Objective To investigate the distribution and evolution rules of Chinese medicine syndromes in prediabetes. Methods A total of 360 patients with pre-diabetes were enrolled in this study. The clustering analysis was used to cluster their symptoms. According to the clustering results combined with expert opinions

the corresponding syndromes were determined. Seventy-seven patients were included in the study according to patients’ wishes.Seventy-seven patients were divided into exposed or non-exposed groups according to interventions

of which 39 were exposed and 38 were non-exposed. On the basis of lifestyle education

Jinqi Jiangtang Tablets（金 芪降糖片） and Jinqi Jiangtang Tablets mimetics（金芪降糖片模拟剂） were administered for 12 months

and 12 months follow-up visit after discontinuation. Pre-diabetic symptom information was collected before admission and at the 12 th and 24 th month of enrollment

and the changes of syndromes before and after the enrollment of the two groups were recorded.Results The results of cluster analysis showed that pre-diabetes syndromes included Yin deficiency and dryness-heat syndrome

Yin deficiency syndrome

Yang deficiency syndrome

blood stasis phlegm coagulation syndrome

dampness heat accumulation in the spleen syndrome

Qi and Yin deficiency syndrome

Qi deficiency syndrome

spleen deficiency and dampness obstruction syndrome

liver depression and spleen deficiency syndrome. At the 12 th month after admission

syndromes of 12 cases（30. 8%） in the exposure group were transformed and 21 cases（55. 3%） in the nonexposed group. There was a significant difference between the two groups（P < 0. 05）. At the 24 th month after admission

syndromes of 27 cases（69. 2%） in the exposure group were transformed

and 28 cases（73. 7%） in the nonexposed group. There was no significant difference between the two groups（P > 0. 05）. Conclusion The characteristics of root causes deficiency and manifestation excess in the pre-diabetic period are obvious. The root causes deficiency is mainly Qi deficiency and Yin deficiency

or accompanied with Yang deficiency. Manifestation excess is marked with dampness obstruction

or phlegm coagulation

or blood stasis. The natural evolution of syndromes has a tendency of heat transformation

and the intervention of Jinqi Jiangtang Tablets can slow this trend.