Association between varying cut-points of intermediate hyperglycemia and risk of mortality, cardiovascular events and chronic kidney disease: a systematic review and meta-analysis

Unjali P Gujral; Ram Jagannathan; Siran He; Minxuan Huang; Lisa R Staimez; Jingkai Wei; Nanki Singh; K M Venkat Narayan

doi:10.1136/bmjdrc-2020-001776

Association between varying cut-points of intermediate hyperglycemia and risk of mortality, cardiovascular events and chronic kidney disease: a systematic review and meta-analysis

BMJ Open Diabetes Res Care. 2021 Apr;9(1):e001776. doi: 10.1136/bmjdrc-2020-001776.

Authors

Unjali P Gujral¹, Ram Jagannathan², Siran He³, Minxuan Huang⁴, Lisa R Staimez⁵, Jingkai Wei⁶, Nanki Singh⁷, K M Venkat Narayan⁵

Affiliations

¹ Rollins School of Public Health, Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA ugujral@emory.edu.
² Divisoin of Hospital Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
³ Department of Nutrition and Health Sciences, Laney Graduate School, Emory University, Atlanta, Georgia, USA.
⁴ Rollins School of Public Health, Department of Epdemiology, Emory University, Atlanta, Georgia, USA.
⁵ Rollins School of Public Health, Hubert Department of Global Health, Emory University, Atlanta, Georgia, USA.
⁶ Department of Epidemiology and Biostatistics, George Washington University School of Public Health and Health Services, Washington, District of Columbia, USA.
⁷ Department of Political Science, Duke University, Durham, North Carolina, USA.

Abstract

Introduction: We conducted a systematic review and meta-analysis to evaluate the updated evidence regarding prediabetes for predicting mortality, macrovascular and microvascular outcomes.

Research design and methods: We identified English language studies from MEDLINE, PubMed, OVID and Cochrane database indexed from inception to January 31, 2020. Paired reviewers independently identified 106 prospective studies, comprising nearly 1.85 million people, from 27 countries. Primary outcomes were all-cause mortality (ACM), cardiovascular mortality (CVDM), cardiovascular disease (CVD), coronary heart disease (CHD) and stroke. Secondary outcomes were heart failure, chronic kidney disease (CKD) and retinopathy.

Results: Impaired glucose tolerance was associated with ACM; HR 1.19, 95% CI (1.15 to 1.24), CVDM; HR 1.21, 95% CI (1.10 to 1.32), CVD; HR 1.18, 95% CI (1.11 to 1.26), CHD; HR; 1.13, 95% CI (1.05 to 1.21) and stroke; HR 1.24, 95% CI (1.06 to 1.45). Impaired fasting glucose (IFG) 110-125 mg/dL was associated with ACM; HR 1.17, 95% CI (1.13 to 1.22), CVDM; HR 1.20, 95% CI (1.09 to 1.33), CVD; HR 1.21, 95% CI (1.09 to 1.33), CHD; HR; 1.14, 95% CI (1.06 to 1.22) and stroke; HR 1.22, 95% CI (1.07 to 1.40). IFG 100-125 mg/dL was associated with ACM; HR 1.11, 95% CI (1.04 to 1.19), CVDM; HR 1.14, 95% CI (1.03 to 1.25), CVD; HR 1.15, 95% CI (1.05 to 1.25), CHD HR; 1.10, 95% CI (1.02 to 1.19) and CKD; HR; 1.09, 95% CI (1.01 to 1.18). Glycosylated hemoglobin A1c (HbA1c) 6.0%-6.4% was associated with ACM; HR 1.30, 95% CI (1.03 to 1.66), CVD; HR 1.32, 95% CI (1.00 to 1.73) and CKD; HR 1.50, 95% CI (1.32 to 1.70). HbA1c 5.7%-6.4% was associated with CVD HR 1.15, 95% CI (1.02 to 1.30), CHD; HR 1.28, 95% CI (1.13 to 1.46), stroke; HR 1.23, 95% CI (1.04 to 1.46) and CKD; HR 1.32, 95% CI (1.16 to 1.50).

Conclusion: Prediabetes is an elevated risk state for macrovascular and microvascular outcomes. The prevention and management of prediabetes should be considered.

Keywords: comorbidity; mortality; prediabetic state.

Publication types

Meta-Analysis
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Cardiovascular Diseases* / epidemiology
Humans
Hyperglycemia* / complications
Hyperglycemia* / epidemiology
Prediabetic State* / epidemiology
Prospective Studies
Renal Insufficiency, Chronic* / epidemiology

Abstract

Publication types

MeSH terms

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