Is prediabetes too late? normalization of hemoglobin A1C in prediabetes is not associated with improved outcomes
Journal of the American College of Cardiology
Background: Generally, prediabetes is accepted as a marker for clinicians to start implementing lifestyle or pharmacologic interventions for patients to prevent progression into Type II Diabetes Mellitus. The impact of normalizing hemoglobin A1c (HgA1c) on major adverse cardiovascular events (MACE) in patients with prediabetes is unclear. Methods: This is a retrospective chart review performed at Beaumont Health System in Michigan, and included data collected between 2006 and 2020. A total of 14,171 patients were included and split into 2 groups: prediabetes group and control group. The prediabetes group included individuals who were prediabetic and remained in the prediabetic range. The control group included patients that were initially prediabetic but then experienced normalization of HgbA1c. All patients were followed over the 14-year study period. MACE was defined as cerebrovascular accident (CVA), myocardial infarction (MI), Unstable Angina and Acute Coronary Syndrome and was determined by querying ICD codes. Chi-Square analysis was used to compare the rate of MACE between the groups. Results: A total of 12,691 patients and 1,480 were included in the prediabetes and control groups, respectively. The incidence of MACE in the prediabetes group (17.97%, 95% CI [17.3%, 18.63%]) was similar with the MACE incidence observed in the control group (17.97%, 95% CI [16.01%, 19.93%]) (p = 0.9943). Conclusion: Normalization of hemoglobin A1c in prediabetes does not appear to decrease the MACE risk. This indicates that the management of patients with prediabetes should be focused on preventing progression into diabetes and optimizing all of the other modifiable cardiovascular risk factors to reduce MACE related morbidity and mortality.
18 Suppl 1
Mando R, Michel A, Waheed M, Karabon P, Halalau A. Is prediabetes too late: normalization of hemoglobin A1C in prediabetes is not associated with improved outcomes. JACC 2021 May 11;77(18 Suppl 1):1603.