Prediabetes is associated with elevated risk of cardiovascular disease and heart failure. In post-hoc analyses published in The Lancet Diabetes & Endocrinology, long-term cardiovascular outcomes were compared between individuals who achieved prediabetes remission and those who did not.
The analyses included data from two landmark trials. These were the US Diabetes Prevention Program Outcomes Study (DPPOS) and the Chinese DaQing Diabetes Prevention Outcomes Study (DaQingDPOS).
Prediabetes remission was defined using American Diabetes Association criteria after 1 year in DPPOS and 6 years in DaQingDPOS. The primary endpoint was cardiovascular death or hospitalization for heart failure over 20 years in DPPOS and 30 years in DaQingDPOS. In DPPOS, inverse probability of treatment weighting is adjusted for baseline differences. A pooled meta-analysis was performed across both cohorts.
In DPPOS, 2402 participants were included. Of these, 275 (11.5%) achieved remission at 1 year, while 2127 (88.5%) did not. After a median follow-up of 20 years, the event rate for the primary endpoint was 1.74 per 1000 person-years (95% CI 0.87-3.48) among those who achieved remission and 4.17 per 1000 person-years (95% CI 3.55-4.89) among those who did not (P = 0.013). The fully adjusted hazard ratio was 0.41 (95% CI 0.20-0.84; P = 0.014).
Findings were consistent in DaQingDPOS, which included 540 participants. Prediabetes remission was associated with a lower risk of the primary endpoint, with a hazard ratio of 0.49 (95% CI 0.28-0.84; P = 0.010). In pooled analyses across both cohorts, remission was associated with a reduced risk of cardiovascular death or hospitalization for heart failure. Similar results were observed when remission was defined as achieving normal glucose regulation at least once during follow-up, with a hazard ratio of 0.43 (95% CI 0.29-0.63; P < 0.0001).
These findings show that prediabetes remission was associated with a sustained reduction in cardiovascular death or hospitalization for heart failure over decades of follow-up.
