People with impaired glucose tolerance (IGT) also have an increased risk of mortality, as well as a high risk of developing type 2 diabetes. In this follow-up analysis of 542 people in China who had taken part in a six-year lifestyle diabetes prevention trial, researchers looked at whether the excess mortality risk was due to an impaired glucose state or if it was the result of subsequent progression to type 2 diabetes. Analysis of 23 years of follow-up data indicates that much of the increased mortality risk could be explained by the development of type 2 diabetes, providing further support for the need for intervention and treatment at the prediabetes stage. http://dx.doi.org/10.2337/dc16-0429