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Prediabetes Diagnosis Linked to increased Risk for CVD, Renal Disease

Apr 28, 2018
 

New study shows patients with diabetes receiving more treatment thus reducing complications

There is controversy over the usefulness of prediabetes as a diagnostic label, rather than just calling it diabetes. Using data from US National Health and Nutrition Examination Surveys (NHANES) between 1988 and 2014, the researchers examined the cardiovascular and renal burdens in adults with prediabetes over time and compared patterns with other glycemic status groups.

 

To get the answer as to risk for CVD and renal disease in patients diagnosed with prediabetes, they analyzed cross-sectional survey data from non-pregnant adults age 20 years and older from the NHANES survey periods 1988-94, 1999-2004, 2005-10, and 2011-14. 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 (5·6-6·9 mmol/L) or an HbA1c of 5.7-6.4% (39-47 mmol/mol); undiagnosed diabetes as an FPG of 126 mg/dL (7.0 mmol/L) or higher or an Hb1c of 6.5% (48 mmol/mol) or higher; and normal glycemic status as an FPG of less than 100 mg/dL (5·6 mmol/L) and an HbA1c of less than 5.7% (39 mmol/mol).

For each group over time, they estimated the prevalence of hypertension and dyslipidemia; 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 1·73m2); 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.

Data was obtained for 27,971 eligible individuals. In 2011-14, in the population of adults with prediabetes, 36 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 (-6.4%); increased use of treatment to lower blood pressure (54.2%) and to reduce lipids (6.6% to 40.2%).and increased goal achievements for blood pressure (25.8% to 62%) and lipids (1.0% to 32.8%). 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.

This study in The Lancet Diabetes & Endocrinology showed that 7.7% of individuals with prediabetes had albuminuria, 51.2% had dyslipidemia, 4.6% showed reduced estimated glomerular filtration rate and 36.6% had hypertension, and the 10-year cardiovascular event risk was between 5% and 7%.

Of the individuals with prediabetes in the 2011 to 2014 group, 24.3% smoked, 36.6% had hypertension, 51.2% had dyslipidemia, 7.7% had albuminuria, and 4.6% showed reduced estimated glomerular filtration rate (eGFR). The 10-year cardiovascular event risk was between 5% and 7%. From the 1988 to 2011 surveys, individuals with prediabetes displayed increased hypertension (+9.7%), a lower rate of smoking (–6.4%), and an increased usage of remedies for high blood pressure (+27.2%) and lipids (+33.6%). These individuals also demonstrated reduced cardiovascular risk, with atherosclerotic cardiovascular disease risk score at –1.9% and the United Kingdom Prospective Diabetes Study diabetes-specific tool at -2.7%. There was no change in myocardial infarction, albuminuria, stroke, or eGFR. Individuals with diagnosed diabetes demonstrated greater improvements than those with prediabetes in all treatments for renal and cardiovascular risk except for smoking. Researchers repeated their analyses using three different definitions of prediabetes, which did not alter the results significantly.

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 might increase the opportunity for cardiovascular and renal risk reduction.

Practice Pearls:

  • This study analyzed data for 27,971 adults who were not pregnant and age 20 years and older from four US National Health and Nutrition Examination Surveys conducted between 1988 and 2014.
  • Individuals diagnosed with diabetes were more likely to receive blood pressure-lowering and cholesterol-lowering therapy compared with individuals with prediabetes.
  • Adults diagnosed with prediabetes showed significantly higher renal and cardiovascular disease risk.

Reference:

Ali MK, Bullard KM, Saydah S, Imperatore G, Gregg EW. Cardiovascular and renal burdens of prediabetes in the USA: analysis of data from serial cross-sectional surveys, 1988–2014[published online February 27, 2018]. Lancet Diabetes Endocrinol. doi: 10.1016/S2213-8587(18)30027-5