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Lower cut-off for prediabetes may prevent cardiovascular disease, study finds

A lower cut-off point for defining prediabetes, allowing earlier lifestyle intervention in at-risk patients, may reduce risk of cardiovascular disease or death according to a recent meta-analysis.

The analysis, published in the BMJ, reported that prediabetes was associated with increased risk of both cardiovascular disease and all-cause mortality in patients with impaired fasting glucose levels.

Researchers, based at three Chinese universities, looked at 53 separate studies, totalling information from over 1.6m patients, and found that under both WHO guidelines, which define prediabetes as fasting plasma glucose of 6.1-6.9mmol/L, and American Diabetes Association (ADA) guidelines, with a lower cut off for prediabetes than the WHO of 5.6mmol/L, those with prediabetes had an increased risk of coronary heart disease, stroke and death from any cause.

Since patients are at risk with fasting glucose levels as low as 5.6mmol/L, this research suggests that adjusting the cut off point for prediabetes in the UK, where NICE guidelines define impaired fasting glucose at the WHO-recommended level of 6.1-6.9mmol/L, may allow earlier intervention that could prevent future cardiovascular events in those at risk.

‘Our findings strongly support the lower cut-off point for impaired fasting glucose proposed by the 2003 ADA guideline, and they have important public health implications. According to the 2003 ADA definition, the prevalence of prediabetes in adults was up to 36.2% in the US and 50.1% in China. Considering the high prevalence of prediabetes, successful intervention in these large populations could have major impacts on public health,’ the researchers said.

The team also cited lifestyle modification as the most effective intervention for prediabetes, saying ‘the results indicate that, on the basis of a “snapshot” measurement of blood glucose, prediabetes is associated with an increased risk of cardiovascular disease as well as all-cause mortality, and early lifestyle interventions should be implemented in these populations.’

With Public Health England warning that the rise of type 2 diabetes could be financially catastrophic for the NHS over the next few decades and GPs being urged to identify those at risk of type 2 diabetes under the National Diabetes Prevention Programme, a lower cut off for prediabetes could see more patients undergoing lifestyle interventions that will reduce their risk of cardiovascular events and full blown type 2 diabetes in the future.

Readers' comments (7)

  • Where does this end then? Pre-prediabetes? Pre-pre-prediabetes? Do we start advising lifestyle modification to everyone whose had more than a sugar free polo since 1974?

    Buy shares in big pharma. They are the only winners here.

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  • Our geriatrician brothers and sisters worry rightly about the effect of long term low grade hypoglycaemia on the elderly brain, and have been saying for years our DM targets are too tight. Course doing less is never a sexy answer.

    I wonder who is right?

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  • Excellent quotes from Tony Copperfield from last year;

    Putting pre- in front of a diagnosis just renders it meaningless. Pre-diabetes? Well, it’s a bit like pre-dead. Except you really will get dead one day.

    If you have pre-diabetes, it sounds like you are definitely going to go on to develop the real thing. Except that you probably aren’t. (At least not anytime soon).

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  • Vinci Ho

    (1) Still old school - there are always doubts about fasting glucose readings and even HbA1c as ways to diagnose prediabetes/Impaired glucose regulation/Borderline Diabetes(old terms including impaired fasting glycaemia,IFG and impaired glucose tolerance,IGT). That's the reason why you need glucose tolerance test in diagnosing gestational diabetes which is obviously time consuming and less practical in mass screening .
    (2) Problem is : are we too obsessed in chasing after glycaemic control after all . All guidelines now agreed that controlling other parameters particularly BP are much more important than chasing after HbA1c targets which matter differently to different age groups . That is why the latest NICE guidance on type 2 diabetes had to concede to tailoring according to individuals. That should be the same philosophy for prediabetes (or whatever terminology you like)
    (3)After all , we are talking really about metabolic syndrome X and obesity ,particularly 'truncal obesity' . The latter applies differently in certain ethnicities e.g. Asian origins where threshold of BMI defining obesity should be lower . Social , economic and political issues are all involved in how to tackle the problem properly . Unfortunately, the proper way is always clouded by different political agendas hiding inside the sleeves of our politicians and their technocrats.

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  • Cobblers

    Probable Cobblers!

    Cochrane UK Senior Fellow in General Practice, Richard Lehman, suggests that pre-diabetes is a form of disease-mongering.

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  • Vinci I agree for me decent bp control most important however we should also not be complacent and ignore poor glycaenic control

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  • Identifying and managing an increased cardiovascular risk, as suggested in the article, is very different to recommending tacking glycaemic control, which some comments above falsely allude to.

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