Microvascular complications in prediabetes: a systematic review & meta-analysis

IF 6.1 3区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes research and clinical practice Pub Date : 2025-05-24 DOI:10.1016/j.diabres.2025.112261

Sama Thiab , Taim Akhal , Meriem Akeblersane , Heet Sheth , Stephen L. Atkin , Alexandra E. Butler

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引用次数: 0

Abstract

Aims

Prediabetes prevalence is increasing with a risk of developing microvascular complications. The American Diabetes Association (ADA) definition is a hemoglobin A1c(HbA1c) of 5.7 %–6.4 % (39–46 mmol/mol) versus the International Experts Committee (IEC) range of 6.0–6.4 % (42–46 mmol/mol). We aimed to determine whether a prediabetic HbA1c or fasting blood glucose (FBG) cut-off exists, above which individuals exhibit increased microvascular complications.

Methods

All prediabetes studies in Embase, MEDLINE, Scopus, Cochrane, CINAHL databases from 1990–May 2023 reporting retinopathy, nephropathy, and/or neuropathy included.

Results

21,215 studies identified, 35 analyzed. Prevalence and incidence of retinopathy was significantly higher by ADA versus IEC criteria (Weighted Mean Difference 2.37 [2.31,2.43] and 1.32 [1.25,1.40], respectively). Receiver Operator Curves for IEC criteria: sensitivity 65.3% specificity 88.0% for retinopathy, AUC 0.88; for ADA criteria at 5.9%: sensitivity 77.5%, specificity 78.4%, AUC 0.73. No studies reported nephropathy/neuropathy by IEC criteria; nephropathy prevalence 1.0%-15.0% for HbA1c and FBG criteria.

Conclusions

Prediabetes ADA criteria (HbA1c 5.7–6.4 %) identified significantly more retinopathy than IEC criteria (HbA1c 6.0–6.4 %), suggesting that ADA criteria are preferable for early retinopathy detection and clinical retinal screening may be considered at HbA1c ≥ 5.7 %. Insufficient studies on the prevalence of nephropathy and neuropathy in prediabetes were available.

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糖尿病前期微血管并发症：系统回顾和荟萃分析

目的：随着微血管并发症的发生，糖尿病患病率正在增加。美国糖尿病协会（ADA）的定义是血红蛋白A1c（HbA1c）为5.7% - 6.4% (39-46 mmol/mol)，而国际专家委员会（IEC）的范围为6.0 - 6.4% （42-46 mmol/mol）。我们的目的是确定是否存在糖尿病前期HbA1c或空腹血糖（FBG）临界值，高于临界值的个体微血管并发症增加。方法纳入Embase、MEDLINE、Scopus、Cochrane、CINAHL数据库中1990年至2023年5月期间报告视网膜病变、肾病和/或神经病变的所有糖尿病前期研究。结果确定了21215项研究，分析了35项。ADA标准视网膜病变的患病率和发病率明显高于IEC标准（加权平均差分别为2.37[2.31,2.43]和1.32[1.25,1.40]）。IEC标准的接受者操作曲线：视网膜病变的敏感性为65.3%，特异性为88.0%，AUC为0.88；ADA标准为5.9%：敏感性77.5%，特异性78.4%,AUC 0.73。没有研究报告符合IEC标准的肾病/神经病变；HbA1c和FBG标准肾病患病率为1.0%-15.0%。结论：与IEC标准（HbA1c 6.0 - 6.4%）相比，sprediabetes ADA标准（HbA1c 5.7 - 6.4%）识别出更多的视网膜病变，提示ADA标准更适用于早期视网膜病变的检测，HbA1c≥5.7%时可考虑进行临床视网膜筛查。关于糖尿病前期肾病和神经病变患病率的研究不足。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes research and clinical practice 医学-内分泌学与代谢

CiteScore

10.30

自引率

3.90%

发文量

862

审稿时长

32 days

期刊介绍： Diabetes Research and Clinical Practice is an international journal for health-care providers and clinically oriented researchers that publishes high-quality original research articles and expert reviews in diabetes and related areas. The role of the journal is to provide a venue for dissemination of knowledge and discussion of topics related to diabetes clinical research and patient care. Topics of focus include translational science, genetics, immunology, nutrition, psychosocial research, epidemiology, prevention, socio-economic research, complications, new treatments, technologies and therapy.