Prediabetes: A window of opportunity to reduce healthcare burden

While the health risks associated with diabetes—including heart attacks and strokes—are well established, these risks could be present well before someone is even diagnosed with the condition, according to new research by The George Institute for Global Health published in the British Medical Journal.

The study found that prediabetes, defined by having higher than normal blood glucose levels but not enough to be classified as having diabetes, is associated with an increased risk of cardiovascular disease (CVD) and death.

Lead author Professor Yuli Huang, Honorary Fellow, Food Policy, at The George Institute for Global Health says the study showed there was a significant opportunity to prevent CVD by identifying and treating people earlier.

"The prevalence of prediabetes and diabetes is rising rapidly in epidemic proportions, especially in low- and middle-income countries. Early detection and proper treatment can have enormous benefits, but left unaddressed, the life-long complications and health impacts can be devastating," he said.

Researchers from The George Institute and Shunde Hospital, Southern Medical University, China analyzed 129 studies involving over 10 million people—the majority being from Europe, Asia and North America—who had prediabetes with and without existing CVD.

They looked at whether prediabetes was linked to higher rates of death and cardiovascular disease in people with and without a history of CVD and whether the criteria used to define prediabetes made a difference.

They found that compared with people who had normal blood glucose levels, those with prediabetes according to American Diabetes Association or World Health Organization criteria were at increased risk of CVD and more likely to die from any cause. Different definitions of prediabetes were associated with a similar outlook in patients who already had a history of CVD.

Professor Huang explained that prediabetes was controversial, and the term has been much debated.

"Some argue that describing people as having prediabetes creates more problems than benefits in terms of prevention and treatment and would put an unsustainable burden on health-care systems," he said.

"But considering the high prevalence of prediabetes, as well as its strong link to health risks seen in our study, successful intervention in this large population could have a major public health impact."

The prevalence of prediabetes is increasing worldwide. It is estimated that more than 470 million people will have prediabetes by 2030 and according to an American Diabetes Association up to 70 percent of these will go on to develop diabetes.

"What is especially concerning is the many millions of people who are unaware they have either condition and don't act early enough," says Professor Huang.

"Early detection and proper treatment can have enormous benefits, but left unaddressed, the life-long complications and health impacts can be devastating," he says.

The researchers hope the results of this study will turn prediabetes from a controversial term into a useful trigger for preventive care that will help address an escalating global health burden.