In this post – Remission of prediabetes leads to significant reduction in cardiovascular morbidity and mortality @יואל קסלר .קום, we present new data published in The Lancet that demonstrates that lifestyle changes leading to remission of prediabetes can halve the risk of cardiovascular morbidity and mortality. The abstract is reprinted below the original article can be found here.

בפוסט הזה – הפוגה של טרום-סוכרת מובילה להפחתה משמעותית בתחלואה ותמותה קרדיווסקולרית @יואל קסלר .קום, אנו מציגים נתונים חדשים המדגימים כי שינויים באורח החיים המובילים להפוגה של טרום-סוכרת יכולים להפחית בחצי את הסיכון לתחלואה ותמותה קרדיווסקולרית.

Prediabetes remission and cardiovascular morbidity and mortality: post-hoc analyses from the Diabetes Prevention Program Outcome study and the DaQing Diabetes Prevention Outcome study

Elsa Vazquez Arreola, PhD^a,† ∙ Prof Qiuhong Gong, MD^b,† ∙ Robert L Hanson, MD^a ∙ Jinping Wang^d ∙ Leontine Sandforth, MD^e,f,g ∙ Siyao He, MD^b ∙ et al.

Summary

Background

Prediabetes is associated with increased risk of cardiovascular disease and heart failure. Multicomponent lifestyle interventions, including diet and physical activity targeting weight loss are recommended for prediabetes management, although their long-term impact on cardiovascular outcomes remains unclear. Reaching prediabetes remission by restoring normal glucose regulation has been shown to profoundly reduce future type 2 diabetes risk outlasting the time of lifestyle intervention. We aimed to investigate whether prediabetes remission is associated with a lower incidence of cardiovascular death or hospitalisation for heart failure compared with non-remission, with a long-term legacy effect.

Methods

Post-hoc analyses were performed from two landmark diabetes prevention trials, the US Diabetes Prevention Program Outcomes Study (DPPOS) and the Chinese DaQing Diabetes Prevention Outcomes Study (DaQingDPOS). Remission was assessed using the American Diabetes Association criteria after 1 year (DPPOS) or 6 years (DaQingDPOS) of intervention. The primary endpoint was cardiovascular death or hospitalisation for heart failure over 20 and 30 years, respectively. In DPPOS, inverse probability of treatment weighting adjusted for baseline differences. A unifying meta-analysis was calculated across both data sets for the primary endpoint and all-cause mortality.

Findings

For DPPOS, follow-up time is reported from the start of the original Diabetes Prevention Program trial, July 31, 1996, to the end of DPPOS phase 3, Feb 23, 2020. In total, 2402 participants were included in DPPOS and 540 in DaQingDPOS. In DPPOS, 275 (11·5%) of 2402 participants reached remission after 1 year of intervention compared with 2127 (88·5%) of 2402 not reaching remission. In DPPOS, after a median follow-up of 20 years, the event rate for cardiovascular death or hospitalisation of heart failure was 1·74 (95% CI 0·87–3·48) per 1000 person-years in participants who reached remission versus 4·17 (95% CI 3·55–4·89) in those without remission (p=0·013) with a fully adjusted hazard ratio of 0·41 (95% CI 0·20–0·84; p=0·014). Results remained robust after adjustment, were confirmed in DaQingDPOS (primary endpoint: HR 0·49 [95% CI 0·28–0·84]; p=0·010), and were supported by a pooled meta-analysis. Results were stable when analysing the composite endpoint in those reaching remission at least once during follow-up, with a HR of 0·43 (0·29–0·63; p<0·0001).

Interpretation

Reaching prediatbetes remission is linked to a decades-long benefit, halving the risk of cardiovascular death or hospitalisation for heart failure in diverse populations. Targeting remission might represent a new approach to cardiovascular prevention.

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