Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Apr;41(4):899-906.
doi: 10.2337/dc17-2530. Epub 2018 Feb 16.

Risk of Cardiovascular Disease and Death in Individuals With Prediabetes Defined by Different Criteria: The Whitehall II Study

Dorte Vistisen  1 , Daniel R Witte  2   3 , Eric J Brunner  4 , Mika Kivimäki  4 , Adam Tabák  4   5 , Marit E Jørgensen  6   7 , Kristine Færch  6
Affiliations

Risk of Cardiovascular Disease and Death in Individuals With Prediabetes Defined by Different Criteria: The Whitehall II Study

Dorte Vistisen et al. Diabetes Care. 2018 Apr.

Abstract

Objective: We compared the risk of cardiovascular disease (CVD) and all-cause mortality in subgroups of prediabetes defined by fasting plasma glucose (FPG), 2-h plasma glucose (2hPG), or HbA1c.

Research design and methods: In the Whitehall II cohort, 5,427 participants aged 50-79 years and without diabetes were followed for a median of 11.5 years. A total of 628 (11.6%) had prediabetes by the World Health Organization (WHO)/International Expert Committee (IEC) criteria (FPG 6.1-6.9 mmol/L and/or HbA1c 6.0-6.4%), and 1,996 (36.8%) by the American Diabetes Association (ADA) criteria (FPG 5.6-6.9 mmol/L and/or HbA1c 5.7-6.4%). In a subset of 4,730 individuals with additional measures of 2hPG, 663 (14.0%) had prediabetes by 2hPG. Incidence rates of a major event (nonfatal/fatal CVD or all-cause mortality) were compared for different definitions of prediabetes, with adjustment for relevant confounders.

Results: Compared with that for normoglycemia, incidence rate in the context of prediabetes was 54% higher with the WHO/IEC definition and 37% higher with the ADA definition (P < 0.001) but declining to 17% and 12% after confounder adjustment (P ≥ 0.111). Prediabetes by HbA1c was associated with a doubling in incidence rate for both the IEC and ADA criteria. However, upon adjustment, excess risk was reduced to 13% and 17% (P ≥ 0.055), respectively. Prediabetes by FPG or 2hPG was not associated with an excess risk in the adjusted analysis.

Conclusions: Prediabetes defined by HbA1c was associated with a worse prognosis than prediabetes defined by FPG or 2hPG. However, the excess risk among individuals with prediabetes is mainly explained by the clustering of other cardiometabolic risk factors associated with hyperglycemia.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Kaplan-Meier survival curves for an event (CVD or mortality) for individuals with prediabetes (light blue and dark blue) versus normal glycemia (gray), using FPG, n = 5,427 (A); HbA1c, n = 5,427 (B); or 2hPG, n = 4,730 (C).
Figure 2
Figure 2
Association between glycemia in the prediabetes range and 10-year risk of an event (CVD or mortality).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. National Diabetes Group Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 1979;28:1039–1057 - PubMed
    1. World Health Organization. WHO Expert Committee on Diabetes Mellitus: Second Report. Geneva, World Health Org., 1980 (Tech. Rep. Ser., no. 646) - PubMed
    1. World Health Organization. Definition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycemia. Geneva, World Health Org., 2006
    1. American Diabetes Association Classification and diagnosis of diabetes. Sec. 2. In Standards of Medical Care in Diabetes—2017 Diabetes Care 2017;40(Suppl. 1):S11–S24 - PubMed
    1. Makaroff LE. The need for international consensus on prediabetes. Lancet Diabetes Endocrinol 2017;5:5–7 - PubMed

Publication types

  NODES
Association 8
INTERN 3
twitter 2