Choosing a pharmacological management strategy for people with type 2 diabetes is controversial because much of the evidence for therapeutic interventions relies on surrogate outcomes.1 Recently however, the way that pre-diabetes is identified has been challenged,2 possibly undermining an NHS England programme to reduce the health burden of the disease.3 At the heart of this lies a debate over the meaning and utility of terms such as non-diabetic hyperglycaemia and pre-diabetes, and unanswered questions over the place of drug treatment.4

Healthier you: the NHS Diabetes Prevention Programme was announced in 2015 with the aim of significantly reducing or delaying the …