Association between pre-diabetes and microvascular and macrovascular disease in newly diagnosed type 2 diabetes
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Objective: The associated risk of vascular disease following diagnosis of type 2 diabetes in people previously identified as having pre-diabetes in real-world settings is unknown. We examined the presence of microvascular and macrovascular disease in individuals with newly diagnosed type 2 diabetes by glycemic status within 3 years before diagnosis. Research design and methods: We identified 159 736 individuals with newly diagnosed type 2 diabetes from the UK Clinical Practice Research Datalink database in England between 2004 and 2017. We used logistic regression models to compare presence of microvascular (retinopathy and nephropathy) and macrovascular (acute coronary syndrome, cerebrovascular and peripheral arterial disease) disease at the time of type 2 diabetes diagnosis by prior glycemic status. Results: Half of the study population (49.9%) had at least one vascular disease, over one-third (37.4%) had microvascular disease, and almost a quarter (23.5%) had a diagnosed macrovascular disease at the time of type 2 diabetes diagnosis. Compared with individuals with glycemic values within the normal range, those detected with pre-diabetes before the diagnosis had 76% and 14% increased odds of retinopathy and nephropathy (retinopathy: adjusted OR (AOR) 1.76, 95% CI 1.69 to 1.85; nephropathy: AOR 1.14, 95% CI 1.10 to 1.19), and 7% higher odds of the diagnosis of acute coronary syndrome (OR 1.07, 95% CI 1.03 to 1.12) in fully adjusted models at time of diabetes diagnosis. Conclusions: Microvascular and macrovascular diseases are detected in 37%–24% of people with newly diagnosed type 2 diabetes. Pre-diabetes before diagnosis of type 2 diabetes is associated with increased odds of microvascular disease and acute coronary syndrome. Detection of pre-diabetes might represent an opportunity for reducing the burden of microvascular and macrovascular disease through heightened attention to screening for vascular complications.
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Similar impact on diabetes complications was reported with screening, diagnosis, and comprehensive risk factor management in the U.K. Clinical Practice Research Datalink database.
“Similar impact on diabetes complications was reported with screening, diagnosis, and comprehensive risk factor management in the U.K. Clinical Practice Research Datalink database (97).”
From 2. Diagnosis and Classification of Diabetes: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [97]
The Methods (Study population; page unavailable) confirm that the study used the UK Clinical Practice Research Datalink, and the Results (Secondary analyses; page unavailable) report lower odds of vascular disease among people with a recorded pre-diabetes diagnosis than among those with pre-diabetes but no diagnostic code. The paper suggests that coding might be associated with more intensive risk-factor management, but it did not measure comprehensive management or establish that screening and management caused a reduction in complications. (LLM, conf=0.87)
Experimental — accuracy not yet measuredRisk models have explored the benefit of intervention, generally finding higher benefit of intervention in those at highest risk, and reduce the risk of diabetes complications.
“Risk models have explored the bene fi t, in general fi nding higher bene fi t of intervention in those at highest risk (96) (see Section 3, ' Prevention or Delay of Diabetes and Associated Comorbidities ' ) and reduce the risk of diabetes complications (97)”
From 2. Diagnosis and Classification of Diabetes: <i>Standards of Care in Diabetes—2024</i> (2024) · cites this paper as [97]
Many people in remission from type 2 diabetes remain in the pre-diabetes range of HbA1c, where cardiovascular disease risk begins to rise.
“However, many people in remission from type 2 diabetes remain in the pre-diabetes range of HbA1c, where cardiovascular disease risk begins to rise [92, 93].”
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The Natural History of Prediabetes and Cardiovascular Disease in the Pediatric Population
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Carpal Tunnel Syndrome and Trigger Finger May Be an Early Symptom of Preclinic Type 2 Diabetes
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Modern-Day Management of the Dysglycemic Continuum: An Expert Viewpoint from the Arabian Gulf
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A Lifestyle Communication Tool: Association of E-cigarette Use and Pre-diabetes
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- Authors
- Palladino, R., Tabak, A. G., Khunti, K., Valabhji, J., Majeed, A., Millett, C., & Vamos, E. P.
- Affiliations
- Imperial College London (GB)
- Department of Epidemiology and Public Health, University College London, London, UK
- University of Leicester (GB)
- Imperial College Healthcare NHS Trust (GB)
- Corresponding author
- Palladino, Raffaele
- ORCID
- Venue
- BMJ Open Diabetes Research & Care
- Publisher
- BMJ
- Published
- 2020-04
- Volume
- 8
- Issue
- 1
- Pages
- e001061
- ISSN
- 2052-4897 (ISSN-L)
- PMC
- PMC7202749
- OpenAlex
- W3019785267
- Cited by
- 98
- References
- 50
- Citations by year
- 2026: 12 · 2025: 11 · 2024: 25 · 2023: 15 · 2022: 18 · 2021: 10 · 2020: 7
- FWCI
- 9.43
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMJ Open Diabetes Research & Care (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion, cc-by-nc)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc)
- Spiral (Imperial College London) (submittedVersion, cc-by-nc)
- Funders
- National Institute for Health and Care Research
- Department of Health and Social Care
- Imperial College London
- 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, newly diagnosed diabetes, microangiopathy, macroangiopathy, diabetic retinopathy, diabetic nephropathy, acute coronary syndrome, cerebrovascular disease, peripheral arterial disease, glycemic status, vascular complications, screening
- MeSH terms
- Blood Glucose, Diabetes Mellitus, Type 2, Diabetic Angiopathies, Humans, Prediabetic State, Vascular Diseases
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