Association between pre-diabetes and microvascular and macrovascular disease in newly diagnosed type 2 diabetes

Abstract

ObjectiveThe associated risk of vascular disease following diagnosis of type 2 diabetes in people previously identified as having pre-diabetes in real-world settings is unknown. We examined the presence of microvascular and macrovascular disease in individuals with newly diagnosed type 2 diabetes by glycemic status within 3 years before diagnosis.Research design and methodsWe identified 159 736 individuals with newly diagnosed type 2 diabetes from the UK Clinical Practice Research Datalink database in England between 2004 and 2017. We used logistic regression models to compare presence of microvascular (retinopathy and nephropathy) and macrovascular (acute coronary syndrome, cerebrovascular and peripheral arterial disease) disease at the time of type 2 diabetes diagnosis by prior glycemic status.ResultsHalf of the study population (49.9%) had at least one vascular disease, over one-third (37.4%) had microvascular disease, and almost a quarter (23.5%) had a diagnosed macrovascular disease at the time of type 2 diabetes diagnosis.Compared with individuals with glycemic values within the normal range, those detected with pre-diabetes before the diagnosis had 76% and 14% increased odds of retinopathy and nephropathy (retinopathy: adjusted OR (AOR) 1.76, 95% CI 1.69 to 1.85; nephropathy: AOR 1.14, 95% CI 1.10 to 1.19), and 7% higher odds of the diagnosis of acute coronary syndrome (OR 1.07, 95% CI 1.03 to 1.12) in fully adjusted models at time of diabetes diagnosis.ConclusionsMicrovascular and macrovascular diseases are detected in 37%–24% of people with newly diagnosed type 2 diabetes. Pre-diabetes before diagnosis of type 2 diabetes is associated with increased odds of microvascular disease and acute coronary syndrome. Detection of pre-diabetes might represent an opportunity for reducing the burden of microvascular and macrovascular disease through heightened attention to screening for vascular complications.

2. Classification and Diagnosis of Diabetes:Standards of Medical Care in Diabetes—2021

“…In the most recent National Institutes of Health (NIH) Diabetes Prevention Program Outcomes Study (DPPOS) report, prevention of progression from prediabetes to diabetes (74) resulted in lower rates of developing retinopathy and nephropathy (75). Similar impact on diabetes complications was reported with screening, diagnosis, and comprehensive risk factor management in the U.K. Clinical Practice Research Datalink database (73). In that report, progression from prediabetes to diabetes augmented risk of complications.…”

Pre-diabetes and COVID-19, could we be missing the silent killer?

“…Pre-diabetes (or intermediate hyperglycemia) is a state in which the blood glucose concentration is above normal but not high enough to diagnose type 2 diabetes. 1 But whether pre-diabetes should concern us during and after the coronavirus disease 2019 (COVID-19) pandemic is an exigent question.…”

The contribution of diabetic micro-angiopathy to adverse outcomes in COVID-19

“…Diabetes is characterised, not only by hyperglycaemia, but also endothelial dysfunction and microcirculatory impairment [9]. Microvascular disease (either retinopathy or nephropathy) is present in over one-third of newlydiagnosed patients with type-2 diabetes (T2D) [10]. The consequences of endothelial dysfunction include dysregulation of vasodilation, fibrinolysis, and anti-aggregation -classically leading to macrovascular disease -and may contribute to microvascular disease retinopathy, nephropathy and neuropathy [10].…”

“…Microvascular disease (either retinopathy or nephropathy) is present in over one-third of newlydiagnosed patients with type-2 diabetes (T2D) [10]. The consequences of endothelial dysfunction include dysregulation of vasodilation, fibrinolysis, and anti-aggregation -classically leading to macrovascular disease -and may contribute to microvascular disease retinopathy, nephropathy and neuropathy [10]. However, evidence of microvascular dysfunction in one organ is a marker of systemic injury.…”

“…In the UK, the hazard ratio for prediabetes in South Asians was 1.67 (1.12-2.50) and for Blacks 1.45 (0.92-2.27), compared to the white population [19]. Although it is alluring to think that people with prediabetes are protected from microvascular disease; early stages of retinopathy, nephropathy, and neuropathy have been reported in people with prediabetes, with a prevalence of up to 10% [10,20].…”