Classifying and communicating risks in prediabetes according to fasting glucose and/or glycated hemoglobin: PREDAPS cohort study

Abstract

Objective

Information about prognostic outcomes can be of great help for people with prediabetes and for physicians in the face of scientific controversy about the cutoff point for defining prediabetes. We aimed to estimate different prognostic outcomes in people with prediabetes.

Design

Prospective cohort of subjects with prediabetes according to American Diabetes Association guidelines.

Main Outcome measures

The probabilities of diabetes onset versus non-onset, the odds against diabetes onset, and the probability of reverting to normoglycemia according to different prediabetes categories were calculated.

Results

The odds against diabetes onset ranged from 29:1 in individuals with isolated FPG of 100–109 mg/dL to 1:1 in individuals with FPG 110–125 mg/dL plus HbA1c 6.0–6.4%. The probability of reversion to normoglycemia was 31.2% (95% CI 24.0–39.6) in those with isolated FPG 100–109 mg/dL and 6.2% (95% CI 1.4–10.0) in those with FPG 110–125 mg/dL plus HbA1c 6.0–6.4%. Of every 100 participants in the first group, 97 did not develop diabetes and 31 reverted to normoglycemia, while in the second group those figures were 52 and 6.

Conclusions

Using odds of probabilities and absolute numbers might be useful for people with prediabetes and physicians to share decisions on potential interventions.

Key points

• Communicating knowledge on the course of the disease to make clinical decisions is not always done appropriately.

• Prediabetes is an example where risk communication is important because the prognosis of subjects with prediabetes is very heterogeneous.

• Depending on fasting plasma glucose and HbA1c levels, the odds of probabilities against diabetes onset ranged from 29: 1 to 1: 1.

• Depending on fasting plasma glucose and HbA1c levels, the number of subjects in 100 who revert to normoglycemia ranged from 31 to 6.

• Using probabilities and number absolutes on the prognosis of prediabetes may be useful for people with prediabetes and physicians to share decisions on potential interventions.

Keywords:

• Prediabetes
• absolute risk
• odds
• progression
• cohort study

PREDAPS study group

Margarita Alonso (CS De la Eria, Asturias), Beatriz Álvarez (CS Andrés Mellado, Madrid), Fernando Álvarez (CS La Calzada 2, Asturias), J Carlos Álvarez (CS Eras de Renueva, León), M^a del Mar Álvarez (CS Hereza, Madrid), J Joaquín Antón (CS Murcia-Centro, Murcia), Oriol Armengol (EAP Poblenou, Barcelona), Sara Artola (CS José Marvá, Madrid), Luis Ávila (Consultorio Almachar, Málaga), Carmen Babace (CS Rodríguez Paterna, La Rioja), Lourdes Barutell (CS Andrés Mellado, Madrid), M^a Jesús Bedoya (CS Hereza, Madrid), Belén Benito (EAP Raval Sud, Barcelona), Beatriz Bilbeny (EAP Raval Sud, Barcelona), Marti Birules (EAP Poblenou, Barcelona), Concepción Blanco (CS Sada, A Coruña), M^a Isabel Bobé (EAP La Mina, Barcelona), Carmen Boente (CS Porriño, Pontevedra), Antonia Borras (CS Canal Salat, Baleares), Remei Bosch (EAP Girona 2, Girona), M^a Jesús Brito (CS La Matanza, Baleares), Pilar Buil (EAP Azpilagaña, Navarra), J José Cabré (EAP Reus-1, Tarragona), Ainoha Cambra (CS Arrabal, Zaragoza), Francisco Carbonell (CS Mislata, Valencia), Francisco Carramiñana (CS San Roque, Badajoz), Lourdes Carrillo (CS La Victoria de Acentejo, Santa Cruz de Tenerife), Ana Casorrán (CS Fuente de San Luis, Valencia), Rafael Colas (CS Santoña, Cantabria), Blanca Cordero (CS Sta. María de Benquerencia, Toledo), Xavier Cos (EAP Sant Martí de Provençals, Barcelona), Gabriel Cuatrecasas (CAP de Sarrià, Barcelona), Cristina De Castro (CS Sta. María de Benquerencia, Toledo), Manuel De la Flor (CS Ntra. Sra. de Gracia, Sevilla), Carlos De la Sen (Consultorio San Gabriel, Alicante), Rosa Mar De Miguel (EAP Pubillas Casas, Barcelona), A María De Santiago (Unidad Docente de Atención Familiar y Comunitaria, Guadalajara), Mercedes Del Castillo (CS Andrés Mellado, Madrid), M^a Carmen Durán (CS Lavadores Vigo, Pontevedra), Patxi Ezkurra (CS Zumaia, Guipúzcoa), Paula Gabriel (EAP Badia del Vallès, Barcelona), Javier Gamarra (CS Medina del Campo Rural, Valladolid), Francisco García (CS Don Benito Este, Badajoz), Luis García-Giralda (CS Murcia Centro, Murcia), F Javier García-Soidán (CS Porriño, Pontevedra), M^a Teresa Gijón (CS Los Yébenes, Madrid), Albert Goday (Endocrinología Hospital del Mar, Barcelona), Ángel Gómez (CS Lasarte, Guipúzcoa), María del Carmen Gómez (CS Vélez-Málaga Norte, Málaga), J Carles González (Girona 3, Girona), María González (CS Alcantarilla Sangonera, Murcia), Esteban Granero (CS Vista Alegre Murcia, Murcia), Ángela Trinidad Gutiérrez (CS El Calero, Las Palmas), Félix Gutiérrez (CS Bombarda-Monsalud, Zaragoza), Luisa Gutiérrez (CS Beraun, Guipúzcoa), M Ángel Gutiérrez (CS Ávila Sur Oeste, Ávila), Ana M^a Hernández (CS El Calero, Las Palmas) , Mercedes Ibáñez (CS Vandel, Madrid), Rosario Iglesias (CS Lain Entralgo, Madrid), Dimas Igual (CS Manuel Encinas, Cáceres), Jaime Innenaraty (CS Hereza Leganes, Madrid), Jaime Iriarte (CS Aizarnazabal-Getaria, Guipúzcua), Ángeles Jurado (CS Salvador Caballero, Granada), Rafael Llanes (Villanueva de la Cañada, Madrid), Flora López (EAP Martorell, Barcelona), Regina López (EAP El Carmel, Barcelona), Riánsares López (CS Artilleros, Madrid), Ángela Lorenzo (CS Alcalá de Guadaira, Madrid), Carmen Losada (UGC Adoratrices, Huelva), Ramón Macía (CS Roces Montevil, Asturias), Fernando Malo (CS Ares, A Coruña), José Mancera (CS Ciudad Jardín, Málaga), M^a José Mansilla (CS Martín de Vargas, Madrid), M^a Teresa Marín (CS General Ricardos, Madrid), José Luis Martín (CS Salvador Caballero, Granada), Ana Martínez (EAP El Carmel, Barcelona), F Javier Martínez (CS Federica Monseny, Madrid), Juan Martínez (CS Yecla, Murcia), M^a del Carmen Martínez (EAP Raval Sud, Barcelona), Rosario Martínez (CS Oñati, Guipúzcoa), Anna Massana (EAP Raval Sud), M^a Soledad Mayayo (CS Martín de Vargas, Madrid), J Javier Mediavilla (CS Burgos Rural, Burgos), Luis Mendo (CS Cadreita, Navarra), J Manuel Millaruelo (CS Torrero La Paz, Zaragoza), Alicia Monzón (CS Vecindario, Las Palmas) , Ana Moreno (CAP San Roque, Badajoz), Pedro Muñoz (Unidad Docente de Medicina Familiar y Comunitaria, Cantabria), Xavier Mundet (EAP Carmel, Barcelona), Teresa Mur (CAP Terrasa Sud, Barcelona), Emma Navarro (CS Añaza, Santa Cruz de Tenerife), Jorge Navarro (CS Salvador Pau, Valencia), Pedro Nogales (CS Las Águilas, Madrid), J Carlos Obaya (CS Chopera, Madrid), Cristina Oria (CS Aizarnazabal-Guetaria, Guipúzcoa), Francisco Javier Ortega (CS Campos-Lampreana, Zamora), Francisca Paniagua (CS Ciudad Jardín, Málaga), José Luis Pardo (CS Orihuela I, Alicante), Francisco Carlos Pérez (CS Martín de Vargas, Madrid), Pedro P Pérez (CS Mallen, Sevilla), Neus Piulats (EAP Raval Sud, Barcelona), Raquel Plana (CS Ponteareas, Pontevedra), Nuria Porta (CAP Terrassa Sud, Barcelona), Santiago Poveda (CS Jumilla, Murcia), Luis Prieto (CS Cáceres-La Mejostilla, Cáceres), Ramón Pujol (EAP Tremp, Lleida), Sol Reixa (CS Arrabal, Zaragoza), Jazmín Ripoll (CS Fuente de San Luis, Valencia), Antonio Rodríguez (EAP Anglès, Girona), J José Rodríguez (CS Villaviciosa de Odón, Madrid), M^a Angeles Rollán (CS Los Yébenes, Madrid), M^a Teresa Rollán (CS Hereza, Madrid), Laura Romera (EAP Raval Nord, Barcelona), Pilar Roura (EAP Badia de Vallès, Barcelona), Jóse Félix Rubio (CS Lasarte, Guipúzcua), Irene Ruiz (EAP La Torrassa, Barcelona), Manuel Antonio Ruiz (CS Agost, Alicante), Isabel Sáenz (CS Espronceda, Madrid), Julio Sagredo (CS Los Rosales, Madrid), Alejandro Salanova (CS Fuente de San Luis, Valencia), L Gabriel Sánchez (CS Carballeda, Zamora), Manuel Sánchez (CS Vista Alegre Murcia, Murcia), Gloria Sanz (CS San José centro, Zaragoza), Mateu Seguí (UBS Es Castell, Baleares), Josefina Servent (EAP El Carmel, Barcelona), Dulce Suárez (CS El Calero, Las Palmas) , Eduard Tarragó (EAP Bellvitge, Barcelona), Jesús Torrecilla (CS Bombarda-Monsalud, Zaragoza), José Luis Torres (CS Rodríguez Paterna, La Rioja), Merè Villaró (CAP Terrassa sud, Barcelona), Carmen Yuste (EAP Badia del Vallès, Barcelona).

Guarantor’s: E. Regidor is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Author contributions

ER and LCS analyzed and interpreted the data. LCS, ER and JFN wrote the outline and edited the manuscript. AR, AG, DC, JDE and SA reviewed/edited the manuscript and contributed to discussion. As reviewed and edited the manuscript. All authors read and approved the final manuscript

Disclosure statement

The declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Additional information

Funding

Sanofi and Novartis gave financial support for the development of the data collection platform, the meetings of researchers, and the monitoring of information collected at baseline. Sanofi and Novartis had no role in the study design, analysis and interpretation of data, writing of the manuscript, nor the decision to submit the manuscript for publication.