The role of age on the risk relationship between prediabetes and major morbidities and mortality: analysis of the Hong Kong diabetes surveillance database of 2 million Chinese adults

Zhang, Xinge; Wu, Hongjiang; Fan, Baoqi; Shi, Mai; Lau, Eric S. H.; Yang, Aimin; Chow, Elaine; Kong, Alice Pik‐Shan; Chan, Juliana C.N.; Ma, Rong; Luk, Andrea O. Y.

doi:10.1016/j.lanwpc.2022.100599

Cited by 10 publications

(11 citation statements)

References 32 publications

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“…It was controversial whether prediabetes increases the risk of cardiovascular disease and all-cause mortality [ 14 – 16 ]. Previous studies have demonstrated the increased risk of CVD and all-cause mortality were associated with the presence of prediabetes in young adults without diabetes and prior CVD [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

“…Patients with HbA1c lower than 38.8 mmol/mol (5.7%) and no prior diagnosis of all kinds of diabetes were categorized as normoglycemic, with HbA1c ranging from 38.8 mmol/mol (5.7%) to 47.5 mmol/mol (6.4%) and no prior diagnosis of all kinds all diabetes were defined as prediabetes while HbA1c higher than 47.5 mmol/mol (6.5%) or with documented hypoglycemic therapy were defined as diabetes (Type II). The estimated glomerular filtration rate (eGFR) was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation [ 16 ], and chronic kidney disease (CKD) was defined as eGFR < 60 mL/min/1.73m 2 [ 17 ]. Congestive heart failure (CHF) was defined as New York Heart Association class > 2 or Killip class > 1.…”

Section: Methodsmentioning

confidence: 99%

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Prediabetes and all-cause mortality in young patients undergoing coronary artery angiography: a multicenter cohort study in China

Ling

et al. 2023

Cardiovasc Diabetol

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Background The prevalence of prediabetes is increasing in young adults and patients undergoing coronary angiography. However, whether prediabetes is a considerable risk factor for all-cause mortality remains undetermined in young patients undergoing coronary angiography. Methods In this study, we retrospectively included 8868 young patients (men aged < 45 years, women aged < 55 years) who underwent coronary angiography (CAG). Patients were categorized as normoglycemic, prediabetes and diabetes according to the HbA1c level or documented history of diabetes. The association of all-cause mortality with diabetes and prediabetes was detected by Cox proportional hazards regression analysis. Results A total of 3240 (36.5%) among 8868 young patients receiving CAG were prediabetes and 2218 (25.0%) were diabetes. 728 patients died during a median follow-up of 4.92 years. Compared to the normoglycemic group, prediabetes increased the risk of all-cause mortality in young CAG patients by 24%(adjusted HR: 1.24, 95% CI: 1.04–1.49, p = 0.019) and diabetes increased the risk of all-cause mortality by 46%(adjusted HR:1.46, 95% CI:1.2–1.79, p < 0.001). Subgroup analysis showed that diabetes and prediabetes increased the risk of death mainly in patients without comorbidities. Conclusion Prediabetes accounts for more than one-third of the young adults undergoing CAG and was associated with an increased risk of all-cause mortality, active prevention strategy should be considered for these patients.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Prediabetes and all-cause mortality in young patients undergoing coronary artery angiography: a multicenter cohort study in China

Ling

et al. 2023

Cardiovasc Diabetol

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“…These evaluations need to compare effects across different populations and ethnic groups, including those that were not adequately represented in our analyses, e.g. Asian populations [21]. Optimizing consensus on definitions is also important in studying intervention effects.…”

Section: Discussionmentioning

confidence: 99%

Heterogeneity in elevated glucose and A1C as predictors of the prediabetes to diabetes transition: Framingham Heart Study, Multi-Ethnic Study on Atherosclerosis, Jackson Heart Study, and Atherosclerosis Risk In Communities

Patel,

Ioannidis,

Gregg

et al. 2024

Preprint

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Aims/hypothesis: There are a number of glycemic definitions for prediabetes; however, the heterogeneity in diabetes transition rates from prediabetes across different glycemic definitions in major US cohorts has been unexplored. We hypothesize that a significant source of variation in the transition rate are cohorts themselves. We estimate the variability in risk and relative risk of diabetes based on diagnostic criteria like fasting glucose and hemoglobin A1C% (HbA1c%). Methods: We estimated transition rate from prediabetes, as defined by fasting glucose between 100-125 and/or 110-125 mg/dL, and HbA1c% between 5.7-6.5% in participant data from the Framingham Heart Study (FHS) Generation 2, FHS Generation 3, Multi-Ethnic Study on Atherosclerosis, Atherosclerosis Risk in Communities, and the Jackson Heart Study. We estimated the heterogeneity and prediction interval across cohorts, stratifying by age, sex, and body mass index. Among individuals with prediabetes, we estimated the relative risk for obesity, blood pressure, education, age, and sex for diabetes. Results: There is substantial heterogeneity in diabetes transition rates across cohorts and prediabetes definitions with large prediction intervals. We observed the individuals with fasting glucose of 100-125 range from 4-14% per 100 person years and 110-125 mg/dL ranging from 2-18 per 100 person-years. For HbA1C between 5.7-6.5%, the transition rate ranged from 2.5-11 per 100 person years (I2 for heterogeneity was greater than 93% for all definitions). Obesity and hypertension did not explain the differences in risk. Conclusion: The absolute transition rate from prediabetes to diabetes significantly depends on both cohort and prediabetes definitions.

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“…By incorporating clinical and laboratory measurements to automatically generate risk scores, such as the extended RUBY model 2, we can increase the efficiency of diagnosing AGT based on OGTT. In a separate territory-wide EHR-based Hong Kong Diabetes Surveillance Database with 1,028,931 people with pre-diabetes, 96% of individuals had an FPG, 96% had routine biochemistry testing performed, and 93% had both FPG and serum creatinine before pre-diabetes diagnosis 37. Since these are routinely captured data, this would not incur additional laboratory or blood-taking costs.…”

Section: Discussionmentioning

confidence: 99%

Enhanced prediction of abnormal glucose tolerance using an extended non-invasive risk score incorporating routine renal biochemistry

He,

Fan,

Lau

et al. 2024

BMJ Open Diab Res Care

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IntroductionType 2 diabetes is preventable in subjects with impaired glucose tolerance based on 2-hour plasma glucose (2hPG) during 75 g oral glucose tolerance test (OGTT). We incorporated routine biochemistry to improve the performance of a non-invasive diabetes risk score to identify individuals with abnormal glucose tolerance (AGT) defined by 2hPG≥7.8 mmol/L during OGTT.Research design and methodsWe used baseline data of 1938 individuals from the community-based “Better Health for Better Hong Kong - Hong Kong Family Diabetes Study (BHBHK-HKFDS) Cohort” recruited in 1998–2003. We incorporated routine biochemistry in a validated non-invasive diabetes risk score, and evaluated its performance using area under receiver operating characteristics (AUROC) with internal and external validation.ResultsThe AUROC of the original non-invasive risk score to predict AGT was 0.698 (95% CI, 0.662 to 0.733). Following additional inclusion of fasting plasma glucose, serum potassium, creatinine, and urea, the AUROC increased to 0.778 (95% CI, 0.744 to 0.809, p<0.001). Net reclassification improved by 31.9% (p<0.001) overall, by 30.8% among people with AGT and 1.1% among people without AGT. The extended model showed good calibration (χ2=11.315, p=0.1845) and performance on external validation using an independent data set (AUROC=0.722, 95% CI, 0.680 to 0.764).ConclusionsThe extended risk score incorporating clinical and routine biochemistry can be integrated into an electronic health records system to select high-risk subjects for evaluation of AGT using OGTT for prevention of diabetes.

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The role of age on the risk relationship between prediabetes and major morbidities and mortality: analysis of the Hong Kong diabetes surveillance database of 2 million Chinese adults

Cited by 10 publications

References 32 publications

Prediabetes and all-cause mortality in young patients undergoing coronary artery angiography: a multicenter cohort study in China

Prediabetes and all-cause mortality in young patients undergoing coronary artery angiography: a multicenter cohort study in China

Heterogeneity in elevated glucose and A1C as predictors of the prediabetes to diabetes transition: Framingham Heart Study, Multi-Ethnic Study on Atherosclerosis, Jackson Heart Study, and Atherosclerosis Risk In Communities

Enhanced prediction of abnormal glucose tolerance using an extended non-invasive risk score incorporating routine renal biochemistry

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