Age, BP, BMI predict development of T2DM, stroke in prediabetic patients
Individuals with impaired fasting glucose (IFG) are highly likely to develop type 2 diabetes mellitus (T2DM), acute myocardial infarction (AMI) or stroke within 5 years of diagnosis, with key predictors including age, blood pressure (BP) and body mass index (BMI), according to a Singapore study.
The odds of developing any of primary outcomes of interest—T2DM, AMI and stroke—were significantly greater among IFG patients aged 40 to 49 years (adjusted odds ratio [aOR], 2.25; 95 percent CI, 1.44 to 3.51), with BP ≥140/90 mmHg (aOR, 1.62; 1.26 to 2.10) and BMI ≥27.5 kg/m2 (aOR, 2.35; 1.61 to 3.41; p<0.001 for all) in multivariable logistic regression models. [Diabetes Res Clin Pract 2017;doi:10.1016/j.diabres.2017.07.018]
Moreover, a gender-specific difference was observed. Female IFG patients were more likely to develop T2DM (aOR, 1.43; 1.10 to 1.85) but less likely to develop AMI and/or stroke (aOR, 0.43; 0.24 to 0.76) compared with their male counterparts.
Five-year clinical data were generated in 2,295 patients (mean age 59 years; 55.6 percent female) diagnosed with IFG from the Singapore National Healthcare Group hospitals and primary care clinics. At least one of the investigated outcomes occurred in 552 (24.1 percent) of the patients, including 492 (21.4 percent) who developed T2DM, 20 (0.9 percent) who developed AMI and 62 (2.7 percent) who developed stroke.
“This study supports the current guidelines for screening of cardiovascular risk factors in Singapore before 40 years of age, especially for females and for those with high BMI of 27.5kg/m2 or greater,” said researchers from the National Healthcare Group in Singapore. [Singapore Med J 2014;55:334]
“However, we could consider reducing the interval for screening, which is currently once every 3 years, for individuals with normal screening results because the rate of progression from new onset IFG to T2DM is high,” they added.
Researchers pointed out that recognizing the predictors presented in the study may be useful in earlier detection of IFG, which will help prevent the onset of diabetes and its macro- and microvascular complications by providing a longer window of opportunity for education, lifestyle change and more aggressive treatment.
The study is not without limitations. Among those that researchers cited included the underestimation of the incidence of T2DM, AMI or stroke due to the use of secondary data that had a number of missing values (eg, smoking status, BP, BMI measurements) and the possibility that the results might be biased toward those who were more likely to seek professional medical services.
“More studies may be required to determine if the modifiable risk factors, such as high-density lipoprotein cholesterol and high BMI levels, can reduce the risk of developing [T2D, AMI or stroke] in the longer term,” researchers said.