Heterogeneity in elevated glucose and A1C as predictors of the prediabetes to diabetes transition: Framingham Heart Study, Multi-Ethnic Study on Atherosclerosis, Jackson Heart Study, and Atherosclerosis Risk In Communities

There are a number of glycemic definitions for prediabetes; however, the heterogeneity in diabetes transition rates from prediabetes across different glycemic definitions in major US cohorts has been unexplored. The researchers estimate the variability in risk and relative risk of adiposity based on diagnostic criteria like fasting glucose and hemoglobin A1C% (HA1C%).

They estimated transition rate from prediabetes, as defined by fasting glucose between 100-125 and/or 110-125 mg/dL, and HA1C% between 5.7-6.5% in participant data from the Framingham Heart Study, Multi-Ethnic Study on Atherosclerosis, Atherosclerosis Risk in Communities, and the Jackson Heart Study. They estimated the heterogeneity and prediction interval across cohorts, stratifying by age, sex and body mass index. For individuals who were prediabetic, they estimated the relative risk for obesity, blood pressure, education, age and sex for diabetes.

There is substantial heterogeneity in diabetes transition rates across cohorts and prediabetes definitions with large prediction intervals. They observed the highest range of rates in individuals with fasting glucose of 110-125 mg/dL ranging from 2-18 per 100 person-years. Across different cohorts, the association obesity or hypertension in the progression to diabetes was consistent, yet it varied in magnitude. They provide a database of transition rates across subgroups and cohorts for comparison in future studies.

The absolute transition rate from prediabetes to diabetes significantly depends on cohort and prediabetes definitions.