Posted Sep 20 , 2018 03:40 AM
Lifetime Prevalence and Prognosis of Prediabetes Without Progression to Diabetes
Echouffo-Tcheugui JB, et al. Diabetes Care 2018_online May 3rd
What were the findings (excerpted from the Abstract)?
Impaired fasting glucose, also termed prediabetes, is increasingly prevalent and is associated with adverse cardiovascular risk (see previous JJDI Journal Club Article posted Jun 11th). The cardiovascular risks attributed to prediabetes may be driven primarily by the conversion from prediabetes to overt diabetes. The authors of this article investigated the frequency of cardiovascular versus non-cardiovascular deaths in people who developed early- and late-onset prediabetes without ever progressing to diabetes using used data from the Framingham Heart Study collected on the Offspring Cohort participants aged 18–77 years at the time of initial fasting plasma glucose (FPG) assessment (1983–1987). The authors used a case-control design focusing on the cause-specific outcome of cardiovascular death to minimize the competing risk issues that would be encountered in time-to-event analyses. They defined diabetes as FPG >126 mg/dL or glucose-lowering medication use, and prediabetes as FPG 100-125 mg/dL. The authors defined the presence of prediabetes or diabetes as meeting the above criteria at >2 consecutive examinations, and early onset as meeting criteria at age <50 years. In their overall sample (including cases and controls), the lifetime prevalence of dysglycemia (prediabetes or diabetes) was 50%, of which the prevalence of individuals who developed prediabetes but never progressed to diabetes was 69%! In comparisons to controls, the risks of cardiovascular death and of CHD-related death increased across the spectrum of lifetime glycemic phenotypes.
Why is this important?
In this study, approximately half of the individuals presented with dysglycemia in their lifetime, of whom two thirds developed prediabetes but never diabetes. These individuals had lower cardiovascular-related mortality compared with those who later developed diabetes. But, compared with persons with normal glucose tolerance, prediabetes did increase CV risk, particularly early-onset prediabetes. Prediabetes does increase CV risk and modifiable CV risk factors should be treated aggressively in this population!
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