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Comparing different definitions of prediabetes with subsequent risk of diabetes: an individual participant data meta-analysis involving 76 513 individuals and 8208 cases of incident diabetes.

Journal article
Authors Crystal Man Ying Lee
Stephen Colagiuri
Mark Woodward
Edward W Gregg
Robert Adams
Fereidoun Azizi
Rafael Gabriel
Tiffany K Gill
Clicerio Gonzalez
Allison Hodge
David R Jacobs Jr
Joshua J Joseph
Davood Khalili
Dianna J Magliano
Kirsten Mehlig
Roger Milne
Gita Mishra
Morgana Mongraw-Chaffin
Julie A Pasco
Masaru Sakurai
Pamela J Schreiner
Elizabeth Selvin
Jonathan E Shaw
Gary Wittert
Hiroshi Yatsuya
Rachel R Huxley
Published in BMJ open diabetes research & care
Volume 7
Issue 1
Pages e000794
ISSN 2052-4897
Publication year 2019
Published at Institute of Medicine, School of Public Health and Community Medicine
Pages e000794
Language en
Links dx.doi.org/10.1136/bmjdrc-2019-0007...
www.ncbi.nlm.nih.gov/entrez/query.f...
Subject categories Epidemiology, Public health medicine research areas

Abstract

There are currently five widely used definition of prediabetes. We compared the ability of these to predict 5-year conversion to diabetes and investigated whether there were other cut-points identifying risk of progression to diabetes that may be more useful.We conducted an individual participant meta-analysis using longitudinal data included in the Obesity, Diabetes and Cardiovascular Disease Collaboration. Cox regression models were used to obtain study-specific HRs for incident diabetes associated with each prediabetes definition. Harrell's C-statistics were used to estimate how well each prediabetes definition discriminated 5-year risk of diabetes. Spline and receiver operating characteristic curve (ROC) analyses were used to identify alternative cut-points.Sixteen studies, with 76 513 participants and 8208 incident diabetes cases, were available. Compared with normoglycemia, current prediabetes definitions were associated with four to eight times higher diabetes risk (HRs (95% CIs): 3.78 (3.11 to 4.60) to 8.36 (4.88 to 14.33)) and all definitions discriminated 5-year diabetes risk with good accuracy (C-statistics 0.79-0.81). Cut-points identified through spline analysis were fasting plasma glucose (FPG) 5.1 mmol/L and glycated hemoglobin (HbA1c) 5.0% (31 mmol/mol) and cut-points identified through ROC analysis were FPG 5.6 mmol/L, 2-hour postload glucose 7.0 mmol/L and HbA1c 5.6% (38 mmol/mol).In terms of identifying individuals at greatest risk of developing diabetes within 5 years, using prediabetes definitions that have lower values produced non-significant gain. Therefore, deciding which definition to use will ultimately depend on the goal for identifying individuals at risk of diabetes.

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