding scale where every point matters for long-term health.

Reference Section

• Medscape Medical News: “Goodbye, Prediabetes, Hello, Type 2 Diabetes Stages?” (April 1, 2026).

Medical Disclaimer: This article is for informational purposes only and should not be considered medical advice. Always consult with qualified healthcare professionals before making any health-related decisions or changes to your treatment plan. The information presented here is based on current research and expert opinions, which may evolve as new evidence emerges.