Patients with prediabetes after myocardial infarction (MI) and obesity may represent a high-risk subgroup for targeted glucagon-like peptide-1 receptor agonist therapy to reduce progression to type 2 diabetes. These data were presented at the European Society of Cardiology Congress 2025.

This observational analysis included 7,398 patients from the Western Denmark Heart Registry with first-time MI, body mass index ≥27 kg/m², and no prior diabetes. Patients were categorized by baseline glycated hemoglobin (HbA1c) into normoglycemia (<39 mmol/mol), prediabetes (39–47 mmol/mol), and higher-range prediabetes (42-47 mmol/mol). Progression to type 2 diabetes (T2D) was assessed over a median follow-up of 4.7 years, along with major adverse cardiovascular events (MACE).

The 5-year risk of incident T2D increased substantially with higher baseline HbA1c. Patients with HbA1c 42–47 mmol/mol had an approximately 18-fold higher risk of developing diabetes compared with those with normoglycemia, while those in the broader prediabetes range (39-47 mmol/mol) had an approximately 8-fold higher risk. In contrast, 5-year MACE risk remained similar across groups at approximately 9% to 11%.

Using extrapolated data from the SELECT trial, the analysis estimated the number needed to treat (NNT) with semaglutide to prevent one case of diabetes over 5 years. In the higher-range prediabetes subgroup (42-47 mmol/mol), the modeled NNT was 2.7, suggesting a potentially large absolute benefit in this population.

These findings suggest that post-MI patients with obesity and higher-range prediabetes may represent a clinically relevant group for targeted diabetes prevention strategies. However, these estimates are based on observational data and trial extrapolation and require confirmation in prospective studies.