Prediabetes is associated with elevated risk of clinical outcomes even without progression to diabetes

IF 8.4 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Mary R. Rooney, Amelia S. Wallace, Justin B. Echouffo Tcheugui, Michael Fang, Jiaqi Hu, Pamela L. Lutsey, Morgan E. Grams, Josef Coresh, Elizabeth Selvin
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引用次数: 0

Abstract

Aims/hypothesis

Prediabetes (HbA1c 39–47 mmol/mol [5.7–6.4%] or fasting glucose 5.6–6.9 mmol/l) is associated with elevated risks of microvascular and macrovascular complications. It is unknown to what extent these risks in prediabetes remain after accounting for progression to diabetes.

Methods

In 10,310 participants from the Atherosclerosis Risk in Communities (ARIC) Study (aged 46–70 years, ~55% women, ~20% Black adults) without diabetes at baseline (1990–1992), we used Cox regression to characterise age- and sex-adjusted associations of prediabetes with ~30 year incidence of complications (composite and separately), including atherosclerotic CVD (ASCVD), heart failure, chronic kidney disease (CKD) and all-cause mortality before and after accounting for intervening incidence of diabetes, modelled as a time-varying variable. We calculated the excess risk of complications in prediabetes remaining after accounting for progression to diabetes.

Results

Of the 60% of adults with prediabetes at baseline, ~30% progressed to diabetes (median time to diabetes, 7 years). Over the maximum follow-up of ~30 years, there were 7069 events (1937 ASCVD, 2109 heart failure, 3288 CKD and 4785 deaths). Prediabetes was modestly associated with risk of any complication (HR 1.21 [95% CI 1.15, 1.27]) vs normoglycaemia. This association remained significant after accounting for progression to diabetes (HR 1.18 [95% CI 1.12, 1.24]) with 85% (95% CI 75, 94%) of the excess risk of any complication in prediabetes remaining. Results were similar for the individual complications.

Conclusions/interpretation

Progression to diabetes explained less than one-quarter of the risks of clinical outcomes associated with prediabetes. Prediabetes contributes to the risk of clinical outcomes even without progression to diabetes.

Graphical Abstract

即使没有发展为糖尿病,糖尿病前期也与临床结果风险升高有关
目的/假设糖尿病前期(HbA1c 39-47 mmol/mol [5.7-6.4%] 或空腹血糖 5.6-6.9 mmol/l)与微血管和大血管并发症风险升高有关。目前尚不清楚糖尿病前期患者在发展为糖尿病后,这些风险会在多大程度上继续存在。方法 在基线期(1990-1992 年)未患糖尿病的 10,310 名社区动脉粥样硬化风险(ARIC)研究参与者(年龄 46-70 岁,约 55% 为女性,约 20% 为黑人成年人)中,我们使用 Cox 回归分析了经年龄和性别调整的糖尿病前期与约 30 年并发症(综合并发症和单独并发症)发病率之间的关系、包括动脉粥样硬化性心血管疾病 (ASCVD)、心力衰竭、慢性肾病 (CKD) 和全因死亡率。结果 在基线糖尿病前期的 60% 成人中,约有 30% 发展为糖尿病(发展为糖尿病的中位时间为 7 年)。在最长约 30 年的随访期间,共发生了 7069 例糖尿病事件(1937 例 ASCVD、2109 例心力衰竭、3288 例慢性肾脏病和 4785 例死亡)。与正常血糖相比,糖尿病前期与任何并发症的风险略有关联(HR 1.21 [95% CI 1.15, 1.27])。如果考虑到糖尿病的进展(HR 1.18 [95% CI 1.12, 1.24]),这种相关性仍然很明显,糖尿病前期任何并发症的超额风险仍有 85% (95% CI 75, 94%)。结论/解释:在与糖尿病前期相关的临床结果风险中,进展为糖尿病的风险不到四分之一。即使没有发展为糖尿病,糖尿病前期也会增加临床结果的风险。
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来源期刊
Diabetologia
Diabetologia 医学-内分泌学与代谢
CiteScore
18.10
自引率
2.40%
发文量
193
审稿时长
1 months
期刊介绍: Diabetologia, the authoritative journal dedicated to diabetes research, holds high visibility through society membership, libraries, and social media. As the official journal of the European Association for the Study of Diabetes, it is ranked in the top quartile of the 2019 JCR Impact Factors in the Endocrinology & Metabolism category. The journal boasts dedicated and expert editorial teams committed to supporting authors throughout the peer review process.
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