Identified evidence suggests that cardiovascular disease ( CVD ) prevention services should consider regulation of blood glucose as a key target for intervention .
The primary objective of this study was to analyze the most up-to- date evidence regarding whether and how blood sugar regulation influences cardiovascular health promotion and disease prevention by carrying out an umbrella review .
Cardiovascular and renal burdens of prediabetes in the USA: analysis of data from serial cross-sectional surveys, 1988-2014.
BACKGROUND There is controversy over the usefulness of prediabetes as a diagnostic label . Using data from US National Health and Nutrition Examination Surveys ( NHANES ) between 1988 and 2014 , we examined the cardiovascular and renal burdens in adults with prediabetes over time and compared patterns with other glycaemic status groups . METHODS We analysed  cross-sectional survey data from non-pregnant adults aged 20 years and older from the NHANES survey periods 1988 - 94 , 1999 - 2004 , 2005 - 10 , and 2011 - 14 . We defined diagnosed diabetes as patients ' self-report that they had been previously diagnosed by a physician or health professional ; among those with no self-reported diabetes , prediabetes was defined as a fasting plasma glucose ( FPG ) concentration of 100 - 125 mg/dL ( 5·6 - 6·9 mmol/L ) or an HbA1c of 5·7 - 6·4 % ( 39 - 47 mmol/mol ) ; undiagnosed diabetes as an FPG of 126 mg/dL ( 7·0 mmol/L ) or higher or an HbA1c of 6·5 % ( 48 mmol/mol ) or higher ; and normal glycaemic status as an FPG of less than 100 mg/dL ( 5·6 mmol/L ) and an HbA1c of less than 5·7 % ( 39 mmol/mol ) . We repeated the analyses using varying definitions of prediabetes ( FPG 110 - 125 mg/dL [ 6·1 - 6·9 mmol/L ] or HbA1c 5·7 - 6·4 % [ 39 - 47 mmol/mol ] , FPG 110 - 125 mg/dL [ 6·1 - 6·9 mmol/L ] or HbA1c 6·0 - 6·4 % [ 42 - 47 mmol/mol ] , and FPG 100 - 125 mg/dL [ 5·6 - 6·9 mmol/L ] and HbA1c 5·7 - 6·4 % [ 39 - 47 mmol/mol ] ) . For each group over time , we estimated the prevalences of hypertension and dyslipidaemia ; and among individuals with those conditions , we estimated the proportions who had been treated and who were achieving care goals . By glycaemic group , we estimated those who were current , former , and never smokers ; mean 10-year risk of cardiovascular disease ( using estimators from the Framingham Heart Study , the United Kingdom Prospect i ve Diabetes Study ( UKPDS ) , and the ACC/AHA ASCVD guidelines ) ; albuminuria ( median and albumin-to-creatinine ratio ≥30 mg/g ) , estimated glomerular filtration rate ( eGFR ; mean and < 60 mL/min per 1·73m2 ) ; and prevalence of myocardial infa rct ion and stroke . For all estimates , we calculated predicted changes between 1988 - 94 and 2011 - 14 using logistic regression models adjusted for age , sex , and race or ethnic group . FINDINGS We obtained data for 27 971 eligible individuals . In 2011 - 14 , in the population of adults with prediabetes , 36·6 % ( 95 % CI 32·8 - 40·5 ) had hypertension , 51·2 % ( 47·0 - 55·3 ) had dyslipidaemia , 24·3 % ( 21·7 - 27·3 ) smoked ; 7·7 % ( 6·8 - 8·8 ) had albuminuria ; 4·6 % ( 3·7 - 5·9 ) had reduced eGFR ; and 10-year cardiovascular event risk ranged from 5 % to 7 % . From 1988 - 94 to 2011 - 14 , adults with prediabetes showed significant increases in hypertension ( + 9·7 percentage points [ 95 % CI 5·4 - 14·0 ] ) ; no change in dyslipidaemia ; decreases in smoking ( -6·4 percentage points [ -10·7 to -2·1 ] ) ; increased use of treatment to lower blood pressure ( 54·2 % [ 49·0 - 59·3 ] to 81·4 % [ 76·7 - 85·3 ] , + 27·2 percentage points [ 20·5 - 33·8 ] p<0·0001 ) and to reduce lipids ( 6·6 % to 40·2 % , + 33·6 percentage points [ 30·2 - 37·0 ] , p<0·0001 ) ; and increased goal achievements for blood pressure ( 25·8 % to 62·0 % , + 36·2 percentage points [ 30·7 - 41·8 ] , p<0·0001 ) and lipids ( 1·0 % to 32·8 % , + 31·8 percentage points [ 29·1 - 34·4 , p<0·0001 ] ) . People with prediabetes also showed decreases in cardiovascular risk ( ASCVD -1·9 percentage points [ -2·5 to -1·3 ] to UKPDS -2·7 [ -3·5 to -1·9 ] , p<0·0001 ) ; but no change in prevalence of albuminuria , reduced eGFR , myocardial infa rct ion , or stroke . Prevalence and patterns were consistent across all prediabetes definitions examined . Compared with adults with prediabetes , adults with diagnosed diabetes showed much larger improvements in cardiovascular and renal risk treatments , apart from smoking , which did not decline . INTERPRETATION Over 25 years , cardiovascular and renal risks and disease have become highly prevalent in adults with prediabetes , irrespective of the definitions used . Identification of people with prediabetes might increase the opportunity for cardiovascular and renal risk reduction . FUNDING None
Identified evidence suggests that cardiovascular disease ( CVD ) prevention services should consider regulation of blood glucose as a key target for intervention .
The primary objective of this study was to analyze the most up-to- date evidence regarding whether and how blood sugar regulation influences cardiovascular health promotion and disease prevention by carrying out an umbrella review .