They’re sicker than we think: an exploratory study profiling the cardio-metabolic health in a sample of adults with pre-diabetes in Aotearoa New Zealand

Abstract

Introduction. Type 2 diabetes mellitus (T2DM) is a highly prevalent and potentially preventable condition associated with significant health, social, and economic costs. The detection and management of pre-diabetes is an important opportunity to prevent or delay the onset of T2DM and associated morbidities; however, its importance is controversial as the health risks associated with pre-diabetes are poorly understood. Aim. To understand the cardio-metabolic health profile of a sample of adults with pre-diabetes in Aotearoa New Zealand. Methods. Secondary analyses of baseline data from all 153 adults recruited to an intervention trial for adults with pre-diabetes were carried out. A profile of cardio-metabolic risk was measured by describing the proportion with metabolic syndrome (MetS) calculated using Adult Treatment Panel III criteria, which includes blood pressure, lipids, and obesity in addition to glycaemic measures. The severity of MetS was calculated as MetS Z-scores. Subgroup analyses for sex, ethnicity and glycated haemoglobin (HbA 1c ) were performed. Results. Overall, 74% of this study population had MetS, and the proportion varied according to ethnicity and HbA 1c level. The severity of MetS was highly variable, with MetS-Z-scores ranging from −1.0 to 2.8. Although mean MetS Z-scores differed according to ethnicity and HbA 1c level, all subgroups included individuals with widely differing severity of MetS, suggesting likely quite different risks for progression to diabetes or cardiovascular disease across the range of pre-diabetes defined by HbA 1c . Discussion. Single biochemical markers of glycaemia are insufficient to ascertain overall cardio-metabolic risk when prioritising clinical efforts for those with pre-diabetes, particularly in primary care, where the potential for preventing or delaying the onset of type 2 diabetes mellitus (T2DM) is significant. Findings indicate the importance of attending to all cardiometabolic risk factors when caring for people with pre-diabetes. The development of tools using multiple relevant variables and predicting a comprehensive range of outcomes would improve timely risk stratification and treatment effect monitoring of pre-diabetes populations.

He Rourou Whai Painga, an Aotearoa New Zealand dietary pattern for metabolic health and whānau wellbeing: protocol for a randomized controlled trial

“…It is therefore a useful tool in assessing the impact of a dietary intervention on metabolic health (19). In an Aotearoa New Zealand population, the MetSSS positively associated with impaired glucose regulatory status and history of cardiovascular disease for all ethnic groups (20,21). This places it in a good position to have utility as a tool to quantify an individual's cardiometabolic disease risk within the multiethnic population of Aotearoa New Zealand (20).…”

“…The MetSSS has been shown to predict future cardiometabolic disease and can be modified by diet, exercise, and pharmacological intervention to estimate change in cardiometabolic disease risk, and is therefore a useful tool in assessing the impact of a dietary intervention (19). It has been validated in a New Zealand population and has been shown to be responsive to diet and lifestyle interventions in people with pre-diabetes (19)(20)(21).…”

It is time for a more targeted approach to prediabetes in primary care in Aotearoa New Zealand

“…More than 66% of those with prediabetes who developed CVD or renal disease did not develop T2DM. 25 Our exploratory NZ study 26 found that 74% of a small sample (n = 153) of adults with prediabetes had metabolic syndrome, and there was considerable variability in the severity of this condition. Together, these findings are a timely reminder of the artificial nature of diagnostic cut-off points and the importance of assessing a comprehensive range of risk factors in those with prediabetes.…”

A high quality Aotearoa New Zealand dietary pattern adapting a Mediterranean diet for metabolic health: a feasibility study

“…It is therefore a useful tool in assessing the impact of a dietary intervention on metabolic health [ 13 ]. It has been validated in a New Zealand population and has been shown to be responsive to diet and lifestyle interventions in people with pre-diabetes [ 13 – 15 ].…”