Prediabetes Diagnosed by A1c Tied With Excess Risks
Prediabetes measured by FPG, 2-hour plasma glucose not linked to increased risk of major event.
(HealthDay News) -- Prediabetes defined by hemoglobin A1c (HbA1c) is associated with worse prognosis than definition by fasting plasma glucose (FPG) or 2-hour plasma glucose (2hPG), according to a study published online in Diabetes Care.
Dorte Vistisen, PhD, from Steno Diabetes Center Copenhagen in Denmark, and colleagues followed 5427 participants aged 50 to 79 years without diabetes for a median of 11.5 years to examine the incidence rates of a major event (nonfatal/fatal cardiovascular disease or all-cause mortality) for different definitions of prediabetes. Of the cohort, 11.6% had prediabetes by the World Health Organization (WHO)/International Expert Committee (IEC) criteria and 36.8% had prediabetes by the American Diabetes Association (ADA) criteria. In a subset of 4730 individuals with additional measures of 2hPG, 14.0% had prediabetes.
The researchers found that the incidence rate in the context of prediabetes vs normoglycemia was 54 and 37% higher with the WHO/IEC and ADA definitions, respectively, and decreased to 17 and 12% after adjustment for confounders. Prediabetes by HbA1c correlated with a doubling in the incidence rate by the IEC and ADA criteria. Excess risk was reduced to 13 and 17%, respectively, upon adjustment. In the adjusted analysis, prediabetes by FPG or 2hPG was not linked to excess risk.
"The excess risk among individuals with prediabetes is mainly explained by the clustering of other cardiometabolic risk factors associated with hyperglycemia," the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.
Vistisen D, Witte DR, Brunner EJ, Kivimäki M, Tabák A, Jørgensen ME, Færch K. Risk of Cardiovascular Disease and Death in Individuals With Prediabetes Defined by Different Criteria: The Whitehall II Study. Diab Care 2018 Feb;dc172530. DOI:10.2337/dc17-2530