Diabetes care: "Prediabetes" may increase the risk of heart failure in people with atrial fibrillation!

According to the 2013 national cross-sectional survey study, the prevalence of prediabetes in China is 35.
7%, and the number of people may be as high as 388.
1 million
.
However, because blood sugar is only slightly increased, it has not yet met the diagnostic criteria for diabetes, and it is often not taken seriously and easy to miss.

So, is prediabetes really harmless?

Recently, a study published in the journal Diabetes care gave a negative answer: pre-diabetic patients also have an increased risk of cardiovascular disease compared with healthy people, calling for better disease management
.

What is prediabetes?

Prediabetes refers to a state in which blood glucose values are higher than normal but do not meet the diagnostic criteria for diabetes, and are the transition stage from normal glucose metabolism to diabetes (i.
e.
, fasting blood glucose ≥ 6.
1mmol/L but < 7.
0mmol/L, or blood glucose ≥7.
8mmol/L but <11.
1mmol/L)
2 hours after meals).
Patients are usually asymptomatic and prone to missed diagnosis
.

Table 1 Diagnostic criteria

At present, China has the largest number of prediabetes in the
world.
In 2008, a large-sample survey study in China showed that according to WHO (1999) standards, the prevalence of prediabetes was 15.
5%, and it was estimated that there were 148 million prediabetes patients; the 2013 national cross-sectional survey showed that according to the American Diabetes Association (ADA) 2010 standards, the prevalence of prediabetes was as high as 35.
7%, and there were about 388.
1 million prediabetes patients
in China.

Diabetes care: prediabetes or increased risk of cardiovascular disease

The researchers evaluated the relationship between
prediabetes and heart failure (HF).
Patients newly diagnosed with atrial fibrillation (AF) between 2015 and 2018 were compared into three groups (normoglycemia, prediabetes, and type 2 diabetes) based on baseline blood glucose status, and the primary finding was the occurrence of heart failure events
.

A total of 17,943 patients with atrial fibrillation (mean age 75.
5 years, 47% female) were included, of which 3711 (20.
7%) had prediabetes and 10127 (56.
4%) had diagnosed diabetes
.
At a mean follow-up of 4.
7 years, 518 (14%) patients with normal blood glucose, 646 (15.
7%) patients with prediabetes, and 1795 (17.
7%) patients with diabetes developed heart failure
.

➤ Patients with prediabetes had a 12% increased risk of heart failure compared with those with normal blood glucose [subdistribution hazard ratio (SHR) 1.
12, 95% CI 1.
03 to 1.
22].

➤ Among prediabetes, 403 (11.
1%) progressed to diabetes and 311 (8.
6%) returned to normal
blood glucose after 2 years.

➤ Patients with diabetes progressed to diabetes had a 50% increased risk of heart failure compared with those maintained with prediabetes (SHR 1.
50, 95% CI 1.
13-1.
97); Patients who restored normosaemia had a 39% lower risk of heart failure (SHR 0.
61, 95% CI 0.
42-0.
94).

Figure 1 Research results

A: cumulative incidence of heart failure in the three groups at baseline; B: Cumulative incidence of heart failure in the pre-diabetic group

Seize the "golden age" of diabetes management

It can be seen that it is very important for the management of prediabetes, and the treatment strategy mainly includes health education management and lifestyle intervention (diet adjustment, weight loss, regular exercise, etc.
), and drug treatment
can be given if necessary.
It is recommended to check blood glucose regularly and pay close attention to other cardiovascular risk factors (e.
g.
, smoking, hypertension, dyslipidemia, etc.
).

References: Jia-Yi Huang, Yi-Kei Tse, Hang-Long Li, et al.
Prediabetes Is Associated With Increased Risk of Heart Failure Among Patients With Atrial Fibrillation.
Diabetes Care.
Published online October 17, 2022.
doi:10.
2337/dc22-1188