Progression rates from HbA1c 6.0-6.4% and other prediabetes definitions to type 2 diabetes: a meta-analysis
Open accessAbstract
Aims/hypothesis Precise estimates of progression rates from 'prediabetes' to type 2 diabetes are needed to optimise prevention strategies for high-risk individuals. There is acceptance of prediabetes defined by impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), but there is some controversy surrounding HbA1c-defined prediabetes ranges, with some favouring 6.0-6.4% (42-46 mmol/mol). Comparing progression rates between groups might aid this issue, thus we aimed to accurately estimate progression rates to diabetes from different prediabetes categories.Methods Meta-analysis of prospective observational studies in which participants had prediabetes at baseline (ADA-defined IFG [5.6-6.9 mmol/l], WHO-defined IFG [6.1-6.9 mmol/l], IGT (7.8-11.0 mmol/l) or raised HbA1c [6.0-6.4%/42-46 mmol/mol]) and were followed up for incident diabetes. Incidence rates were combined using Bayesian random effects models.Results Overall, 70 studies met the inclusion criteria. In the six studies that used raised HbA1c, the pooled incidence rate (95% credible interval) of diabetes was 35.6 (15.1, 83.0) per 1,000 person-years. This rate was most similar to that for ADA-defined IFG (11 studies; 35.5 [26.6, 48.0]) and was non-significantly lower than WHO-defined IFG (34 studies; 47.4 [37.4, 59.8]), IGT (46 studies, 45.5 [37.8, 54.5]) and IFG plus IGT (15 studies, 70.4 [53.8, 89.7]). Similar results were seen when the data were analysed by the criteria used to diagnose diabetes.Conclusions/interpretation This study provides evidence that progression rates differ by prediabetes definition, which has implications for the planning and implementation of diabetes prevention programmes. HbA1c 6.0-6.4% might identify people at a lower diabetes risk than other prediabetes definitions, but further research is needed.
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The number of participants diagnosed with T2DM in the control groups in the included trials was higher than that estimated from observational studies.
“The number of participants diagnosed with T2DM in the control groups in the included trials was higher than that estimated from observational studies (Cheng 2006; Morris 2013).”
From Diet, physical activity or both for prevention or delay of type 2 diabetes mellitus and its associated complications in people at increased risk of developing type 2 diabetes mellitus (2017) · cites this paper as Morris 2013
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- Authors
- Morris, D. H., Khunti, K., Achana, F., Srinivasan, B., Gray, L. J., Davies, M. J., & Webb, D.
- Affiliations
- University of Leicester (GB)
- Corresponding author
- Morris, D. H.
- Venue
- Diabetologia
- Published
- 2013-04-13
- Volume
- 56
- Issue
- 7
- Pages
- 1489-1493
- ISSN
- 0012-186X (ISSN-L)
- 1432-0428
- OpenAlex
- W2019934596
- Cited by
- 229
- References
- 10
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 12 · 2023: 16 · 2022: 13 · 2021: 16 · 2020: 21 · 2019: 27 · 2018: 23 · 2017: 23 · 2016: 28 · 2015: 18 · 2014: 16 · 2013: 3
- FWCI
- 17.04
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Diabetologia (publishedVersion)
- PubMed (publishedVersion)
- Figshare (submittedVersion, cc-by)
- Leicester Research Archive (University of Leicester) (submittedVersion, other-oa)
- Funders
- University Hospitals of Leicester NHS Trust
- National Institute for Health and Care Research (RP-DG-1210-10183, RP-PG-0606-1272)
- Diabetes UK
- University of Leicester
- Loughborough University
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- prediabetes, type 2 diabetes, disease progression rate, HbA1c, impaired fasting glucose, impaired glucose tolerance, diabetes incidence, diabetes prevention
- MeSH terms
- Diabetes Mellitus, Type 2, Glycated Hemoglobin, Humans, Prediabetic State, Prospective Studies, Disease Progression
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