Prediabetes in youngsters linked to a nearly 80 percent increased risk of CVD

Kanas Chan
30 Jan 2023
Prof Ronald Ma, Prof Juliana Chan and Prof Andrea Luk
From left: Prof Ronald Ma, Prof Juliana Chan and Prof Andrea Luk

Prediabetes in youngsters is associated with an 88 percent lifetime risk of diabetes and a nearly 80 percent higher risk of cardiovascular disease (CVD), researchers from the Chinese University of Hong Kong (CUHK) have reported.  

Data from the International Diabetes Federation showed that 300 million people worldwide have prediabetes. “Although it is highly preventable, prediabetes is often overlooked by the general public and healthcare professionals due to its silent and nonurgent nature as well as low awareness of its adverse health impacts,” noted the researchers.

To estimate the lifetime risk of progression from prediabetes to diabetes, a population-based cohort study was conducted using data from the Hong Kong Diabetes Surveillance Database (HKDSD). More than 2.6 million individuals (prediabetes, 38.9 percent) were included and followed up from 2001 to 2019. [PLoS Med 2022;19:e1004045]

Based on the researchers’ estimates, young Chinese individuals with prediabetes at 20 years of age have a very high expected lifetime risk of diabetes, with 88 percent of them eventually developing diabetes. “They would live with diabetes for an average of 33 years, or 52 percent of their remaining lifespan,” reported the researchers.

“Young people born in recent years appeared to be more affected than those born in earlier years, which could be attributed to nutritional transition and sedentary lifestyle,” remarked Professor Andrea Luk of the Department of Medicine & Therapeutics, CUHK. “Early progression to diabetes can be highly devastating for a person, especially if affected when young, since it is associated with many major clinical events.”

In view of that, the research team conducted a retrospective analysis of HKDSD between 2000 and 2019 (n=1,630,942; prediabetes, 32.4 percent). Results showed that prediabetes at 20–39 years of age was associated with higher risks of CVD (hazard ratio [HR], 1.79; 95 percent confidence interval [CI], 1.59–2.01), end-stage kidney disease (HR, 1.67; 95 percent CI, 1.38–2.03), all-site infection (HR, 1.30; 95 percent CI, 1.21–1.40), and all-cause mortality (HR, 1.36; 95 percent CI, 1.20–1.55) vs normoglycaemia. [Lancet Reg Health West Pac 2022;30:100599]

Notably, the risk associations were stronger in young individuals than older people, even after excluding subsequent development of diabetes and adjusting for metabolic factors, highlighting the importance of age in identifying high-risk populations with prediabetes and in preventive strategies.

“Although these estimates in young people are alarming, in a post hoc analysis of a diabetes prevention study conducted in the US, younger adults achieved greater improvements in body composition and cardiometabolic markers from lifestyle intervention than older adults,” noted Professor Ronald Ma of the Department of Medicine & Therapeutics, CUHK.

“Our findings have shed new light on the clinical ramifications of this diagnosis and drawn public attention to the importance of regular blood glucose screening even in young people, especially if they have a family member with diabetes or other risk factors,” said Professor Juliana Chan of the Department of Medicine & Therapeutics, CUHK. 
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