The association between non-diabetic hyperglycaemia and incident vascular disease

Abstract

Abstract Background It is unknown whether the associated risk of vascular disease for individuals with non-diabetic hyperglycaemia (NDH) persists following the Type 2 diabetes (T2D) diagnosis. We assessed whether NDH detection before the T2D diagnosis is associated with different risk of incident vascular disease following the T2D diagnosis. Methods Population-based retrospective cohort study including 159,736 individuals with newly diagnosed T2D from the CPRD database in England between 2004 and 2017. Outcomes: incident retinopathy, nephropathy, and composite macrovascular disease. We employed time-partitioned Cox regression models partitioning the 10-year follow-up period into 4 equal time segments to model differences in rates between groups with different glycaemic status in the 3 years before diagnosis of T2D. Results Following T2D diagnosis those with prior NDH had 86%, 58%, and 42% increased rates of retinopathy in the 30 months, between 31 and 60 months, and 61 and 90 months, respectively(0-30 months: HR 1.86,95%CI 1.69-2.04;31-60 months: HR 1.58,95%CI 1.37-1.84;61-90 months:HR 1.42,95%CI 1.10-1.83), as compared with those with prior normoglycaemia. They also had 16% and 25% increased rates of nephropathy in the period 0-30 months and 31-60 months, respectively (0-30 months: HR 1.16,95%CI 1.07-1.26;31-60 months: HR 1.25,95%CI 1.09-1.42). Individuals with prior NDH had 19% reduced rate of macrovascular disease in the first 30 months of the study period (HR 0.81,95%CI 0.71-0.93), as compared with individuals with glycaemic values within the normal range. Conclusions Individuals detected with NDH had increased rates of microvascular disease up to 7.5 years following the diagnosis of T2D. Timely testing and identification of NDH and specific clustering of NDH with other risk factors for T2D might prompt earlier risk factor assessment and tailored vascular risk reduction strategies during the NDH phase to reduce the burden of vascular disease following the diagnosis of T2D Key messages Individuals detected with NDH had increased rates of microvascular disease up to 7.5 years following the diagnosis of T2D, as compared with individuals with prior normoglycaemia. Timely detection of NDH and specific clustering with other risk factors for T2D might prompt earlier and tailored vascular risk reduction strategies to reduce the burden of vascular disease.