A new long-term study published in the journal ofDiabetes Carerevealed that early metabolic patterns in prediabetes can forecast the risk of developing severe complications decades later in individuals at risk of type 2 diabetes (T2D). The findings highlight that while many people with prediabetes remain metabolically stable, specific subgroups face sharply increased risks of vision, nerve, kidney, and heart problems. The research analyzed clinical data from 1,732 participants, tracking 12 health-related traits including blood sugar levels, insulin resistance, kidney function, blood pressure, and cholesterol. To make sense of these long-term patterns, the team applied tensor decomposition to uncover longitudinal trajectories, and Gaussian mixture modeling to classify patients into clusters. Complication risks for each group were then compared using regression analyses. The study identified 4 clear clusters of prediabetes progression: The study points to a critical shift in how prediabetes should be viewed. Roughly two-thirds of individuals appear “metabolically resilient,” showing low long-term complication rates even if they progress to diabetes. However, the remaining third exhibit early metabolic signals that precede specific, severe complications. Overall, this research emphasized that preventive strategies must be tailored accordingly. For those with early kidney issues, the window to prevent cardiovascular disease may actually come before diabetes fully develops. Also, aggressive management of insulin resistance in high-risk individuals could stave off vision and nerve damage. Kobayashi, E., Linden-Santangeli, N. J., Chan, N., Toomey, C. B., Mudaliar, S., Temprosa, M., Edelstein, S., Goyal, R., Rangamani, P., Majithia, A. R., Diabetes Prevention Program Research Group, Bray, G. A., Gadde, K. M., Culbert, I. W., Arceneaux, J., Chatellier, A., Dragg, A., Champagne, C. M., Duncan, C., … Hivert, M.-F. (2025). Longitudinal metabolic trajectories in Diabetes Prevention Program participants reveal subgroups with varying micro- and macrovascular complication risks. Diabetes Care,. https://doi.org/10.2337/dc25-0866