Pre-diabetes/IH is a risk factor for major adverse cardiac and cerebrovascular events (MACCE) with mild-to-moderate blood glucose elevations triggering the same microvascular changes observed in type 2 diabetes [Mando, 2021; Hsu, 2023]. Compared with normoglycaemia, there is an increased risk of cardiovascular disease (CVD)  in individuals with pre-diabetes/IH [Duan, 2021; Cai, 2020] and macrovascular/microvascular disease complications [Echouffo-Tcheugui, 2021; Bergman, 2024]. Heart failure (HF) and pre-diabetes/IH may coexist in approximately 19% of HF patients, significantly impacting patient outcomes [Håkansson, 2022]. Furthermore, pre-diabetes/IH was positively associated with a risk of incidence of CV outcomes, coronary heart disease and HF [Schlesinger, 2022]. The incidence of kidney disease increases in pre-diabetic/IH patients [Kim, 2019; Gujral, 2021].  When phenotyping individuals with pre-diabetes/IH, a distinct phenotype emerged who was at moderate risk of progressing to type 2 diabetes but at an increased risk of kidney disease and all-cause mortality [Wagner, 2021].  Moreover, the 1-h PG test has also been strongly correlated with predicting the risk of either CVD or renal disease [Peng, 2024]. Pre-diabetes/IH offers an early therapeutic window to diagnose and initiate preventative treatments at an early, reversible stage and before the occurrence of significant renal damage especially as glomerular hyperfiltration can detect asymptomatic patients at risk of future nephropathy before albuminuria is detected [Shilpasree, 2021]. For pre-diabetic/IH individuals with CVD, lifestyle modification and pharmacotherapy are very similar to those for preventing pre-diabetes/IH progression to type 2 diabetes [Tabák, 2012; Echouffo-Tcheugui, 2023]. Metformin minimises the incidence of CVD and associated mortality but has not yet been approved by the US FDA for pre-diabetic/IH patients to prevent or delay the risk of diabetes [Dutta, 2023].