Posted Jun 11 , 2018 03:19 AM

Cardiovascular and renal burdens of prediabetes in the USA: Analysis of data from serial cross-sectional surveys, 1988-2014

Ali MK, et al. Lancet Diabetes and Endocrinology 2018;6:392-403

What were the findings (excerpted from the Abstract)?

The authors analyzed cross-sectional survey data from non-pregnant adults aged 20 years and older from the NHANES survey periods 1988-94, 1999-2004, 2005-10, and 2011-2014. They defined diagnosed diabetes as patients’ self-report that they had been previously diagnosed by a physician or health professional; among those with no self-reported diabetes, prediabetes was defined as a fasting plasma glucose (FPG) concentration of 100-125 mg/dL or an A1C of 5.7-6.4%, undiagnosed diabetes as a FPG of 126 or higher or an A1C of 6.5%, and normal glycemic status as a FPG of less than100 mg/dL and an A1C of less than 5.7%. For each group over time, they estimated the prevalence of hypertension and dyslipidemia; and among individuals with those conditions, they estimated the proportions who had been treated and who were achieving care goals. By glycemic group, they estimated those who were current, former, and never smokers; mean 10-year risk of cardiovascular disease (using estimators from the Framingham Heart Study, the United Kingdom Prospective Diabetes Study [UKPDS], and the ACC/AHA ASCVD guidelines); albuminuria (median and albumin-to-creatinine ratio ≥30 mg/g), estimated glomerular filtration rate (eGFR; mean and ≤60 ml/min per 1.73 m2.); and prevalence of myocardial infarction and stroke. For all estimates, they calculated predicted changes between 1988-94 and 2011-14 using logistic regression models adjusted for age, sex, and race or ethnic group. They obtained data for 27971 eligible individuals. In 2011-14, in the population of adults with prediabetes, 36·6% (95% CI 32·8-40·5) had hypertension, 51.2% had dyslipidemia, 24.3%, smoked; 7.7% had albuminuria; 4.6% had reduced eGFR; and 10-year cardiovascular event risk ranged from 5% to 7%. From 1988-94 to 2011-14, adults with prediabetes showed significant increases in hypertension (+9.7 percentage points); no change in dyslipidemia; decreases in smoking (-64 percentage points); increased use of treatment to lower blood pressure (+27.2 percentage points), and to reduce lipids (+33.6 percentage points); and increased goal achievements for blood pressure (+36.2 percentage points) and lipids (+31.8 percentage points). People with prediabetes also showed decreases in cardiovascular risk; ACC/AHA ASCVD -1.9 percentage points; UKPDS -2.7 percentage points; but no change in prevalence of albuminuria, reduced eGFR, myocardial infarction, or stroke. Prevalence and patterns were consistent across all prediabetes definitions examined. Compared with adults with prediabetes, adults with diagnosed diabetes showed much larger improvements in cardiovascular and renal risk treatments, apart from smoking, which did not decline.

Why is this important?

Over 25 years, cardiovascular and renal risks and disease have become highly prevalent in adults with prediabetes irrespective of the definitions used. Identification of people with prediabetes may increase the opportunities for cardiovascular and renal risk reduction. While the diagnosis of prediabetes has been increasing over time, the contribution of prediabetes co-morbidities has not been well appreciated. The data from this study suggests that we need to be more aggressive in not only identifying prediabetes but also looking for co-morbidities and treating them more aggressively. Do you currently treat people with pre-diabetes? Are you screening for hypertension and renal compromise? Will you now?

Read the Abstract: