The global increase in FPG is likely tied to the increase in BMI. While exposure is increasing, age-standardised attributable mortaliy rate is not; a related pattern is that the prevalence of diabetes is increasing, but deaths from diabetes have been declining, likely because clinical management of the macrovascular complications of diabetes has improved in many (but not all) locations. Prevention trials show that with intensive resources devoted to weight loss and physical activity, reductions in FPG can be achieved; however, these interventions have not been implemented at a national scale and adherence in the long run is challenging. Systematic efforts to screen for high FPG implemented in some countries may increase awareness and action in more patients but can be resource-intensive. Clinical interventions to reduce FPG can be effective, although there are more recent debates on the appropriate targets for treatment in some cases. With FPG increasing in many settings, it is difficult to determine the population effect of treatment of blood sugar on population FPG. FPG remains one of the risk factors that is most likely influenced at the primary health-care level, emphasising the role of universal coverage for primary care in a multipronged response to this increasing problem.
