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Objective: To analyze the difference of expression of Wnt protein family member 5a (Wnt5a) in prediabetes and diabetes mellitus and its correlation with immune inflammation in patients with prediabetes. Methods: From November 2020 to Novem2021, 64 patients with prediabetes who treated in Zaozhuang Municipal Hospital were selected as group A，51 patients with diabetes were selected as group B, and 50 healthy people who underwent physical examination were selected as group C. The baseline data of 3 groups were collected, level of Wnt5a was determined, expression difference of Wnt5a in prediabetes and diabetes was analyzed, the related indicators of immune inflammation were determined, and the correlation between Wnt5a and immune inflammation in patients with prediabetes was analyzed. Predictive value of Wnt5a for prediabetes and diabetes was analyzed by ROC curve, and its cutoff values were determined for clinical disease prediction. Results: Compared with group B, Wnt5a level, immune inflammatory indexes Th1, Th17, Th22, IFN-γ, IL-17A and IL-22 levels in group A were decreased (P<0.05) . Logistic regression analysis showed that fasting blood glucose, Wnt5a, Th1, Th17, Th22, IFN-γ, IL-17A and IL-22 were independent risk factors for the occurrence of prediabetes (P<0.05) . Wnt5a was positively correlated with immune inflammation-related indicators Th1, Th17, Th22, IFN-γ, IL-17A and IL-22 in patients with prediabetes (P<0.05) . ROC curve showed that AUC values of Wnt5a in predicting prediabetes and diabetes were 0.921 and 0.897, respectively, and the AUC were all>0.7, which indicating that Wnt5a had a higher predictive value for prediabetes and diabetes (P<0.05) . Conclusion: There is a certain difference in expression of Wnt5a in prediabetes and diabetes. When level of 42.38 pg/ml≤Wnt5a<62.50 pg/ml, it is prediabetes, and when level of Wnt5a≥62.50 pg/ml, it indicates that the transition from prediabetes to diabetes has occurred, and believed that Wnt5a is related to immune inflammation in prediabetic patients, which may increase the degree of insulin resistance by amplifying local immune inflammation in prediabetic patients and eventually lead to the occurrence of diabetes. [ABSTRACT FROM AUTHOR]