Harry Glauber1, William M Vollmer2, Gregory A Nichols3. 1. Retired Endocrinologist, formerly at the Sunnyside Medical Center in Clackamas, OR, and the Center for Health Research in Portland, OR, and former Visiting Scientist at the Galil Center for Telemedicine, Medical Informatics and Personalized Medicine at RB Rappaport Faculty of Medicine, Technion Israel Institute of Technology in Haifa. harryg123123@gmail.com. 2. Senior Investigator at the Center for Health Research in Portland, OR. william.vollmer@kpchr.org. 3. Senior Investigator at the Center for Health Research in Portland, OR. greg.nichols@kpchr.org.
Abstract
CONTEXT: Given the dramatic rise in the incidence of type 2 diabetes mellitus (T2DM) in recent decades, identifying individuals at increased risk of T2DM and validating methods to reduce their risk of disease progression is important. With more than one-third of US adults having prediabetes, a more precise stratification of absolute risk of T2DM incidence would help in prioritizing prevention efforts. OBJECTIVE: To develop a simple and clinically useful schema to stratify short-term (2-year) absolute risk of T2DM. DESIGN: Observational study of more than 77,000 adult members (age 18-75 years) from 3 Regions of the Kaiser Foundation Health Plan with prediabetes (hemoglobin A1C [HbA1C] = 5.7%-6.4%). MAIN OUTCOME MEASURES: The 2-year probability for development of diabetes as a function of baseline HbA1C and body mass index (BMI). RESULTS: The 2-year risk of diabetes diagnosis varied widely by HbA1C and BMI. A small subset (5.2%) had a very high risk of T2DM developing within 2 years. Another 13.3% had a moderate 2-year risk of T2DM, whereas most (81.5%) of the population was at much lower risk. Thus, most Kaiser Foundation Health Plan members with prediabetes have only modest risk of progression to T2DM within 2 years. CONCLUSION: Using HbA1C and BMI, we created a simple stratification scheme to more precisely estimate risk of T2DM incidence. This will enable more efficient assignment of prevention interventions and clinical and laboratory follow-up to the small subset at highest risk, while minimizing the potentially negative effects of overdiagnosis among the majority with prediabetes who are not at high short-term risk of T2DM.
CONTEXT: Given the dramatic rise in the incidence of type 2 diabetes mellitus (T2DM) in recent decades, identifying individuals at increased risk of T2DM and validating methods to reduce their risk of disease progression is important. With more than one-third of US adults having prediabetes, a more precise stratification of absolute risk of T2DM incidence would help in prioritizing prevention efforts. OBJECTIVE: To develop a simple and clinically useful schema to stratify short-term (2-year) absolute risk of T2DM. DESIGN: Observational study of more than 77,000 adult members (age 18-75 years) from 3 Regions of the Kaiser Foundation Health Plan with prediabetes (hemoglobin A1C [HbA1C] = 5.7%-6.4%). MAIN OUTCOME MEASURES: The 2-year probability for development of diabetes as a function of baseline HbA1C and body mass index (BMI). RESULTS: The 2-year risk of diabetes diagnosis varied widely by HbA1C and BMI. A small subset (5.2%) had a very high risk of T2DM developing within 2 years. Another 13.3% had a moderate 2-year risk of T2DM, whereas most (81.5%) of the population was at much lower risk. Thus, most Kaiser Foundation Health Plan members with prediabetes have only modest risk of progression to T2DM within 2 years. CONCLUSION: Using HbA1C and BMI, we created a simple stratification scheme to more precisely estimate risk of T2DM incidence. This will enable more efficient assignment of prevention interventions and clinical and laboratory follow-up to the small subset at highest risk, while minimizing the potentially negative effects of overdiagnosis among the majority with prediabetes who are not at high short-term risk of T2DM.
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