Prediabetes a Useful Indicator for Cardiovascular and Renal Risks

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Individuals diagnosed with diabetes were more likely to receive blood pressure-lowering and cholesterol-lowering therapy compared with individuals with prediabetes.
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 show significantly higher renal and cardiovascular disease risk, according to a study published in The Lancet Diabetes & Endocrinology.

This study analyzed data for 27,971 adults who were not pregnant and aged 20 years and older from 4 US National Health and Nutrition Examination Surveys conducted between 1988 and 2014. The conditions for normal glycemic status included a fasting plasma glucose (FPG) concentration below 100 mg/dL, and a prediabetes diagnosis included an FPG between 100 and 125 mg/dL. Undiagnosed diabetes included a FPG of at least 126 mg/dL.

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 3 different definitions of prediabetes, which did not alter the results significantly.

These results suggest that, “[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.”

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

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