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PubMed This is a summary of 18 peer-reviewed journal articles Updated
Endocrinology · Prediabetes

Protecting Your Heart and Organs: The Hidden Risks of Prediabetes

At a Glance

Prediabetes is linked to modestly higher risks of heart disease, stroke, and chronic kidney disease, and some people have early nerve or eye changes. Managing blood pressure, cholesterol, tobacco use, activity, and eating habits helps protect organs.

A common misconception about prediabetes is that it is a “waiting room” where no damage occurs until you cross the threshold into type 2 diabetes. However, research shows that the metabolic changes of prediabetes are observationally associated with increased risks to your blood vessels, heart, and kidneys well before a diabetes diagnosis is ever made [1][2].

Cardiovascular and Heart Health

Prediabetes is associated with a modest but measurable increase in the risk of heart-related issues. Compared to people with normal blood sugar, those with prediabetes have an approximately:

  • 15% higher risk of composite cardiovascular disease [1].
  • 16% higher risk of coronary heart disease [1].
  • 14% higher risk of stroke [1].

It is important to note that much of this risk is linked to other “partners” of prediabetes, such as high blood pressure, high cholesterol, and excess weight [3][4]. When these other factors are managed well, the independent risk from prediabetes itself becomes much smaller [3]. This highlights why treating your whole cardiovascular profile—not just your blood sugar—is the best way to protect your heart [5].

Early Effects on the Kidneys

Your kidneys are highly sensitive to changes in blood sugar. Prediabetes is linked to a roughly 21% higher risk of developing chronic kidney disease (CKD) over time [6].

In the prediabetes stage, these changes are often “silent” and might appear as:

  • Hyperfiltration: The kidneys initially work “too hard” to filter blood, which can eventually lead to stress on the kidneys [7].
  • Albuminuria: Small amounts of protein (albumin) leaking into the urine, which is one of the earliest signs of kidney stress [8][9].

Because of these risks, your clinician may consider a baseline kidney check depending on your individual risk factors like hypertension, using two tests: the eGFR (a blood test for filtration) and the ACR (a urine test for protein) [10][11].

Microvascular Signs: Nerves and Eyes

While major complications like blindness or amputation are rare in prediabetes, subtle “microvascular” changes can be detected in some people [12][13].

  • Neuropathy (Nerve Damage): Some studies have found that cardiac autonomic neuropathy (which affects involuntary functions like heart rate) may be present in about 9% of people with prediabetes [13]. Peripheral neuropathy (numbness or tingling in the feet) has also been observed more frequently in prediabetes than in those with normal sugar [14].
  • Retinopathy (Eye Damage): Small changes in the blood vessels at the back of the eye are found in approximately 7% to 8% of people with prediabetes [12][15].

What This Means for Your Care

Despite these findings, you usually do not need the full battery of annual specialist screenings (like dilated eye exams or podiatry visits) that people with confirmed diabetes require [16][5]. Universal screening for these complications isn’t standard for prediabetes unless you have specific symptoms or other high-risk factors [13][15].

Instead, the “standard of care” focuses on:

  1. Annual Glycemic Testing: Checking your HbA1c or fasting glucose once a year to monitor for progression [17].
  2. Cardiovascular Risk Assessment: Regularly monitoring blood pressure and lipids (cholesterol) [5][4].
  3. Symptom Awareness: Reporting any new tingling, vision changes, or foot pain to your doctor promptly [18]. (Seek urgent care for sudden vision loss, severe chest pain, or stroke symptoms.)

By treating prediabetes seriously now, you are not just preventing a future diagnosis—you are actively protecting your heart, kidneys, and nerves today.

Common questions in this guide

Does prediabetes raise my risk of heart disease or stroke?
Yes. Compared with normal blood sugar, prediabetes is associated with a modestly higher risk of cardiovascular disease, coronary heart disease, and stroke. Blood pressure, cholesterol, and excess weight often contribute substantially, so managing your full cardiovascular profile is important.
Should I have my kidney function checked if I have prediabetes?
A clinician may consider a baseline kidney check based on your overall risk, especially if you have high blood pressure or other concerns. The tests commonly used are eGFR, a blood test that estimates kidney filtration, and ACR, a urine test that detects albumin.
Do I need annual eye exams or foot checks for prediabetes?
People with prediabetes usually do not need the full annual specialist screening schedule recommended for established diabetes. A specialized eye or foot evaluation may be appropriate if you have symptoms or other high-risk factors, so discuss the timing with your clinician.
Can prediabetes cause nerve or eye changes before diabetes?
Some people with prediabetes have subtle changes such as peripheral neuropathy, which can cause tingling or numbness, or changes in the small blood vessels at the back of the eye. Severe complications such as blindness or amputation are rare at this stage, but new tingling, foot pain, or vision changes should be reported.
How often should prediabetes be monitored?
Annual HbA1c or fasting glucose testing is commonly used to monitor progression. Blood pressure and cholesterol should also be checked regularly, with the schedule tailored to your health history. Seek urgent care for sudden vision loss, severe chest pain, or stroke symptoms.

Questions to Ask Your Doctor

Curated prompts to bring to your next appointment.

  1. 1.Given that prediabetes carries a modest increase in heart risk, what is my calculated 10-year cardiovascular risk score?
  2. 2.Should we check my kidney function using both an eGFR blood test and a urine albumin-to-creatinine ratio (ACR) test?
  3. 3.How often should we monitor my blood pressure and cholesterol levels now that I have this diagnosis?
  4. 4.If I am experiencing tingling or numbness in my feet, should I have a more detailed neurological exam now rather than waiting for a diabetes diagnosis?
  5. 5.Are there specific signs of early kidney or eye issues I should watch for that would trigger more specialized screening?

Questions For You

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References

References (18)
  1. 1

    Association between prediabetes and risk of all cause mortality and cardiovascular disease: updated meta-analysis.

    Cai X, Zhang Y, Li M, et al.

    BMJ (Clinical research ed.) 2020; (370()):m2297 doi:10.1136/bmj.m2297.

    PMID: 32669282
  2. 2

    Prediabetes is associated with elevated risk of clinical outcomes even without progression to diabetes.

    Rooney MR, Wallace AS, Echouffo Tcheugui JB, et al.

    Diabetologia 2025; (68(2)):357-366 doi:10.1007/s00125-024-06315-0.

    PMID: 39531040
  3. 3

    Risk of Cardiovascular Disease and Death in Individuals With Prediabetes Defined by Different Criteria: The Whitehall II Study.

    Vistisen D, Witte DR, Brunner EJ, et al.

    Diabetes care 2018; (41(4)):899-906 doi:10.2337/dc17-2530.

    PMID: 29453200
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    Cardiovascular and renal burdens of prediabetes in the USA: analysis of data from serial cross-sectional surveys, 1988-2014.

    Ali MK, Bullard KM, Saydah S, et al.

    The lancet. Diabetes & endocrinology 2018; (6(5)):392-403 doi:10.1016/S2213-8587(18)30027-5.

    PMID: 29500121
  5. 5

    Management of dyslipidemia and atherosclerotic cardiovascular risk in prediabetes.

    Neves JS, Newman C, Bostrom JA, et al.

    Diabetes research and clinical practice 2022; (190()):109980 doi:10.1016/j.diabres.2022.109980.

    PMID: 35787415
  6. 6

    Prediabetes and the risk of incident chronic kidney disease in adults: A systematic review and meta-analysis.

    Fang S, Huang J, Chen Y

    Biomolecules & biomedicine 2026; (26(8)):1290-1305 doi:10.17305/bb.2026.13524.

    PMID: 41575827
  7. 7

    MAFLD and glomerular hyperfiltration in subjects with prediabetes, visceral obesity and "preserved" kidney function: A cross-sectional study.

    Parvanova A, Abbate M, Yañez AM, et al.

    Diabetes research and clinical practice 2023; (201()):110729 doi:10.1016/j.diabres.2023.110729.

    PMID: 37230296
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    Prediabetes and Risk of Glomerular Hyperfiltration and Albuminuria in the General Nondiabetic Population: A Prospective Cohort Study.

    Melsom T, Schei J, Stefansson VT, et al.

    American journal of kidney diseases : the official journal of the National Kidney Foundation 2016; (67(6)):841-50.

    PMID: 26744126
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    Modified cut-off value of the urine albumin-to-creatinine ratio is helpful for identifying patients at high risk for chronic kidney disease in prediabetes.

    Liu J, Yang L, Wu J, et al.

    Acta diabetologica 2025; doi:10.1007/s00592-025-02518-y.

    PMID: 40960628
  10. 10

    A primary care guide to the screening and pharmacologic management of chronic kidney disease in people living with type 2 diabetes.

    Wright EE, Cebrian A, Ngui D

    Primary care diabetes 2025; (19(5)):411-421 doi:10.1016/j.pcd.2025.05.005.

    PMID: 40903105
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    Baseline and 4-year associations between prediabetes and kidney impairment: Insights from the ILERVAS cohort.

    Izarra A, Bermúdez-López M, Valdivielso JM, et al.

    Diabetes, obesity & metabolism 2026; (28(5)):3777-3787 doi:10.1111/dom.70560.

    PMID: 41705635
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    The prevalence of retinopathy in prediabetes: A systematic review.

    Kirthi V, Nderitu P, Alam U, et al.

    Survey of ophthalmology 2022; (67(5)):1332-1345 doi:10.1016/j.survophthal.2022.04.002.

    PMID: 35430245
  13. 13

    The prevalence of cardiac autonomic neuropathy in prediabetes: a systematic review.

    Eleftheriadou A, Williams S, Nevitt S, et al.

    Diabetologia 2021; (64(2)):288-303 doi:10.1007/s00125-020-05316-z.

    PMID: 33164108
  14. 14

    Diabetes and obesity are the main metabolic drivers of peripheral neuropathy.

    Callaghan BC, Gao L, Li Y, et al.

    Annals of clinical and translational neurology 2018; (5(4)):397-405 doi:10.1002/acn3.531.

    PMID: 29687018
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    Prevalence of Retinopathy in Prediabetic Populations: A Systematic Review and Meta-Analysis.

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    Cureus 2023; (15(11)):e49602 doi:10.7759/cureus.49602.

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    Screening for Prediabetes and Type 2 Diabetes: US Preventive Services Task Force Recommendation Statement.

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    JAMA 2021; (326(8)):736-743 doi:10.1001/jama.2021.12531.

    PMID: 34427594
  17. 17

    A position statement on screening and management of prediabetes in adults in primary care in Australia.

    Bell K, Shaw JE, Maple-Brown L, et al.

    Diabetes research and clinical practice 2020; (164()):108188 doi:10.1016/j.diabres.2020.108188.

    PMID: 32360708
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    Neuropathy in prediabetes.

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    PMID: 37470302

This page is for informational purposes only and does not constitute medical advice. Discuss your heart, kidney, nerve, and eye screening needs with your healthcare professional.

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