RT Journal Article
SR Electronic
T1 Comparing different definitions of prediabetes with subsequent risk of diabetes: an individual participant data meta-analysis involving 76 513 individuals and 8208 cases of incident diabetes
JF BMJ Open Diabetes Research & Care
JO BMJ Open Diab Res Care
FD American Diabetes Association
SP e000794
DO 10.1136/bmjdrc-2019-000794
VO 7
IS 1
A1 Crystal Man Ying Lee
A1 Stephen Colagiuri
A1 Mark Woodward
A1 Edward W Gregg
A1 Robert Adams
A1 Fereidoun Azizi
A1 Rafael Gabriel, MD, PhD
A1 Tiffany K Gill
A1 Clicerio Gonzalez
A1 Allison Hodge
A1 David R Jacobs Jr, Jr.
A1 Joshua J Joseph
A1 Davood Khalili
A1 Dianna J Magliano
A1 Kirsten Mehlig
A1 Roger Milne
A1 Gita Mishra
A1 Morgana Mongraw-Chaffin
A1 Julie A Pasco
A1 Masaru Sakurai
A1 Pamela J Schreiner
A1 Elizabeth Selvin
A1 Jonathan E Shaw
A1 Gary Wittert
A1 Hiroshi Yatsuya
A1 Rachel R Huxley
YR 2019
UL http://drc.bmj.com/content/7/1/e000794.abstract
AB Objective There are currently five widely used definition of prediabetes. We compared the ability of these to predict 5-year conversion to diabetes and investigated whether there were other cut-points identifying risk of progression to diabetes that may be more useful.Research design and methods We conducted an individual participant meta-analysis using longitudinal data included in the Obesity, Diabetes and Cardiovascular Disease Collaboration. Cox regression models were used to obtain study-specific HRs for incident diabetes associated with each prediabetes definition. Harrell’s C-statistics were used to estimate how well each prediabetes definition discriminated 5-year risk of diabetes. Spline and receiver operating characteristic curve (ROC) analyses were used to identify alternative cut-points.Results Sixteen studies, with 76 513 participants and 8208 incident diabetes cases, were available. Compared with normoglycemia, current prediabetes definitions were associated with four to eight times higher diabetes risk (HRs (95% CIs): 3.78 (3.11 to 4.60) to 8.36 (4.88 to 14.33)) and all definitions discriminated 5-year diabetes risk with good accuracy (C-statistics 0.79–0.81). Cut-points identified through spline analysis were fasting plasma glucose (FPG) 5.1 mmol/L and glycated hemoglobin (HbA1c) 5.0% (31 mmol/mol) and cut-points identified through ROC analysis were FPG 5.6 mmol/L, 2-hour postload glucose 7.0 mmol/L and HbA1c 5.6% (38 mmol/mol).Conclusions In terms of identifying individuals at greatest risk of developing diabetes within 5 years, using prediabetes definitions that have lower values produced non-significant gain. Therefore, deciding which definition to use will ultimately depend on the goal for identifying individuals at risk of diabetes.