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Meeting ideal levels of CV health reduces risk of T2D in patients with normal fasting glucose

Stephen Padilla
21 Nov 2018

Higher ideal levels of dietary intake, physical activity, smoking, blood pressure (BP), cholesterol and body mass index (BMI) are associated with a dose-dependent lower risk of type 2 diabetes (T2D) for individuals with normal fasting glucose but not impaired fasting glucose, according to a study presented at the American Heart Association (AHA) Scientific Sessions 2018.

“This suggests the AHA 2020 guidelines may be more effective for primordial vs primary prevention of diabetes among middle-aged and older adults,” researchers said.

A total of 7,662 non-Hispanic whites and African Americans from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study without prevalent diabetes at baseline (2003–2006), who completed the follow-up exam (2013–2016), were included.

As defined by the AHA 2020 Impact Goals, participants were categorized as having ideal, intermediate or poor cardiovascular health based on baseline ideal cardiovascular health (ICH) components (eg, total cholesterol, BP, dietary intake, tobacco use, physical activity and BMI.

“We categorized participants based on their total number of components that were ideal (0–1 “poor,” 2–3 “intermediate,” and 4+ “ideal”),” researchers said.

Modified Poisson regression was used to calculate incident rate ratios (IRR) adjusting for age, sex, education, income, race, alcohol use, estimated glomerular filtration rate, urine albumin: creatinine ratio and high-sensitivity C-reactive protein. Glycaemic status (normal vs impaired fasting glucose) was then stratified after confirming significant interactions with multiplicative interaction terms and application of likelihood ratio test.

Of the REGARDS participants (mean age 63.0 years; 56 percent female; 26 percent African American), 560 had incident diabetes (median follow-up, 9.5 years). Compared with individuals with 0–1 ICH components, those with 2–3 and 4+ components had 31-percent (IRR, 0.69; 95 percent CI, 0.61–0.79) and 71-percent lower (IRR, 0.29; 0.20–0.42) risk of T2D, respectively. [AHA 2018, abstract EPI07]

These risks were 36-percent (IRR, 0.64; 0.52–0.79) and 80-percent lower (IRR, 0.20; 0.10–0.37) among participants with normal fasting glucose (n=5,930), and 8-percent (IRR, 0.92; 0.80–1.07) and 13-percent lower (IRR, 0.87; 0.58–1.30) among those with baseline impaired fasting glucose (n=1,732; p<0.0001 for interaction by baseline glucose status).

A previous study reported that T2D and its related complications inflict heavy health burdens worldwide, with no effective measures to fully cope with the diseases. The interaction between genetic and environmental risk is the main cause of the diabetes epidemic. In addition, many other factors are attributable to the diseases. [Int J Med Sci 2014;11:1185-1200]

“ICH is associated with lower risk of incident diabetes, but whether this association varies by baseline glycemia (normal [<100 mg/dL] vs impaired fasting glucose [100–125 mg/dL]) remains to be clarified,” researchers said.

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