Prediabetes, defined as elevated but not diabetic blood glucose levels, is a high-risk state for developing diabetes. The annual conversion rate from prediabetes to diabetes is 5%–10%, with a similar proportion reverting to normoglycaemia. The prevalence of prediabetes is increasing globally, projected to exceed 470 million by 2030. Prediabetes is characterized by insulin resistance and β-cell dysfunction, which can lead to early forms of nephropathy, chronic kidney disease, small fiber neuropathy, diabetic retinopathy, and increased risk of macrovascular disease. Multifactorial risk scores can optimize diabetes risk estimation using non-invasive parameters and blood-based metabolic traits. Lifestyle modification is the cornerstone of diabetes prevention in prediabetic individuals, with evidence of a 40%–70% relative risk reduction. Pharmacotherapy may also offer benefits, particularly with metformin. The long-term effects of lifestyle and drug interventions are promising, reducing diabetes risk and delaying its onset. However, cost-effectiveness and health benefits of different screening and treatment strategies require further evaluation.Prediabetes, defined as elevated but not diabetic blood glucose levels, is a high-risk state for developing diabetes. The annual conversion rate from prediabetes to diabetes is 5%–10%, with a similar proportion reverting to normoglycaemia. The prevalence of prediabetes is increasing globally, projected to exceed 470 million by 2030. Prediabetes is characterized by insulin resistance and β-cell dysfunction, which can lead to early forms of nephropathy, chronic kidney disease, small fiber neuropathy, diabetic retinopathy, and increased risk of macrovascular disease. Multifactorial risk scores can optimize diabetes risk estimation using non-invasive parameters and blood-based metabolic traits. Lifestyle modification is the cornerstone of diabetes prevention in prediabetic individuals, with evidence of a 40%–70% relative risk reduction. Pharmacotherapy may also offer benefits, particularly with metformin. The long-term effects of lifestyle and drug interventions are promising, reducing diabetes risk and delaying its onset. However, cost-effectiveness and health benefits of different screening and treatment strategies require further evaluation.