Identifying Prediabetes Could Prevent Renal Risk
Cardiovascular and renal risks have become highly prevalent among adults with prediabetes over the past 25 years, according to a recent study.
For their study, the researchers evaluated data from the National Health and Nutrition Examination Surveys (NHANES) on 27,971 non-pregnant adults aged 20 years and older. Data were obtained for 1988 to 1994, 1999 to 2004, 2005 to 2010, and 2011 to 2014.
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Patients were categorized as having diagnosed diabetes, undiagnosed diabetes, prediabetes, or normal glycemic status. Various definitions of prediabetes were used in the analyses:
- Fasting plasma glucose (FPG) 110 to 125 mg/dL or hemoglobin A1c (HbA1c) 5.7% to 6.4%
- FPG 110 to 125 mg/dL or HbA1c 6.0% to 6.4%
- FPG 100 to 125 mg/dL and HbA1c 5.7% to 6.4%)
The researchers estimated the prevalence of hypertension and dyslipidemia for each group over time. For patients with conditions, the researchers also estimated the proportions of patients who had been treated and were achieving care goals.
Various other factors, such as smoking status, albuminuria, estimated glomerular filtration rate (eGFR), and the prevalence of myocardial infarction (MI) and stroke were also taken into account.
Among adults with prediabetes, 2011-2014 data indicated that 36.6% had hypertension, 51.2% had dyslipidemia, 24.3% smoked, 7.7% had albuminuria, 4.6%. had reduced eGFR. In this population, the 10-year cardiovascular event risk was found to range from 5% to 7%
Results showed that, between the periods of 1988 to 1994 and 2011 to 2014, adults with prediabetes had significant increases in hypertension, no change in dyslipidemia, decreased smoking, increased use of treatment to lower high blood pressure and to reduce lipids, and increased goal achievements for blood pressure and lipids.
Adults with prediabetes were also found to have decreased cardiovascular risk, but no change in the prevalence of albuminuria, reduced eGFR, MI, or stroke.
The researchers noted that adults with diagnosed diabetes demonstrated significantly greater improvements in cardiovascular and renal risk treatments compared with adults with prediabetes. The only exception in this population was smoking, which did not decrease.
“Over 25 years, cardiovascular and renal risks and disease have become highly prevalent in adults with prediabetes, irrespective of the definitions used,” the researchers concluded. “Identification of people with prediabetes might increase the opportunity for cardiovascular and renal risk reduction.”
Ali MK, McKeever Bullard K, Saydah S, Imperatore G, Gregg EW. Cardiovascular and renal burdens of prediabetes in the USA: analysis of data from serial cross-sectional surveys, 1988–2014. Lancet Diabetes Endocrinol. 2018;6(5):392-403. https://doi.org/10.1016/S2213-8587(18)30027-5
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