In patients with diabetes, atherosclerosis is the main reason for impaired life expectancy, and diabetic nephropathy and retinopathy are the largest contributors to end-stage renal disease and blindness, respectively. Notably, a large number of people presents with vascular complications already at the time of diabetes diagnosis, suggesting that the natural history of vascular damage in diabetes starts very early in the course of the disease. Indeed, accumulating evidence shows that mechanisms leading to diabetic vascular complications starts since the prediabetes stage, which therefore may represent an ideal therapeutic window to implement precocious interventions to halt the burden of cardiometabolic disease worldwide. Prof. Pozzilli, a KOL in the field, will discuss the impact of prediabetes and related comorbidities on vascular complications of diabetes.