Can a Better Definition of "Prediabetes" Help to Identify the Long-Term Risks?

A team led by researchers at Johns Hopkins Bloomberg School of Public Health has found that a more accurate definition of "prediabetes" could be useful in identifying patients at risk of long-term complications from the disease.

The authors conducted a prospective cohort study of participants in the Atherosclerosis Risk in Communities (ARIC) study who did not have diagnosed diabetes. Overall, the investigators assessed fasting glucose and hemoglobin A1C levels of 10,844 adults between 1990 and 1992, following participants’ cases for up to 22 years to evaluate their likelihood of developing diabetes, kidney disease, and cardiovascular disease, or to die of all causes.
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In addition, the researchers evaluated fasting and 2-hour glucose levels of 7,194 adults who were tested between 1996 and 1998, following cases in this group for as long as 15 years.

Using an A1C-based definition, the authors found that those determined to be prediabetic were 50% more likely to develop kidney disease and were twice as likely to develop cardiovascular disease. These patients were also at 60% greater risk of dying from any cause compared with those with normal A1C levels, according to the authors, who noted that the link was not as definitive when using glucose tests to identify those with prediabetes.

Patients with prediabetes "are at very high risk of developing diabetes, and they are also at high risk for bad outcomes such as heart disease and kidney disease," said study coauthor Elizabeth Selvin, PhD, MPH, a professor of epidemiology and medicine at the Welch Center for Prevention, Epidemiology and Clinical Research and the Johns Hopkins Bloomberg School of Public Health.

"It is important for health care providers to identify people with prediabetes and intervene to prevent these complications. Even modest weight loss and other lifestyle changes can help prevent progression from prediabetes to diabetes," Dr Selvin said, adding that drug treatments might also be considered for some prediabetic patients.

"We need a clear definition of prediabetes, so we can know who to target for lifestyle and other types of interventions, possibly glucose-lowering drugs," she said, noting there is currently no national or international consensus on the optimal definition of prediabetes.

"If we don't have a clear definition of prediabetes, reimbursement and making health care treatment decisions can be highly problematic."

—Mark McGraw

Reference:

Warren B, Pankow JS, Matsushita K, et al. Comparative prognostic performance of definitions of prediabetes: a prospective cohort analysis of the Atherosclerosis Risk in Communities (ARIC) study [published online November 15, 2016]. Lancet Diabetes Endocrinol. 2016. doi: dx.doi.org/10.1016/S2213-8587(16)30321-7.