The Curbsiders Internal Medicine Podcast REBOOT: #481 Prediabetes and Diabetes Prevention with Dr. Scott Isaacs
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Mar 9, 2026 
Scott Isaacs MD, an endocrinologist and obesity medicine specialist at Emory and AACE president, walks through screening and spotting atypical prediabetes. He outlines which tests to use and pitfalls to watch for. He covers exam clues, lifestyle strategies, metformin and other meds, and how to combine therapies and follow patients over time.
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Prediabetes Is Widespread And Often Undiagnosed
- Prediabetes is extremely common and often clusters with metabolic syndrome features like high BP, obesity, and dyslipidemia.
- Scott Isaacs notes ~38% of US adults have prediabetes and many are undiagnosed, so screening matters.
Screen Widely According To Risk And Age
- Screen broadly: ADA recommends all adults ≥35 and younger adults with risk factors; USPSTF targets adults 35–70 with overweight/obesity.
- Risk factors include family history, high-risk ethnicity, hypertension, dyslipidemia, PCOS, gestational diabetes, and inactivity.
Order A1C And Fasting Glucose Together When Possible
- Use A1C or fasting plasma glucose to screen; consider doing both simultaneously to avoid repeat visits.
- A1C correlates best with incident diabetes, complications, and mortality, so it's a practical primary screen.