Fasting Glucose Best Predictor of Diabetes Risk

Ajay Gupta, M.D. of Imperial College London said at the European Society of Cardiology/World Congress of Cardiology that, each 1 mmol/l increase above 5 mmol/l was associated with a 5.8-fold increase in the risk of new onset-diabetes (95%CI 5.23-6.43).

The primary results of the 19,342-patient trial, which were reported last year, indicated that combination therapy with Norvasc (amlodipine) and Aceon (perindopril) was more effective than treatment with the beta-blocker atenolol with or without bendroflumethiazide.

At baseline, 14,120 of the ASCOT patients were not diabetic, but over 5.5 years of follow-up 1,366 patients developed diabetes.

Another significant predictor of new-onset diabetes was body mass index. Every five-unit increase in BMI over 35 kg/ m² increased risk of new onset diabetes by 49% (hazard ratio 1.49 [1.-38-1.62 P<0.001]).

Serum triglyceride and systolic blood pressure were also identified as risk factors.

Dr. Gupta also said, in contrast that high HDL, age older than 55, and moderate alcohol use significantly reduced the risk of new-onset diabetes.

Norvasc-based treatment cut the risk of new-onset diabetes by 34% compared with atenolol-based treatment (amlodipine ± perindopril in comparison with atenolol ± thiazide treatment): (HR 0.66 95%CI 0.59-0.74) (P<0.001), he said.

Using the identified risk factors, the investigators developed a composite risk score. For patients in the highest quartile, the risk of new-onset diabetes was 19-fold higher than those in the lowest quartile, Dr. Gupta said.

Jose Luis Zamorano Gomez, M.D., of the University of Madrid said the analysis by Dr. Gupta may provide the basis for accurately predicting new-onset diabetes risk in patients with hypertension, but he said the associations reported here need to be confirmed in other trials.

Practice Pearl:

• Explain to interested patients that hypertension is closely associated with diabetes and these findings suggest a number of risk factors that may increase the risk of new-onset diabetes in patients with hypertension and may be predictive in a risk score model.

European Society of Cardiology/World Congress of Cardiology, Gupta AK "Determinants of new onset diabetes among hypertensive patients randomized in the ASCOT-BPLA Trial"