Pre-Diabetes Associated With Increased All-Cause and Cardiovascular Mortality

MedicalResearch.com Interview with:
Yuli Huang and Yunzhao Hu
Department of Cardiology, the First People’s Hospital of Shunde,
Shunde District, Foshan, PR China.

Medical Research: What are the main findings of the study?

Response: “Prediabetes” is a general term that refers to an intermediate stage between normoglycaemia and overt type 2 diabetes mellitus (T2DM). It includes 2 groups of individuals, those with impaired glucose tolerance (IGT) and those with impaired fasting glucose (IFG). In 2003, the American Diabetes Association (ADA) redefined the fasting plasma glucose (FPG) concentration range for diagnosing IFG from 110 to 125 mg/dl to 100 to 125 mg/dl in order to better identify individuals at future type 2 diabetes mellitus risk. However, this change has been contentious and was not adopted by the World Health Organization (WHO) Expert Group or other international guidelines.

In this meta-analysis, we included data from 26 prospective cohort studies with for 280,185 participants and found that, after controlling for multiple cardiovascular risk factors, the presence of prediabetes at baseline, defined as defined as IFG of 110 to 125 mg/dL(IFG 110), IGT or combined IFG 110 and/or IGT, was associated with increased risk of all-cause and cardiovascular mortality. Specifically, IFG 110 was associated with 12% and 19% increase of all-cause and cardiovascular mortality, IGT was associated with 33% and 23% increase of all-cause and cardiovascular mortality, combination of IFG110 and/or IGT was associated with 21% and 21% increase of all-cause and cardiovascular mortality, respectively. Although IFG 100 was not associated with all-cause or cardiovascular mortality in the overall analysis, the risk was greater in young and middle age males according to subgroup analyses.

Medical Research: What was most surprising about the results?
Response:

1. Although IFG 100 was not associated with all-cause or cardiovascular mortality in the overall analysis, the risk was greater in young and middle age males according to subgroup analyses.

2.When we compared the risk of all-cause mortality between the different definitions of prediabetes, the risk was greater for IGT than for IFG 110. However, there were no significant differences in the risk of cardiovascular mortality.

Medical Research: What should clinicians and patients take away from your report?

Response:These findings have important clinical and public health implications.

  1. As the risks of all-cause and cardiovascular mortality were increased in people with prediabetes, clinicians should be aware that it is important to screening for prediabetes.
  2. Second, lifestyle intervention (weight control, stop smoking and healthy diet etc.) should be suggested earlier and recommended as the mainstay of treatment for prediabetes in the general population.
  3. Third, long-term, large-scale studies of high-risk individuals, especially those with IGT or combination of IGT and IFG, are urgently needed to explore the effects of drug-based interventions on all-cause and cardiovascular mortality in people with prediabetes.

 

Medical Research: What recommendations do you have for future research as a result of this study?
Response

  1. First, future researches are needed to explore the underlying distinct pathophysiology and aetiology associated with IGF and IFG and mortality.
  2. Second, prior studies showed that, although lifestyle changes and drug-based interventions were successful in delaying progression of prediabetes to overt type 2 diabetes mellitus, the risks of all-cause or cardiovascular mortality were not reduced, possibly because of the small sample size, inadequate follow-up duration, and the low cardiovascular risk of the participants in the individual studies. So long-term, large-scale studies are urgently needed to explore the effects of interventions (including lifestyle intervention and drug treatment) on the risk of mortality in people with prediabetes.

Citation:

Associations of prediabetes with all-cause and cardiovascular 
mortality: A meta-analysis Annals of Medicine Posted online on September 18, 2014. (doi:10.3109/07853890.2014.955051)