Barbara H Bardenheier1, Wen-Chih Wu2, Andrew R Zullo3, Stefan Gravenstein4, Edward W Gregg5. 1. Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA. Electronic address: Barbara_bardenheier@brown.edu. 2. Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA. 3. Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA; Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA|Department of Pharmacy, Rhode Island Hospital, Providence, RI, USA. 4. Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, RI, USA; Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA; Center of Innovation in Long-Term Services and Supports, Providence Veterans Affairs Medical Center, Providence, RI, USA. 5. Imperial College London, London, UK.
Abstract
AIMS: Primary prevention studies have indicated that structured lifestyle change programs in adults with an annual diabetes risk of 4.7% are cost-effective. However, few population-based studies have quantified the risk of diabetes among adults with prediabetes. METHODS: We used the nationally representative U.S. Health and Retirement Study to identify adults aged ≥ 52 years with prediabetes (A1c: 5.7% - 6.4%) in 2006 and followed them to 2014 to assess diabetes status defined by A1c ≥ 6.5% in 2010 or 2014 or by self-report of a diabetes diagnosis by various risk factors. RESULTS: Among the 1,406 adults with prediabetes (average 4.7 years of follow-up), risk factors significantly associated with subsequent incident diabetes with adjusted annual risk of diabetes ≥ 4.7% were: male gender (4.8%); aged 52-64 years (5.0%); Black race (5.5%); obesity (body mass index (kg/m2) ≥ 30.0, 6.8%); large waist circumference (women: > 35 in.; men: > 40 in., 4.9%); C-reactive protein levels ≥ 3 ug/L (5.5%); treated for high cholesterol (4.7%); treated for hypertension (5.3%); and moderate mobility loss (4.8%). CONCLUSIONS: Primary prevention interventions among adults with prediabetes who also have moderate mobility loss or well-known risk factors for diabetes are likely to be cost-effective.
AIMS: Primary prevention studies have indicated that structured lifestyle change programs in adults with an annual diabetes risk of 4.7% are cost-effective. However, few population-based studies have quantified the risk of diabetes among adults with prediabetes. METHODS: We used the nationally representative U.S. Health and Retirement Study to identify adults aged ≥ 52 years with prediabetes (A1c: 5.7% - 6.4%) in 2006 and followed them to 2014 to assess diabetes status defined by A1c ≥ 6.5% in 2010 or 2014 or by self-report of a diabetes diagnosis by various risk factors. RESULTS: Among the 1,406 adults with prediabetes (average 4.7 years of follow-up), risk factors significantly associated with subsequent incident diabetes with adjusted annual risk of diabetes ≥ 4.7% were: male gender (4.8%); aged 52-64 years (5.0%); Black race (5.5%); obesity (body mass index (kg/m2) ≥ 30.0, 6.8%); large waist circumference (women: > 35 in.; men: > 40 in., 4.9%); C-reactive protein levels ≥ 3 ug/L (5.5%); treated for high cholesterol (4.7%); treated for hypertension (5.3%); and moderate mobility loss (4.8%). CONCLUSIONS: Primary prevention interventions among adults with prediabetes who also have moderate mobility loss or well-known risk factors for diabetes are likely to be cost-effective.