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Cited by 103Diabetes, Cardiovascular Risks, and LipoproteinsDiabetes Management and ResearchDiabetes Treatment and Management

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Association between pre-diabetes and microvascular and macrovascular disease in newly diagnosed type 2 diabetes

Open access
Palladino, Raffaele, Tabak, Adam G, Khunti, Kamlesh, Valabhji, Jonathan, Majeed, Azeem, Millett, Christopher, Vamos, Eszter P·2020·BMJ Open Diabetes Research & Care
DOI 10.1136/bmjdrc-2019-001061PMC PMC7202749
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Abstract

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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Figure 1 Prevalence of microvascular (retinopathy and nephropathy) and macrovascular (acute coronary syndrome, cerebrovascular, and peripheral arterial disease) diseases present at time of the diagnosis of type 2 diabetes according to glycemic status in the 3 years before the diagnosis of type 2 diabetes. A microvascular disease was considered being present at time of type 2 diabetes diagnosis if the condition was diagnosed between 5 years before and 15 months after the diagnosis of type 2 diabetes. A macrovascular disease was considered being present at time of type 2 diabetes diagnosis if the condition was diagnosed any time before the diagnosis and during the year following the diagnosis of type 2 diabetes. For the detection of pre-diabetes, the WHO/International Expert Committee diagnostic criteria were adopted (FPG: 6.1–6.9 mmol/L, OGTT 7.8–11.1 mmol/L, HbA1c 42 to 47 mmol/mol or 6.0%–6.4%). FPG, fasting plasma glucose; OGTT, oral glucose tolerance test; T2D, type 2 diabetes.
Figure 1 Prevalence of microvascular (retinopathy and nephropathy) and macrovascular (acute coronary syndrome, cerebrovascular, and peripheral arterial disease) diseases present at time of the diagnosis of type 2 diabetes according to glycemic status in the 3 years before the diagnosis of type 2 diabetes. A microvascular disease was considered being present at time of type 2 diabetes diagnosis if the condition was diagnosed between 5 years before and 15 months after the diagnosis of type 2 diabetes. A macrovascular disease was considered being present at time of type 2 diabetes diagnosis if the condition was diagnosed any time before the diagnosis and during the year following the diagnosis of type 2 diabetes. For the detection of pre-diabetes, the WHO/International Expert Committee diagnostic criteria were adopted (FPG: 6.1–6.9 mmol/L, OGTT 7.8–11.1 mmol/L, HbA1c 42 to 47 mmol/mol or 6.0%–6.4%). FPG, fasting plasma glucose; OGTT, oral glucose tolerance test; T2D, type 2 diabetes.CC BY-NC · PubMed Central
Figure 2 Association between glycemic testing and detection of pre-diabetes and presence of microvascular disease at the time of diagnosis of type 2 diabetes. Adjusted ORs and 95% CIs have been estimated employing multivariable logistic regression models adjusted for age, sex, ethnicity (white, South Asian, black, other, unknown), smoking status (non-smoker, ex-smoker, smoker), total cholesterol, systolic and diastolic blood pressure, number of coexisting chronic conditions, number of primary care visits in the previous year, general practice index of multiple deprivation, and year of diagnosis of type 2 diabetes. AOR, adjusted odds ratio; T2D, type 2 diabetes.
Figure 2 Association between glycemic testing and detection of pre-diabetes and presence of microvascular disease at the time of diagnosis of type 2 diabetes. Adjusted ORs and 95% CIs have been estimated employing multivariable logistic regression models adjusted for age, sex, ethnicity (white, South Asian, black, other, unknown), smoking status (non-smoker, ex-smoker, smoker), total cholesterol, systolic and diastolic blood pressure, number of coexisting chronic conditions, number of primary care visits in the previous year, general practice index of multiple deprivation, and year of diagnosis of type 2 diabetes. AOR, adjusted odds ratio; T2D, type 2 diabetes.CC BY-NC · PubMed Central
Figure 3 Association between glycemic testing and detection of pre-diabetes and presence of macrovascular disease at the time of diagnosis of type 2 diabetes. Adjusted ORs and 95% CIs have been estimated employing multivariable logistic regression models adjusted for age, sex, ethnicity (white, South Asian, black, other, unknown), smoking status (non-smoker, ex-smoker, smoker), total cholesterol, systolic and diastolic blood pressure, number of coexisting chronic conditions, number of primary care visits in the previous year, general practice index of multiple deprivation, and year of diagnosis of type 2 diabetes. AOR, adjusted odds ratio; T2D, type 2 diabetes.
Figure 3 Association between glycemic testing and detection of pre-diabetes and presence of macrovascular disease at the time of diagnosis of type 2 diabetes. Adjusted ORs and 95% CIs have been estimated employing multivariable logistic regression models adjusted for age, sex, ethnicity (white, South Asian, black, other, unknown), smoking status (non-smoker, ex-smoker, smoker), total cholesterol, systolic and diastolic blood pressure, number of coexisting chronic conditions, number of primary care visits in the previous year, general practice index of multiple deprivation, and year of diagnosis of type 2 diabetes. AOR, adjusted odds ratio; T2D, type 2 diabetes.CC BY-NC · PubMed Central

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  1. Ashra NB , Spong R , Carter P , et al . A systematic review and metaanalysis assessing the effectiveness of pragmatic lifestyle interventions for the prevention of type 2 diabetes mellitus in routine practice. London, the UK: Public Health England, 2015.

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Metadata

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)
DOI
10.1136/bmjdrc-2019-001061
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
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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