Regression from prediabetes to normal glucose regulation is associated with reduction in cardiovascular risk

Results from the diabetes prevention program outcomes study

Leigh Perreault, Marinella Temprosa, Kieren Mather, Ed Horton, Abbas Kitabchi, Mary Larkin, Maria G. Montez, Debra Thayer, Trevor J. Orchard, Richard F. Hamman, Ronald B. Goldberg

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

OBJECTIVE: Restoration of normal glucose regulation (NGR) in people with prediabetes significantly decreases the risk of future diabetes. We sought to examine whether regression to NGR is also associated with a long-Term decrease in cardiovascular disease (CVD) risk. RESEARCH DESIGN AND METHODS The Framingham (2008) score (as an estimate of the global 10-Year CVD risk) and individual CVD risk factors were calculated annually for the Diabetes Prevention Program Outcomes Study years 1-10 among those patients who returned to NGR at least once during the Diabetes Prevention Program (DPP) compared with those who remained with prediabetes or those in whomdiabetes developed during DPP (N = 2,775). RESULTS: The Framingham scores by glycemic exposure did not differ among the treatment groups; therefore, pooled estimates were stratified by glycemic status and were adjusted for differences in risk factors at DPP baseline and in the treatment arm. During 10 years of follow-Up, the mean Framingham 10-Year CVD risk scores were highest in the prediabetes group (16.2%), intermediate in the NGR group (15.5%), and 14.4% in people with diabetes (all pairwise comparisons P < 0.05), but scores decreased over time for those people with prediabetes (18.6% in year 1 vs. 15.9% in year 10, P < 0.01). The lower score in the diabetes group versus other groups, a declining score in the prediabetes group, and favorable changes in each individual risk factor in all groups were explained, in part, by higher or increasingmedication use for lipids and blood pressure. CONCLUSIONS: Prediabetes represents a high-Risk state for CVD. Restoration of NGR and/or medical treatment of CVD risk factors can significantly reduce the estimated CVD risk in people with prediabetes.

Original languageEnglish
Pages (from-to)2622-2631
Number of pages10
JournalDiabetes Care
Volume37
Issue number9
DOIs
StatePublished - 2014

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Prediabetic State
Cardiovascular Diseases
Outcome Assessment (Health Care)
Glucose
Therapeutics
Blood Pressure
Lipids

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing
  • Medicine(all)

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Regression from prediabetes to normal glucose regulation is associated with reduction in cardiovascular risk : Results from the diabetes prevention program outcomes study. / Perreault, Leigh; Temprosa, Marinella; Mather, Kieren; Horton, Ed; Kitabchi, Abbas; Larkin, Mary; Montez, Maria G.; Thayer, Debra; Orchard, Trevor J.; Hamman, Richard F.; Goldberg, Ronald B.

In: Diabetes Care, Vol. 37, No. 9, 2014, p. 2622-2631.

Research output: Contribution to journalArticle

Perreault, L, Temprosa, M, Mather, K, Horton, E, Kitabchi, A, Larkin, M, Montez, MG, Thayer, D, Orchard, TJ, Hamman, RF & Goldberg, RB 2014, 'Regression from prediabetes to normal glucose regulation is associated with reduction in cardiovascular risk: Results from the diabetes prevention program outcomes study', Diabetes Care, vol. 37, no. 9, pp. 2622-2631. https://doi.org/10.2337/dc14-0656
Perreault, Leigh ; Temprosa, Marinella ; Mather, Kieren ; Horton, Ed ; Kitabchi, Abbas ; Larkin, Mary ; Montez, Maria G. ; Thayer, Debra ; Orchard, Trevor J. ; Hamman, Richard F. ; Goldberg, Ronald B. / Regression from prediabetes to normal glucose regulation is associated with reduction in cardiovascular risk : Results from the diabetes prevention program outcomes study. In: Diabetes Care. 2014 ; Vol. 37, No. 9. pp. 2622-2631.
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AU - Temprosa, Marinella

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AU - Horton, Ed

AU - Kitabchi, Abbas

AU - Larkin, Mary

AU - Montez, Maria G.

AU - Thayer, Debra

AU - Orchard, Trevor J.

AU - Hamman, Richard F.

AU - Goldberg, Ronald B.

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N2 - OBJECTIVE: Restoration of normal glucose regulation (NGR) in people with prediabetes significantly decreases the risk of future diabetes. We sought to examine whether regression to NGR is also associated with a long-Term decrease in cardiovascular disease (CVD) risk. RESEARCH DESIGN AND METHODS The Framingham (2008) score (as an estimate of the global 10-Year CVD risk) and individual CVD risk factors were calculated annually for the Diabetes Prevention Program Outcomes Study years 1-10 among those patients who returned to NGR at least once during the Diabetes Prevention Program (DPP) compared with those who remained with prediabetes or those in whomdiabetes developed during DPP (N = 2,775). RESULTS: The Framingham scores by glycemic exposure did not differ among the treatment groups; therefore, pooled estimates were stratified by glycemic status and were adjusted for differences in risk factors at DPP baseline and in the treatment arm. During 10 years of follow-Up, the mean Framingham 10-Year CVD risk scores were highest in the prediabetes group (16.2%), intermediate in the NGR group (15.5%), and 14.4% in people with diabetes (all pairwise comparisons P < 0.05), but scores decreased over time for those people with prediabetes (18.6% in year 1 vs. 15.9% in year 10, P < 0.01). The lower score in the diabetes group versus other groups, a declining score in the prediabetes group, and favorable changes in each individual risk factor in all groups were explained, in part, by higher or increasingmedication use for lipids and blood pressure. CONCLUSIONS: Prediabetes represents a high-Risk state for CVD. Restoration of NGR and/or medical treatment of CVD risk factors can significantly reduce the estimated CVD risk in people with prediabetes.

AB - OBJECTIVE: Restoration of normal glucose regulation (NGR) in people with prediabetes significantly decreases the risk of future diabetes. We sought to examine whether regression to NGR is also associated with a long-Term decrease in cardiovascular disease (CVD) risk. RESEARCH DESIGN AND METHODS The Framingham (2008) score (as an estimate of the global 10-Year CVD risk) and individual CVD risk factors were calculated annually for the Diabetes Prevention Program Outcomes Study years 1-10 among those patients who returned to NGR at least once during the Diabetes Prevention Program (DPP) compared with those who remained with prediabetes or those in whomdiabetes developed during DPP (N = 2,775). RESULTS: The Framingham scores by glycemic exposure did not differ among the treatment groups; therefore, pooled estimates were stratified by glycemic status and were adjusted for differences in risk factors at DPP baseline and in the treatment arm. During 10 years of follow-Up, the mean Framingham 10-Year CVD risk scores were highest in the prediabetes group (16.2%), intermediate in the NGR group (15.5%), and 14.4% in people with diabetes (all pairwise comparisons P < 0.05), but scores decreased over time for those people with prediabetes (18.6% in year 1 vs. 15.9% in year 10, P < 0.01). The lower score in the diabetes group versus other groups, a declining score in the prediabetes group, and favorable changes in each individual risk factor in all groups were explained, in part, by higher or increasingmedication use for lipids and blood pressure. CONCLUSIONS: Prediabetes represents a high-Risk state for CVD. Restoration of NGR and/or medical treatment of CVD risk factors can significantly reduce the estimated CVD risk in people with prediabetes.

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