-
Metabolic Syndrome and Related Disorders Aug 2023Prediabetes is a novel risk factor recently associated with changes in the left ventricle. Our aim is to determine if prediabetes is associated with heart failure (HF)...
Prediabetes is a novel risk factor recently associated with changes in the left ventricle. Our aim is to determine if prediabetes is associated with heart failure (HF) and structural heart disease. We conducted a cross-sectional study and performed screening echocardiograms to consecutive primary care patients. We calculated the hemoglobin A1c (HbA1c) within 3 months of the echocardiogram and classified patients as having normal glucose, low-risk or high-risk prediabetes or diabetes. Our primary outcome was HF defined as an ejection fraction (EF) <50% and HF with preserved EF. Our secondary outcome was structural heart disease defined as having either a large atrium, left ventricular hypertrophy, or low EF. We included 15,056 patients who underwent a screening echocardiogram and had a recorded HbA1c. Only 2794 patients had a normal blood glucose, 4201 had low-risk prediabetes, 2499 had high-risk prediabetes, and the remainder had diabetes. The adjusted odds ratio (ORs) of HF for low-risk prediabetes, high-risk prediabetes and diabetes were 1.38 [confidence interval (95% CI) 1.07-1.78] ( = 0.01), 1.47 (95% CI 1.05-2.01) ( = 0.01), and 1.60 (95% CI 1.16-2.01) ( < 0.01), respectively, when compared with normoglycemic patients. The adjusted OR of HF with preserved EF for low- and high-risk prediabetes and diabetes were 1.17 (95% CI 0.86-1.60) ( = 0.30), 1.60 (95% CI 1.15-2.21) ( < 0.01), and 1.63 (95% CI 1.24-2.13) ( < 0.01), respectively, when compared with normoglycemic patients. Prediabetes is a prevalent condition associated with structural heart disease and HF.
Topics: Humans; Stroke Volume; Prediabetic State; Cross-Sectional Studies; Glycated Hemoglobin; Heart Failure; Ventricular Function, Left; Primary Health Care
PubMed: 35930273
DOI: 10.1089/met.2021.0006 -
Journal of the American Board of Family... 2020Prediabetes is increasing in prevalence and is associated with risk of developing diabetes, heart disease, stroke, and retinopathy. Clinicians have limited tools to...
BACKGROUND
Prediabetes is increasing in prevalence and is associated with risk of developing diabetes, heart disease, stroke, and retinopathy. Clinicians have limited tools to facilitate prediabetes discussions within primary care visits.
PURPOSE
1) Develop a Patient and Stakeholder Advisory Committee (PASAC) to design, evaluate, and revise a prediabetes shared decision aid, and 2) evaluate the feasibility and experience of implementing the tool within primary care practice.
METHODS
A prediabetes decision aid (double-sided infographic with decision questions) was created by a PASAC that included patients, primary care clinicians, diabetes educators, endocrinologists, and pharmacists. Five clinicians within 3 primary care practices tested the prediabetes tool with 50 adult patients with prediabetes. Patients completed 2 surveys immediately after the office visit and 6 weeks later. Clinicians and PASAC members completed a postintervention survey.
RESULTS
The prediabetes shared decision aid was created through a deliberative process over 3 PASAC meetings. Ninety-six percent of patients felt the tool prepared them to decide on a diabetes prevention plan, and 100% of clinicians would use the tool again and felt the tool did not extend visit length.
DISCUSSION
It was feasible to cocreate a prediabetes shared decision aid within a PASAC and implement the tool within a primary care setting. Patients and clinicians reported a prediabetes discussion, which may mitigate rates of progression to diabetes and associated complications. Future research should evaluate which of the intervention components most effectively promotes discussion of prediabetes within a primary care setting.
Topics: Adult; Decision Support Techniques; Diabetes Mellitus; Humans; Pharmacists; Prediabetic State; Primary Health Care
PubMed: 32179609
DOI: 10.3122/jabfm.2020.02.190070 -
Circulation. Cardiovascular Imaging Oct 2023
Topics: Adult; Humans; Prediabetic State; Coronary Artery Disease; Cardiovascular Diseases; Protestantism; Florida; Risk Factors; Diabetes Mellitus; Heart Disease Risk Factors
PubMed: 37772410
DOI: 10.1161/CIRCIMAGING.123.016079 -
Metabolic Syndrome and Related Disorders May 2023The metabolic syndrome (MetS) is a cluster of risk factors for cardiovascular disease (CVD). Prediabetes is defined by either impaired glucose tolerance or by one of the... (Review)
Review
The metabolic syndrome (MetS) is a cluster of risk factors for cardiovascular disease (CVD). Prediabetes is defined by either impaired glucose tolerance or by one of the more sensitive or more stringent criterion for impaired fasting glucose (IFG) or HbA1c levels that have been promulgated over the years. IFG is one of the risk factors for CVD included in the definition of the MetS. However, there is very little evidence that IFG is independently associated with CVD regardless of which criterion is used for its diagnosis. The CVD risk of the MetS is related to the other risk factors of central obesity, hypertension, elevated triglyceride, and low high-density lipoprotein cholesterol levels. If the components of the MetS are supposed to be risk factors for CVD, the dysglycemia of prediabetes should not be included in its definition.
Topics: Humans; Metabolic Syndrome; Prediabetic State; Risk Factors; Glucose Intolerance; Cardiovascular Diseases; Blood Glucose
PubMed: 37042661
DOI: 10.1089/met.2023.0005 -
Journal of the American Board of Family... 2021Lifestyle modification can significantly reduce the risk of developing diabetes. However, the effect of prediabetes status awareness on perceptions of health and health...
INTRODUCTION
Lifestyle modification can significantly reduce the risk of developing diabetes. However, the effect of prediabetes status awareness on perceptions of health and health behaviors are mixed. We used the 2015 to 2016 National Health and Nutrition Examination Survey (NHANES) data to evaluate the association of prediabetes status awareness with self-reported perception of health and health behaviors.
METHODS
A secondary analysis was performed on the 2015 to 2016 NHANES, which is a biannual, cross-sectional survey designed to be representative of the civilian, noninstitutionalized United States population. Survey participants were interviewed at home and invited to a mobile examination center to undergo examinations and laboratory measurements. Inclusion and exclusion criteria were applied to create prediabetes-aware and prediabetes-unaware groups. The groups were propensity-score matched based on Body Mass Index, A1c, race, and education. Measures of health perception and health behaviors were analyzed, including feeling at risk for developing diabetes, general health status, perception of weight, desire to lose weight, dietary behaviors, and physical activity behaviors.
RESULTS
Participants who were prediabetes aware were more likely to report a perceived risk of diabetes and to consider themselves overweight. Prediabetes awareness was not associated with any difference in dietary or physical activity behaviors.
CONCLUSIONS
Although participants who were aware of their prediabetes status were more likely to report a perceived threat of developing diabetes, they did not report increased engagement in health behaviors. Future research can better understand how these aspects of a health belief model affect engagement in health behaviors for people with prediabetes.
Topics: Cross-Sectional Studies; Diabetes Mellitus; Humans; Nutrition Surveys; Perception; Prediabetic State; United States
PubMed: 33452101
DOI: 10.3122/jabfm.2021.01.200146 -
Drugs Nov 2020Fasting hyperglycemia, impaired glucose tolerance, prediabetes, and diabetes are frequently present in patients treated with second-generation antipsychotics (SGAPs) for... (Review)
Review
Fasting hyperglycemia, impaired glucose tolerance, prediabetes, and diabetes are frequently present in patients treated with second-generation antipsychotics (SGAPs) for schizophrenia, bipolar disorder, and other severe mental illnesses. These drugs are known to produce weight gain, which may lead to insulin resistance, glucose intolerance, and metabolic syndrome, which constitute important risk factors for the emergence of diabetes. The aim of this review was to formulate therapeutic guidelines for the management of diabetes in patients treated with SGAPs, based on the association between SGAP-induced weight gain and glucose dysregulation. A systematic search in PubMed from inception to March 2020 for randomized controlled trials (RCTs) of diabetes or prediabetes in patients treated with SGAPs was performed. PubMed was also searched for the most recent clinical practice guidelines of interventions for co-morbid conditions associated with diabetes mellitus (DM) (arterial hypertension and dyslipidemia), lifestyle interventions and switching from high metabolic liability SGAPs to safer SGAPs. The search identified 14 RCTs in patients treated with SGAPs. Drug therapy using metformin as first-line therapy and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) or perhaps sodium-glucose cotransporter-2 (SGLT2) inhibitors as add-on therapy, might be preferred in these patients as well, as they favorably influence glucose metabolism and body mass index, and provide cardio-renal benefits in general to the DM population, although for the SGLT-2 inhibitors there are no RCTs in this specific patient category so far. Metformin is also useful for treatment of prediabetes. Arterial hypertension should be treated with angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers, and statins should be used for correction of dyslipidemia. The outcome of lifestyle-changing interventions has been disappointing. Switching from clozapine, olanzapine, or quetiapine to lower cardiometabolic-risk SGAPs, like aripiprazole, brexpiprazole, cariprazine, lurasidone, or ziprasidone, has been recommended.
Topics: Antipsychotic Agents; Bipolar Disorder; Blood Glucose; Drug Substitution; Glucose Intolerance; Healthy Lifestyle; Humans; Hyperglycemia; Hypoglycemic Agents; Practice Guidelines as Topic; Prediabetic State; Randomized Controlled Trials as Topic; Schizophrenia; Treatment Outcome
PubMed: 32930957
DOI: 10.1007/s40265-020-01393-x -
Metabolic Syndrome and Related Disorders Apr 2021To characterize the associations of clinical risk factors, lifestyle factors, and wellness measures with prediabetes and new type 2 diabetes mellitus (T2DM) diagnosis...
To characterize the associations of clinical risk factors, lifestyle factors, and wellness measures with prediabetes and new type 2 diabetes mellitus (T2DM) diagnosis in Hispanic adults and guide primary prevention. Biobank enrolled 3733 Hispanic adults from Phoenix, AZ, United States, from 2013 to 2018. This analysis included participants with euglycemia, prediabetes, or new T2DM diagnosis (, no prior T2DM diagnosis) at enrollment. Participants completed a baseline questionnaire on cardiometabolic risk factors and wellness measures and provided biometric measurements. The associations of factors and measures with odds (95% confidence interval) of prediabetes and new T2DM diagnosis were analyzed in logistic regression models. Among 3299 participants with euglycemia ( = 1301), prediabetes ( = 1718), and new T2DM diagnosis ( = 280) at enrollment, 72% were women ( = 2376/3299). In adjusted models, most cardiometabolic risk factors were positively associated with prediabetes and new T2DM diagnosis, with stronger associations for new T2DM diagnosis. Obesity (body mass index ≥30 kg/m vs. lower) was associated with higher odds of new T2DM diagnosis (3.14 [2.30-4.28]; < 0.01) than prediabetes versus euglycemia (1.96 [1.66-2.32]; < 0.01) and Interaction ( = 0.01). Similarly, waist circumference, family history of diabetes, and average systolic and diastolic blood pressure were associated with higher odds of new T2DM diagnosis versus euglycemia than prediabetes versus euglycemia. Using stepwise logistic regression modeling, a parsimonious model of age, family history of diabetes, waist circumference, diastolic blood pressure, passive tobacco exposure, and self-rated general health were associated with new T2DM diagnosis versus euglycemia. In Hispanic adults, modifiable cardiometabolic and lifestyle factors were associated with prediabetes and new T2DM diagnosis. Personalized interventions targeting these factors and measures could guide T2DM primary prevention efforts among Hispanic adults.
Topics: Adult; Diabetes Mellitus, Type 2; Female; Hispanic or Latino; Humans; Prediabetic State; Risk Factors; Waist Circumference
PubMed: 33439762
DOI: 10.1089/met.2020.0102 -
Frontiers in Endocrinology 2023Diabetes Mellitus is a public health problem associated with complications such as neuropathy; however, it has been proposed that these may begin to develop during... (Review)
Review
Diabetes Mellitus is a public health problem associated with complications such as neuropathy; however, it has been proposed that these may begin to develop during prediabetes and may also be present in persons with obesity. Diabetic peripheral neuropathy is the presence of signs and/or symptoms of peripheral nerve dysfunction in people living with diabetes, which increases the risk of developing complications and has a deleterious impact on quality of life. As part of the therapeutic protocol for diabetes, screening tests to identify peripheral neuropathy are suggested, however, there are no recommendations for people with prediabetes and obesity without symptoms such as pain, numbness, or paresthesias. Moreover, clinical screening tests that are usually used to recognize this alteration, such as tendon reflex, temperature sensation, and pressure and vibration perception, might be subjective as they depend on the evaluator's experience thus the incorrect application of these tests may not recognize the damage to small or large-nerve fibers. Recent evidence suggests that an objective study such as the impairment of the rate-dependent depression of the H-reflex could be used as a biomarker of spinal disinhibition and hence may provide more information on sensorimotor integration.
Topics: Humans; Prediabetic State; H-Reflex; Quality of Life; Diabetic Neuropathies; Obesity
PubMed: 37476495
DOI: 10.3389/fendo.2023.1206552 -
Primary Care Diabetes Feb 2023Neuropathic pain is associated with several clinical conditions, including anxiety, depression, sleep disorders, and decreased quality of life; however, less evaluated...
AIMS
Neuropathic pain is associated with several clinical conditions, including anxiety, depression, sleep disorders, and decreased quality of life; however, less evaluated in prediabetes. This study aims to assess neuropathic pain through validated diagnostic tools in prediabetes.
METHODS
One hundred and seventy-two patients with prediabetes and 170 controls were included in this cross-sectional study. The Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) Pain Scale and Douleur Neuropathique 4 Questions (DN4) were used to evaluate neuropathic pain. The Visual Analog Scale (VAS) was used to estimate pain intensity.
RESULTS
Twenty-three (13.4%) and 12 (7%) patients with prediabetes were diagnosed with neuropathic pain using DN4 and LANSS questionnaires, respectively. Neuropathic pain rates of the patients were higher than controls with two pain scales (p < 0.001). VAS scores were higher in prediabetes group than in controls (p = 0.021). LANSS, DN4, and VAS scores were positively correlated with HbA1c level (r = 0.184, p = 0.016; r = 0.180, p = 0.018; r = 0.188, p = 0.014, respectively). LANNS and DN4 scores were higher in female patients than in males (p < 0.001).
CONCLUSIONS
Neuropathic pain was increased in prediabetes by DN4 and LANNS questionnaires. An appropriate diagnosis of neuropathic pain in prediabetes may prevent patients from different pain-related clinical conditions.
Topics: Male; Humans; Female; Cross-Sectional Studies; Prediabetic State; Quality of Life; Reproducibility of Results; Neuralgia; Surveys and Questionnaires
PubMed: 36435735
DOI: 10.1016/j.pcd.2022.11.004 -
JAMA Aug 2021Type 2 diabetes is common and is a leading cause of morbidity and disability. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Type 2 diabetes is common and is a leading cause of morbidity and disability.
OBJECTIVE
To review the evidence on screening for prediabetes and diabetes to inform the US Preventive Services Task Force (USPSTF).
DATA SOURCES
PubMed/MEDLINE, Cochrane Library, and trial registries through September 2019; references; and experts; literature surveillance through May 21, 2021.
STUDY SELECTION
English-language controlled studies evaluating screening or interventions for prediabetes or diabetes that was screen detected or recently diagnosed.
DATA EXTRACTION AND SYNTHESIS
Dual review of abstracts, full-text articles, and study quality; qualitative synthesis of findings; meta-analyses conducted when at least 3 similar studies were available.
MAIN OUTCOMES AND MEASURES
Mortality, cardiovascular morbidity, diabetes-related morbidity, development of diabetes, quality of life, and harms.
RESULTS
The review included 89 publications (N = 68 882). Two randomized clinical trials (RCTs) (25 120 participants) found no significant difference between screening and control groups for all-cause or cause-specific mortality at 10 years. For harms (eg, anxiety or worry), the trials reported no significant differences between screening and control groups. For recently diagnosed (not screen-detected) diabetes, 5 RCTs (5138 participants) were included. In the UK Prospective Diabetes Study, health outcomes were improved with intensive glucose control with sulfonylureas or insulin. For example, for all-cause mortality the relative risk (RR) was 0.87 (95% CI, 0.79 to 0.96) over 20 years (10-year posttrial assessment). For overweight persons, intensive glucose control with metformin improved health outcomes at the 10-year follow-up (eg, all-cause mortality: RR, 0.64 [95% CI, 0.45 to 0.91]), and benefits were maintained longer term. Lifestyle interventions (most involving >360 minutes) for obese or overweight persons with prediabetes were associated with reductions in the incidence of diabetes (23 RCTs; pooled RR, 0.78 [95% CI, 0.69 to 0.88]). Lifestyle interventions were also associated with improved intermediate outcomes, such as reduced weight, body mass index, systolic blood pressure, and diastolic blood pressure (pooled weighted mean difference, -1.7 mm Hg [95% CI, -2.6 to -0.8] and -1.2 mm Hg [95% CI, -2.0 to -0.4], respectively). Metformin was associated with a significant reduction in diabetes incidence (pooled RR, 0.73 [95% CI, 0.64 to 0.83]) and reduction in weight and body mass index.
CONCLUSIONS AND RELEVANCE
Trials of screening for diabetes found no significant mortality benefit but had insufficient data to assess other health outcomes; evidence on harms of screening was limited. For persons with recently diagnosed (not screen-detected) diabetes, interventions improved health outcomes; for obese or overweight persons with prediabetes, interventions were associated with reduced incidence of diabetes and improvement in other intermediate outcomes.
Topics: Adult; Aged; Cause of Death; Diabetes Mellitus, Type 2; Female; Humans; Male; Mass Screening; Middle Aged; Obesity; Overweight; Prediabetic State; Risk Reduction Behavior
PubMed: 34427595
DOI: 10.1001/jama.2021.10403