Prediabetes marks increased vascular risk
medwireNews: People who meet the criteria for prediabetes during the 3 years before a type 2 diabetes diagnosis have a higher burden of vascular disease than those who do not, research shows.
“While there are many unanswered questions regarding its detection, pre-diabetes has significant clinical implications for microvascular and macrovascular diseases and type 2 diabetes outcomes,” say Raffaele Palladino (Imperial College London, UK) and co-researchers.
“A major consideration is whether targeted preventive strategies that identify individuals with pre-diabetes for interventions would provide opportunities for vascular risk reduction, considering that major benefits are likely to occur from early diagnosis and treatment.”
The team’s study focused on 65,787 people with type 2 diabetes, identified in the UK Clinical Practice Research Datalink from 2004 to 2017, who had at least one glucose test during the 3 years before their diagnosis.
Of these, 66.7% met the threshold for prediabetes based on WHO/International Expert Committee criteria for fasting plasma glucose, glycated hemoglobin, oral glucose tolerance test, or a combination of these.
“[I]ndividuals with glycemic values within the normal range might include a subgroup of individuals with a more rapid progression to type 2 diabetes or could represent people with a similar glycemic trajectory leading to diabetes but with a diagnosis earlier in the natural history of the disease or most likely a combination of these mechanisms,” write the researchers in BMJ Open Diabetes Research & Care.
People with prediabetes were slightly but significantly older than those who had normoglycemia and were more likely to be male. At the time of diabetes diagnosis, they had higher average BMI and blood pressure, and they had significantly higher rates of both micro- and macrovascular disease.
Specifically, 42.4% of those with previously detected prediabetes had microvascular disease at the time of diabetes diagnosis, compared with 30.7% of those who previously had normal blood glucose levels. The corresponding rates were 25.2% versus 13.9% for retinopathy and 23.8% versus 20.7% for nephropathy.
And there was a similar pattern for macrovascular disease, which was present in 29.8% versus 26.9% of those with and without previous prediabetes. This difference was driven by acute coronary disease, with a corresponding 24.2% versus 21.0% having a history of this condition. Cerebrovascular disease and peripheral vascular disease, on the other hand, were slightly less common in people with previous prediabetes, at 6.5% versus 6.9% and 4.6% versus 4.7%, respectively.
All these differences remained statistically significant after accounting for confounders including age, gender, smoking status, socioeconomic status, blood pressure and cholesterol levels, and comorbidities.
The researchers stress that people with glucose testing recorded in the 3 years prior to diabetes diagnosis represented only 41.2% of all the people they identified with type 2 diabetes.
People who were not tested had a higher average glycated hemoglobin level at diagnosis than those who were, at 59.4 versus 47.0–50.4 mmol/mol (7.6 vs 6.5–6.8%), and they also had a higher rate of retinopathy than people who were tested but had normoglycemia, at 22.9% versus 13.9%.
This may reflect “late diagnosis of type 2 diabetes […] leading to delayed treatment,” say Palladino and team.
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