Pre-diabetes presents in three main phenotypes—isolated impaired fasting glucose, isolated impaired glucose tolerance, and combined impaired fasting glucose plus impaired glucose tolerance—each with distinct pathophysiological profiles. Findings presented at EASD 2025 analyzed 3,190 adults from the National Health and Nutrition Examination Survey 2011–2016 to investigate the relationship between body mass index and pre-diabetes phenotypes. 

Logistic regression and restricted cubic spline analyses revealed strong positive associations between overweight or obesity and isolated impaired fasting glucose and combined impaired fasting glucose plus impaired glucose tolerance. By contrast, isolated impaired glucose tolerance demonstrated a U-shaped pattern, with elevated odds in both underweight and obese participants. 

These results suggest that weight status influences pre-diabetes risk differently depending on phenotype. The findings emphasize the importance of targeted lifestyle and weight management interventions, aiming to reduce progression to type 2 diabetes and improve preventive strategies based on specific pre-diabetes patterns.