Lifetime risk to progress from pre-diabetes to type 2 diabetes among women and men: comparison between American Diabetes Association and World Health Organization diagnostic criteria

Thijs T W van Herpt; Symen Ligthart; Maarten J G Leening; Mandy van Hoek; Aloysius G Lieverse; M Arfan Ikram; Eric J G Sijbrands; Abbas Dehghan; Maryam Kavousi

doi:10.1136/bmjdrc-2020-001529

Lifetime risk to progress from pre-diabetes to type 2 diabetes among women and men: comparison between American Diabetes Association and World Health Organization diagnostic criteria

BMJ Open Diabetes Res Care. 2020 Nov;8(2):e001529. doi: 10.1136/bmjdrc-2020-001529.

Authors

Thijs T W van Herpt^{1

2

3}, Symen Ligthart^{1

3}, Maarten J G Leening^{3

4}, Mandy van Hoek¹, Aloysius G Lieverse², M Arfan Ikram^{3

5

6}, Eric J G Sijbrands¹, Abbas Dehghan^{7

8}, Maryam Kavousi⁹

Affiliations

¹ Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
² Department of Internal Medicine, Máxima Medical Center, Eindhoven, The Netherlands.
³ Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
⁴ Department of Cardiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
⁵ Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
⁶ Department of Radiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
⁷ Department of Epidemiology and Biostatistics, Imperial College London, London, UK.
⁸ MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK.
⁹ Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands m.kavousi@erasmusmc.nl.

Abstract

Introduction: Pre-diabetes, a status conferring high risk of overt diabetes, is defined differently by the American Diabetes Association (ADA) and the WHO. We investigated the impact of applying definitions of pre-diabetes on lifetime risk of diabetes in women and men from the general population.

Research design and methods: We used data from 8844 women without diabetes and men aged ≥45 years from the prospective population-based Rotterdam Study in the Netherlands. In both gender groups, we calculated pre-diabetes prevalence according to ADA and WHO criteria and estimated the 10-year and lifetime risk to progress to overt diabetes with adjustment for competing risk of death.

Results: Out of 8844 individuals, pre-diabetes was identified in 3492 individuals (prevalence 40%, 95% CI 38% to 41%) according to ADA and 1382 individuals (prevalence 16%, 95% CI 15% to 16%) according to WHO criteria. In both women and men and each age category, ADA prevalence estimates doubled WHO-defined pre-diabetes. For women and men aged 45 years having ADA-defined pre-diabetes, the 10-year risk of diabetes was 14.2% (95% CI 6.0% to 22.5%) and 9.2% (95% CI 3.4% to 15.0%) compared with 23.2% (95% CI 6.8% to 39.6%) and 24.6% (95% CI 8.4% to 40.8%) in women and men with WHO-defined pre-diabetes. At age 45 years, the remaining lifetime risk to progress to overt diabetes was 57.5% (95% CI 51.8% to 63.2%) vs 80.2% (95% CI 74.1% to 86.3%) in women and 46.1% (95% CI 40.8% to 51.4%) vs 68.4% (95% CI 58.3% to 78.5%) in men with pre-diabetes according to ADA and WHO definitions, respectively.

Conclusion: Prevalence of pre-diabetes differed considerably in both women and men when applying ADA and WHO pre-diabetes definitions. Women with pre-diabetes had higher lifetime risk to progress to diabetes. The lifetime risk of diabetes was lower in women and men with ADA-defined pre-diabetes as compared with WHO. Improvement of pre-diabetes definition considering appropriate sex-specific and age-specific glycemic thresholds may lead to better identification of individuals at high risk of diabetes.

Keywords: diabetes mellitus; diagnosis; pre-diabetic state; risk assessment; type 2.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Diabetes Mellitus, Type 2* / diagnosis
Diabetes Mellitus, Type 2* / epidemiology
Female
Glucose Tolerance Test
Humans
Male
Middle Aged
Netherlands
Prediabetic State* / diagnosis
Prediabetic State* / epidemiology
Prospective Studies
United States / epidemiology
World Health Organization