Prediabetes Linked to Higher CVD and CKD Rates
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Treatment guidelines for pre-diabetes primarily focus on glycemic control and lifestyle management. Few evidence-based cardiovascular and kidney risk-reduction strategies are available in this population.

This study aimed to characterize cardiovascular and kidney outcomes across the glycemic spectrum.

Among participants in the UK Biobank without prevalent type 1 diabetes, cardiovascular, or kidney disease, Cox models tested the association of glycemic exposures (type 2 diabetes [T2D], pre-diabetes, normoglycemia) with outcomes (ASCVD, chronic kidney disease [CKD], and heart failure), adjusting for demographic, lifestyle, and cardiometabolic risk factors.

Results:
-- Among 336,709 individuals (mean age 56.3 years, 55.4% female), 46,911 (13.9%) had pre-diabetes and 12,717 (3.8%) had T2D.

-- Over median follow-up of 11.1 years, 6,476 (13.8%) individuals with pre-diabetes developed more than 1 incident outcome, of whom only 802 (12.4%) developed T2D prior to an incident diagnosis.

-- Pre-diabetes and T2D were independently associated with ASCVD, CKD, and heart failure.

-- Compared with HbA1c less than 5.0%, covariate-adjusted risks increased significantly for ASCVD above HbA1c 5.4%, CKD above HbA1c 6.2%, and heart failure above HbA1c 7.0%.

Conclusively, pre-diabetes and T2D were associated with ASCVD, CKD, and heart failure, but a substantial gradient of risk was observed across HbA1c levels below the threshold for diabetes. These findings highlight the need to design risk-reduction strategy across the glycemic spectrum.

Source: https://www.jacc.org/doi/10.1016/j.jacc.2021.05.004
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