Highlights
- •Individuals with prediabetes are at increased risk for incident diabetes.
- •The lower fasting and postprandial glucose, the lower risk for incident diabetes.
- •Lower-than-normal glycemic levels “normalized” the diabetes risk from prediabetes.
- •Stringent glycemic control of prediabetes is beneficial for diabetes prevention.
Abstract
Aims/hypothesis
To determine whether lower than currently accepted glycemic levels could lead to optimal
risk reduction of incident diabetes among individuals with prediabetes.
Methods
We enrolled 9903 individuals with prediabetes and 16,902 individuals with normoglycemia
from a prospective cohort participating health check-ups between 2006 and 2017. While
classifying fasting glucose into <5.0, 5.0–5.5, and 5.6–6.9 mmol/L and postprandial
glucose into <6.7, 6.7–7.7, and 7.8–11.0 mmol/L, we grouped fasting/postprandial glucose
into five categories (<5.0/<6.7, <5.0/6.7–7.7, 5.0–5.5/<6.7, 5.0–5.5/6.7–7.7 mmol/L,
5.6–6.9/7.8–11.0 mmol/L). The primary outcome was incident diabetes.
Results
In individuals with prediabetes, the presence of a baseline fasting glucose <5.0 mmol/L
or a postprandial glucose <6.7 mmol/L led to a greater risk reduction of incident
diabetes with hazard ratios of 0.34 (95% confidence interval, 0.27–0.42) and 0.47
(0.41–0.54), respectively, relative to a fasting glucose 5.6–6.9 mmol/L and a postprandial
glucose 7.8–11.0 mmol/L. For individuals with prediabetes having fasting/postprandial
glucose <5.0/<6.7 mmol/L, the incidence of 6.4 (4.7–8.8) per 1000 person-years corresponded
to that of 5.8 (4.2–8.0) per 1000 person-years for individuals with normoglycemia
having 5.0–5.5/6.7–7.7 mmol/L.
Conclusions/interpretation
Given that lower-than-normal glycemic levels were plausible for optimal risk reduction
of diabetes, stringent glycemic management could be beneficial for diabetes prevention
among individuals with prediabetes.
Keywords
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Article info
Publication history
Published online: February 02, 2023
Accepted:
January 30,
2023
Received in revised form:
January 16,
2023
Received:
August 29,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
