Assessment of the management and clinical outcomes of patients with non-diabetic hyperglycaemia and newly diagnosed type 2 diabetes in primary care in England

Abstract

Background

It is unknown whether the detection of non-diabetic hyperglycaemia before the diagnosis of Type 2 diabetes is associated with vascular disease at time or following the diagnosis of Type 2 diabetes. Aim

I assessed the association between glycaemic testing and detection of non-diabetic hyperglycaemia before the diagnosis of Type 2 diabetes is associated and vascular disease at time or following the diagnosis of Type 2 diabetes. Methods

I identified 159,736 individuals with newly diagnosed Type 2 diabetes from the CPRD database in England between 2004 and 2017. I used logistic regression models to compare presence of vascular disease at the time of Type 2 diabetes diagnosis by prior glycaemic status. I employed time-partitioned Cox regression models to model differences in rates of vascular disease and mortality following the diagnosis of Type 2 diabetes. Results

Half of the study population (49.9%) had at least one vascular disease, over one-third (37.4%) had microvascular disease, and almost a quarter (23.5%) had a diagnosed macrovascular disease at the time of Type 2 diabetes diagnosis. Individuals with prior non-diabetic hyperglycaemia were more likely to have microvascular disease and coronary heart disease at time of diagnosis of Type 2 diabetes. As compared with individuals with glycaemic values within the normal range in the three years before the diagnosis of Type 2 diabetes, those detected with non-diabetic hyperglycaemia had increased risk of microvascular disease that persisted up to 7.5 years. Conclusions Non-diabetic hyperglycaemia before diagnosis of Type 2 diabetes is associated with increased odds of microvascular disease and coronary heart disease in newly diagnosed Type 2 diabetes. It is also associated with increased rates of microvascular disease following the diagnosis of Type 2 diabetes. Detection of non-diabetic hyperglycaemia might represent an opportunity for a timely identification of NDH and specific clustering of NDH with other risk factors for T2D, which might prompt earlier assessment for risk factors and tailored cardiovascular risk reduction strategies during the NDH phase to reduce the burden of vascular disease.