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Lifetime risk for prediabetes, diabetes increases with BMI, waist circumference
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Middle-aged adults with normoglycemia have a nearly 50% remaining lifetime risk for developing prediabetes, whereas those with prediabetes have a 31% remaining lifetime risk for developing diabetes, according to research in The Lancet Diabetes & Endocrinology.
Symen Ligthart, MD, of the department of epidemiology at Erasmus University Medical Center, Rotterdam, the Netherlands, and colleagues also found that, although lifetime risk decreases with advancing age, elevated BMI and waist circumference increase the risk.
“Our data suggest that the lifetime risk of developing prediabetes for a normoglycemic individual aged 45 years is one in two, and one in three nondiabetic individuals aged 45 years will develop diabetes,” Ligthart and colleagues wrote. “Three-quarters of individuals with prediabetes at age 45 years will eventually progress to diabetes, and half of the patients with diabetes at the same age will start insulin treatment.”
Ligthart and colleagues analyzed data from 10,050 participants in the population-based Rotterdam study, a prospective, three-cohort study of 14,926 adults aged at least 45 years (mean age, 65.2 years; 57% women), beginning in 1990. At baseline, 74% of participants were normoglycemic; 14% had prediabetes; 12% had diabetes. Researchers analyzed medical records, hospital discharge letters, pharmacy data and serum fasting glucose measurements taken at study center visits and identified all cases of prediabetes and diabetes. Researchers calculated lifetime risk, using a modified version of survival analysis adjusted for the competing risk for death, and estimated the lifetime risk for progression from prediabetes to diabetes and for progression to insulin use.
Within the cohort, 1,148 participants developed prediabetes; 828 developed diabetes and 237 began insulin therapy during 14.7 years of follow-up.
Researchers found that normoglycemic adults aged 45 years had a remaining lifetime risk of 48.7% for developing prediabetes (95% CI, 46.2-51.3), a 31.3% remaining lifetime risk for diabetes (95% CI, 29.3-33.3) and a 9.1% remaining lifetime risk for insulin use (95% CI, 7.8-10.3). Those aged 45 years with prediabetes had a 74% lifetime risk (95% CI, 67.6-80.5) for progressing to diabetes; those with diabetes had a 49.1% lifetime risk (95% CI, 38.2-60) for progressing to insulin use.
Advancing age — but not sex — attenuated the risks, according to researchers, while increasing BMI and waist circumference increased risk.
“Stratification by BMI showed that normoglycemic people with healthy weight at age 45 years had a significantly lower prediabetes lifetime risk compared with overweight and obese individuals,” the researchers wrote. “Stratification by waist circumference showed similar effects on lifetime risks for diabetes in individuals with prediabetes. Similarly, in individuals with diabetes, the lifetime risk for insulin use among patients with diabetes was higher with increasing BMI and waist circumference.”
In commentary accompanying the study, Kamlesh Khunti, FRCGP, FRCP, MD, PhD, of the Diabetes Research Center at University of Leicester and Leicester General Hospital, and colleagues noted that patients prefer lifetime risk estimates, which measure the cumulative risk for developing a disease during the remainder of a person’s life, vs. 10- to 20-year risk estimates.
“We welcome the investigators’ attempt to accurately describe progression rates to type 2 diabetes because this is important for clearly identifying people who are at high risk, and for the implementation of effective planning, interventions and monitoring,” Khunti and colleagues wrote. – by Regina Schaffer
Disclosure: Ligthart reports no relevant financial disclosures. Khunti reports being a consultant, speaker, advisory board member for and/or receiving grants from AstraZeneca, Boehringer Ingelheim, Janssen, Lilly, Merck, Novartis, Novo Nordisk, Roche and Sanofi-Aventis. Please see the full study and commentary for the other authors’ relevant financial disclosures.
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