Association of prediabetes by fasting glucose and/or haemoglobin A1c levels with subclinical atherosclerosis and impaired renal function: Observations from the Dallas Heart Study

Frank Y F Xing, Ian J Neeland, M. Odette Gore, Colby R. Ayers, Andre R M Paixao, Aslan T Turer, Jarett D Berry, Amit Khera, James A de Lemos, Darren K McGuire

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Abstract

Background: Prediabetes defined by fasting plasma glucose (FPG) and glycosylated haemoglobin (HbA1c) predicts incident diabetes, but their individual and joint associations with micro- and macro-vascular risk remain poorly defined. Methods: FPG, HbA1c, coronary artery calcium (CAC), carotid wall thickness, estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) were measured in adults free from prior diabetes or cardiovascular disease (CVD) in the Dallas Heart Study 2 (DHS-2), a population-based cohort study. Prediabetes was defined by FPG 100.125 mg/dL and/or HbA1c 5.7%.6.4%. Multivariable logistic regression was used to analyse associations of HbA1c and/or FPG in the prediabetes range with subclinical atherosclerosis and renal measures. Results: The study comprised 2340 participants, median age = 49 years; 60% women and 50% black. Those with prediabetes were older (52 vs 48 years), more often men (63% vs 53%), black (53% vs 47%) and obese (58% vs 40%; p < 0.001 for each). Prediabetes was captured by FPG alone (43%), HbA1c alone (30%) or both (27%). Those with prediabetes by HbA1c or FPG versus normal HbA1c/FPG had more CAC [odds ratio (OR) = 1.8; 95% confidence interval (CI) = 1.5.2.2], higher carotid wall thickness (1.32 vs 1.29 mm, p < 0.001), eGFR < 60 mL/min [OR = 1.6 (95% CI = 1.1.2.4)], UACR > 30 mg/dL [OR = 1.8 (95% CI = 1.2.2.7)] and a higher odds for the composite eGFR + UACR [chronic kidney disease (CKD) ≥ 2] [OR = 1.9 (95% CI = 1.5.2.6)]. After multivariable adjustment, none of these associations remained significant. Conclusion: Prediabetes defined by HbA1c and/or FPG criteria is crudely associated with markers of diabetic macroand micro-vascular disease, but not after statistical adjustment, suggesting the relationships are attributable to other characteristics of the prediabetes population.

Original languageEnglish (US)
Pages (from-to)11-18
Number of pages8
JournalDiabetes and Vascular Disease Research
Volume11
Issue number1
DOIs
StatePublished - Jan 2014

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Prediabetic State
Fasting
Atherosclerosis
Hemoglobins
Kidney
Glucose
Social Adjustment
Glomerular Filtration Rate
Blood Vessels
Albumins
Creatinine
Urine
Glycosylated Hemoglobin A
Population Characteristics
Chronic Renal Insufficiency
Vascular Diseases
Coronary Vessels
Cohort Studies
Cardiovascular Diseases
Logistic Models

Keywords

  • HbA1c
  • impaired fasting glucose
  • nephropathy
  • prediabetes
  • subclinical atherosclerosis

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

@article{4aebe816d07b48d1b5a77ea285aba828,
title = "Association of prediabetes by fasting glucose and/or haemoglobin A1c levels with subclinical atherosclerosis and impaired renal function: Observations from the Dallas Heart Study",
abstract = "Background: Prediabetes defined by fasting plasma glucose (FPG) and glycosylated haemoglobin (HbA1c) predicts incident diabetes, but their individual and joint associations with micro- and macro-vascular risk remain poorly defined. Methods: FPG, HbA1c, coronary artery calcium (CAC), carotid wall thickness, estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) were measured in adults free from prior diabetes or cardiovascular disease (CVD) in the Dallas Heart Study 2 (DHS-2), a population-based cohort study. Prediabetes was defined by FPG 100.125 mg/dL and/or HbA1c 5.7{\%}.6.4{\%}. Multivariable logistic regression was used to analyse associations of HbA1c and/or FPG in the prediabetes range with subclinical atherosclerosis and renal measures. Results: The study comprised 2340 participants, median age = 49 years; 60{\%} women and 50{\%} black. Those with prediabetes were older (52 vs 48 years), more often men (63{\%} vs 53{\%}), black (53{\%} vs 47{\%}) and obese (58{\%} vs 40{\%}; p < 0.001 for each). Prediabetes was captured by FPG alone (43{\%}), HbA1c alone (30{\%}) or both (27{\%}). Those with prediabetes by HbA1c or FPG versus normal HbA1c/FPG had more CAC [odds ratio (OR) = 1.8; 95{\%} confidence interval (CI) = 1.5.2.2], higher carotid wall thickness (1.32 vs 1.29 mm, p < 0.001), eGFR < 60 mL/min [OR = 1.6 (95{\%} CI = 1.1.2.4)], UACR > 30 mg/dL [OR = 1.8 (95{\%} CI = 1.2.2.7)] and a higher odds for the composite eGFR + UACR [chronic kidney disease (CKD) ≥ 2] [OR = 1.9 (95{\%} CI = 1.5.2.6)]. After multivariable adjustment, none of these associations remained significant. Conclusion: Prediabetes defined by HbA1c and/or FPG criteria is crudely associated with markers of diabetic macroand micro-vascular disease, but not after statistical adjustment, suggesting the relationships are attributable to other characteristics of the prediabetes population.",
keywords = "HbA1c, impaired fasting glucose, nephropathy, prediabetes, subclinical atherosclerosis",
author = "Xing, {Frank Y F} and Neeland, {Ian J} and Gore, {M. Odette} and Ayers, {Colby R.} and Paixao, {Andre R M} and Turer, {Aslan T} and Berry, {Jarett D} and Amit Khera and {de Lemos}, {James A} and McGuire, {Darren K}",
year = "2014",
month = "1",
doi = "10.1177/1479164113514239",
language = "English (US)",
volume = "11",
pages = "11--18",
journal = "Diabetes and Vascular Disease Research",
issn = "1479-1641",
publisher = "SAGE Publications Ltd",
number = "1",

}

TY - JOUR

T1 - Association of prediabetes by fasting glucose and/or haemoglobin A1c levels with subclinical atherosclerosis and impaired renal function

T2 - Observations from the Dallas Heart Study

AU - Xing, Frank Y F

AU - Neeland, Ian J

AU - Gore, M. Odette

AU - Ayers, Colby R.

AU - Paixao, Andre R M

AU - Turer, Aslan T

AU - Berry, Jarett D

AU - Khera, Amit

AU - de Lemos, James A

AU - McGuire, Darren K

PY - 2014/1

Y1 - 2014/1

N2 - Background: Prediabetes defined by fasting plasma glucose (FPG) and glycosylated haemoglobin (HbA1c) predicts incident diabetes, but their individual and joint associations with micro- and macro-vascular risk remain poorly defined. Methods: FPG, HbA1c, coronary artery calcium (CAC), carotid wall thickness, estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) were measured in adults free from prior diabetes or cardiovascular disease (CVD) in the Dallas Heart Study 2 (DHS-2), a population-based cohort study. Prediabetes was defined by FPG 100.125 mg/dL and/or HbA1c 5.7%.6.4%. Multivariable logistic regression was used to analyse associations of HbA1c and/or FPG in the prediabetes range with subclinical atherosclerosis and renal measures. Results: The study comprised 2340 participants, median age = 49 years; 60% women and 50% black. Those with prediabetes were older (52 vs 48 years), more often men (63% vs 53%), black (53% vs 47%) and obese (58% vs 40%; p < 0.001 for each). Prediabetes was captured by FPG alone (43%), HbA1c alone (30%) or both (27%). Those with prediabetes by HbA1c or FPG versus normal HbA1c/FPG had more CAC [odds ratio (OR) = 1.8; 95% confidence interval (CI) = 1.5.2.2], higher carotid wall thickness (1.32 vs 1.29 mm, p < 0.001), eGFR < 60 mL/min [OR = 1.6 (95% CI = 1.1.2.4)], UACR > 30 mg/dL [OR = 1.8 (95% CI = 1.2.2.7)] and a higher odds for the composite eGFR + UACR [chronic kidney disease (CKD) ≥ 2] [OR = 1.9 (95% CI = 1.5.2.6)]. After multivariable adjustment, none of these associations remained significant. Conclusion: Prediabetes defined by HbA1c and/or FPG criteria is crudely associated with markers of diabetic macroand micro-vascular disease, but not after statistical adjustment, suggesting the relationships are attributable to other characteristics of the prediabetes population.

AB - Background: Prediabetes defined by fasting plasma glucose (FPG) and glycosylated haemoglobin (HbA1c) predicts incident diabetes, but their individual and joint associations with micro- and macro-vascular risk remain poorly defined. Methods: FPG, HbA1c, coronary artery calcium (CAC), carotid wall thickness, estimated glomerular filtration rate (eGFR) and urine albumin-to-creatinine ratio (UACR) were measured in adults free from prior diabetes or cardiovascular disease (CVD) in the Dallas Heart Study 2 (DHS-2), a population-based cohort study. Prediabetes was defined by FPG 100.125 mg/dL and/or HbA1c 5.7%.6.4%. Multivariable logistic regression was used to analyse associations of HbA1c and/or FPG in the prediabetes range with subclinical atherosclerosis and renal measures. Results: The study comprised 2340 participants, median age = 49 years; 60% women and 50% black. Those with prediabetes were older (52 vs 48 years), more often men (63% vs 53%), black (53% vs 47%) and obese (58% vs 40%; p < 0.001 for each). Prediabetes was captured by FPG alone (43%), HbA1c alone (30%) or both (27%). Those with prediabetes by HbA1c or FPG versus normal HbA1c/FPG had more CAC [odds ratio (OR) = 1.8; 95% confidence interval (CI) = 1.5.2.2], higher carotid wall thickness (1.32 vs 1.29 mm, p < 0.001), eGFR < 60 mL/min [OR = 1.6 (95% CI = 1.1.2.4)], UACR > 30 mg/dL [OR = 1.8 (95% CI = 1.2.2.7)] and a higher odds for the composite eGFR + UACR [chronic kidney disease (CKD) ≥ 2] [OR = 1.9 (95% CI = 1.5.2.6)]. After multivariable adjustment, none of these associations remained significant. Conclusion: Prediabetes defined by HbA1c and/or FPG criteria is crudely associated with markers of diabetic macroand micro-vascular disease, but not after statistical adjustment, suggesting the relationships are attributable to other characteristics of the prediabetes population.

KW - HbA1c

KW - impaired fasting glucose

KW - nephropathy

KW - prediabetes

KW - subclinical atherosclerosis

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U2 - 10.1177/1479164113514239

DO - 10.1177/1479164113514239

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C2 - 24344119

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VL - 11

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JO - Diabetes and Vascular Disease Research

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