Without diagnosis and then intervention, pre-diabetes/IH will develop into type 2 diabetes at a rate of 5–10% per annum. However, this rate increases for those who already display risk factors for type 2 diabetes such as, increased age, being overweight or having higher glycaemic values close to those for type 2 diabetes [Bailey, 2023]. Better criteria are needed to identify high-risk individuals and to identify them early in the type 2 diabetes trajectory. Guidelines for pre-diabetes/IH or type 2 diabetes screening state that it should be considered in asymptomatic adults who are overweight or obese or who have one or more risk factors including a history of CVD, first degree relative with diabetes, or those diagnosed with hypertension/on therapy for hypertension [ADA, 2024]. Delayed diagnosis of IH also obviates the potential benefit of earlier intervention when ß-cell function is more intact (above the threshold levels for IGT and IFG) providing greater scope for therapeutic support [Bergman, 2023; Bergman and Dorcely 2023]. Therefore, more sensitive, reliable and accurate biomarkers measures are required to diagnose individuals with IH [Luís, 2022; Ortez-Martinez, 2022].The IDF Position Statement [Bergman, 2024], details the data linking higher glycaemic levels seen in individuals with pre-diabetes/IH with worsening metabolic and atherogenic profiles, as well as other comorbidities such as microvascular and macrovascular complications, and risks for obstructive sleep apnoea, cystic fibrosis-related diabetes, metabolic dysfunction-associated steatotic liver disease and premature mortality. Pre-diabetes/IH (and diabetes) are heterogenous, comorbid disorders with a large variation in manifestations, trajectories and outcomes [McGuire, 2016]. Therefore, identifying various different pre-diabetes phenotypes may allow for a more individualised approach to treatment and management and potentially improve the clinical patient outcomes [Wamil, 2023].