Takeaway
- Pre-diabetes and type 2 diabetes (T2D) were associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD), chronic kidney disease (CKD) and heart failure (HF).
- A substantial gradient of risk was also observed across glycated haemoglobin (HbA1c) levels below the threshold for diabetes.
Why this matters
- Findings emphasise the need to design specific cardiovascular and kidney risk reduction strategies across the glycaemic spectrum, including below thresholds used to define diabetes.
Study design
- This study included 336,709 participants from the UK Biobank without prevalent type 1 diabetes, ASCVD, CKD and HF.
- Primary outcomes: ASCVD (composite of coronary artery disease, ischaemic stroke and peripheral artery disease), CKD and HF.
- Funding: None.
Key results
- Of 336,709 participants, 277,081 (82.3%) had normoglycaemia, 46,911 (13.9%) had pre-diabetes and 12,717 (3.8%) had T2D.
- Over a median follow-up of 11.1 years, 6476 (13.8%) participants with pre-diabetes developed ≥1 incident outcome (ASCVD, CKD and HF).
- Of these, 1930 (29.8%) developed T2D during follow-up and 802 (12.4%) developed T2D prior to an incident diagnosis.
- Pre-diabetes was associated with an increased risk of (adjusted HR [aHR]; 95% CI):
- ASCVD (1.11; 1.08-1.15; P<.001);
- CKD (1.08; 1.02-1.14; P=.009); and
- HF (1.07; 1.01-1.14; P=.03).
- Similarly, T2D was associated with an increased risk of (aHR; 95% CI):
- ASCVD (1.44; 1.37-1.51);
- CKD (1.57; 1.46-1.69); and
- HF (1.25; 1.14-1.37; P<.001 for all).
- Compared with HbA1c <5.0%, risks of ASCVD significantly increased above HbA1c 5.4%, CKD above HbA1c 6.2% and HF above HbA1c 7.0%.
Limitations
- Underestimation of population attributable risks associated with dysglycaemia.
This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.
