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Periodontal Disease: The sixth complication of diabetes mellitus

Harald Löe
Jan 1, 1993; 16:329-334
Supplement 1: Diabetes in Native Americans




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Relationship of Glucose Tolerance and Plasma Insulin to the Incidence of Coronary Heart Disease: Results from Two Population Studies in Finland

Kalevi Pyörälä
Mar 1, 1979; 2:131-141
Proceedings of the Kroc Foundation International Conference on Epidemiology of Diabetes and its Macrovascular Complications




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Coronary Heart Disease Incidence and Cardiovascular Mortality in Busselton with Reference to Glucose and Insulin Concentrations

T A Welborn
Mar 1, 1979; 2:154-160
Proceedings of the Kroc Foundation International Conference on Epidemiology of Diabetes and its Macrovascular Complications




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Consensus Development Conference on the Diagnosis of Coronary Heart Disease in People With Diabetes: 10-11 February 1998, Miami, Florida

American Diabetes Association
Sep 1, 1998; 21:1551-1559
Consensus Development Conference Report




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Hyperglycemie and Microvascular and Macrovascular Disease in Diabetes

Ronald Klein
Feb 1, 1995; 18:258-268
Kelly West Lecture 1994




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Metabolic Implications of Body Fat Distribution

Per Björntorp
Dec 1, 1991; 14:1132-1143
Diet and Diabetes




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Diabetes and Glucose Tolerance as Risk Factors for Cardiovascular Disease: The Framingham Study

W B Kannel
Mar 1, 1979; 2:120-126
Proceedings of the Kroc Foundation International Conference on Epidemiology of Diabetes and its Macrovascular Complications




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Memo: Prior COVID-19 diagnosis 'permanently disqualifying' for U.S. military service

Military Entrance Processing Stations won't process individuals who have had COVID-19 for military service, even if they've fully recovered from the virus, the Pentagon confirmed this week.




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Type 1 Diabetes Mellitus and Cardiovascular Disease: A Scientific Statement From the American Heart Association and American Diabetes Association

Sarah D. de Ferranti
Oct 1, 2014; 37:2843-2863
Scientific Statement




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Dalcetrapib Reduces Risk of New-Onset Diabetes in Patients With Coronary Heart Disease

Gregory G. Schwartz
May 1, 2020; 43:1077-1084
Emerging Therapies: Drugs and Regimens




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Disclosures: Standards of Medical Care in Diabetes--2020


Jan 1, 2020; 43:S205-S206
Disclosures




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Genetic Discrimination Between LADA and Childhood-Onset Type 1 Diabetes Within the MHC

OBJECTIVE

The MHC region harbors the strongest loci for latent autoimmune diabetes in adults (LADA); however, the strength of association is likely attenuated compared with that for childhood-onset type 1 diabetes. In this study, we recapitulate independent effects in the MHC class I region in a population with type 1 diabetes and then determine whether such conditioning in LADA yields potential genetic discriminators between the two subtypes within this region.

RESEARCH DESIGN AND METHODS

Chromosome 6 was imputed using SNP2HLA, with conditional analysis performed in type 1 diabetes case subjects (n = 1,985) and control subjects (n = 2,219). The same approach was applied to a LADA cohort (n = 1,428) using population-based control subjects (n = 2,850) and in a separate replication cohort (656 type 1 diabetes case, 823 LADA case, and 3,218 control subjects).

RESULTS

The strongest associations in the MHC class II region (rs3957146, β [SE] = 1.44 [0.05]), as well as the independent effect of MHC class I genes, on type 1 diabetes risk, particularly HLA-B*39 (β [SE] = 1.36 [0.17]), were confirmed. The conditional analysis in LADA versus control subjects showed significant association in the MHC class II region (rs3957146, β [SE] = 1.14 [0.06]); however, we did not observe significant independent effects of MHC class I alleles in LADA.

CONCLUSIONS

In LADA, the independent effects of MHC class I observed in type 1 diabetes were not observed after conditioning on the leading MHC class II associations, suggesting that the MHC class I association may be a genetic discriminator between LADA and childhood-onset type 1 diabetes.




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EPA releases expanded list of SARS-CoV-2 disinfectants

Washington — The Environmental Protection Agency announced March 13 that it was adding nearly 200 additional products that have qualified for use against SARS-CoV-2, the novel coronavirus that causes the disease COVID-19.




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Small Business Administration: Dentists can apply for both economic injury disaster and paycheck protection program loans

Dentists can apply for both Economic Injury Disaster Loans and Paycheck Protection Program 7(a) loans, the Small Business Administration told the American Dental Association on April 6.




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SBA changes grant computation for Economic Injury Disaster Loans

The ADA has received updated information from the Small Business Administration regarding grant advances on Economic Injury Disaster Loans during the COVID-19 pandemic.




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SBA announces funding no longer available for Economic Injury Disaster Loans, Paycheck Protection Program

The Small Business Administration said that as of April 16, the agency is unable to accept any new applications for the Paycheck Protection Program or the Economic Injury Disaster Loans due to a lack of funding.




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ADA antibiotics guideline authors to discuss C. diff infections in dentistry during Peggy Lillis Foundation conference

Two of the authors of the American Dental Association's antibiotics guideline will discuss C. diff infections and antibiotic stewardship in dentistry April 21 as part of a free, online conference organized by the Peggy Lillis Foundation.




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May JADA discusses calcium hydroxide overfill risk during root canals

Overfill of medication or obturation materials in endodontic treatment can cause permanent neurologic injury, and there are steps clinicians can take to help prevent that, according to an article published in the May issue of The Journal of the American Dental Association.




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Researchers discover microbe that could control spread of malaria

A microbe found in mosquitoes that appears to block malaria could be used to control spread of the disease in humans, according to researchers in Kenya and Britain.




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Brain model links herpes virus to development of Alzheimer's disease

Bio-engineered models of the human brain infected with herpes simplex virus-1 develop many of the same characteristics found in Alzheimer's disease, according to a new analysis published by Science Advances.




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Arthritis drug shows promise against respiratory distress caused by COVID-19

Anakinra, a drug developed to treat rheumatoid arthritis might help patients who have developed acute respiratory distress syndrome caused by COVID-19, a small study published by The Lancet Rheumatology has found.




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The Association of Lipoprotein(a) Plasma Levels With Prevalence of Cardiovascular Disease and Metabolic Control Status in Patients With Type 1 Diabetes

OBJECTIVE

To investigate the association of the cardiovascular risk factor lipoprotein (Lp)(a) and vascular complications in patients with type 1 diabetes.

RESEARCH DESIGN AND METHODS

Patients with type 1 diabetes receiving regular care were recruited in this observational cross-sectional study and divided into four groups according to their Lp(a) levels in nmol/L (very low <10, low 10–30, intermediate 30–120, high >120). Prevalence of vascular complications was compared between the groups. In addition, the association between metabolic control, measured as HbA1c, and Lp(a) was studied.

RESULTS

The patients (n = 1,860) had a median age of 48 years, diabetes duration of 25 years, and HbA1c of 7.8% (61 mmol/mol). The median Lp(a) was 19 (interquartile range 10–71) nmol/L. No significant differences between men and women were observed, but Lp(a) levels increased with increasing age. Patients in the high Lp(a) group had higher prevalence of complications than patients in the very low Lp(a) group. The age- and smoking-status–adjusted relative risk ratio of having any macrovascular disease was 1.51 (95% CI 1.01–2.28, P = 0.048); coronary heart disease, 1.70 (95% CI 0.97–3.00, P = 0.063); albuminuria, 1.68 (95% CI 1.12–2.50, P = 0.01); and calcified aortic valve disease, 2.03 (95% CI 1.03–4.03; P = 0.042). Patients with good metabolic control, HbA1c <6.9% (<52 mmol/mol), had significantly lower Lp(a) levels than patients with poorer metabolic control, HbA1c >6.9% (>52 mmol/mol).

CONCLUSIONS

Lp(a) is a significant risk factor for macrovascular disease, albuminuria, and calcified aortic valve disease in patients with type 1 diabetes. Poor metabolic control in patients with type 1 diabetes is associated with increased Lp(a) levels.




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Wilson Disease With Novel Compound Heterozygote Mutations in the ATP7B Gene Presenting With Severe Diabetes

OBJECTIVE

To determine the relationship between ATP7B mutations and diabetes in Wilson disease (WD).

RESEARCH DESIGN AND METHODS

A total of 21 exons and exon-intron boundaries of ATP7B were identified by Sanger sequencing.

RESULTS

Two novel compound heterozygous mutations (c.525 dupA/ Val176Serfs*28 and c.2930 C>T/ p.Thr977Met) were detected in ATP7B. After d-penicillamine (D-PCA) therapy, serum aminotransferase and ceruloplasmin levels in this patient were normalized and levels of HbA1c decreased. However, when the patient ceased to use D-PCA due to an itchy skin, serum levels of fasting blood glucose increased. Dimercaptosuccinic acid capsules were prescribed and memory recovered to some extent, which was accompanied by decreased insulin dosage for glucose control by 5 units.

CONCLUSIONS

This is the first report of diabetes caused by WD.




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Obstructive Sleep Apnea, a Risk Factor for Cardiovascular and Microvascular Disease in Patients With Type 2 Diabetes: Findings From a Population-Based Cohort Study

OBJECTIVE

To determine the risk of cardiovascular disease (CVD), microvascular complications, and mortality in patients with type 2 diabetes who subsequently develop obstructive sleep apnea (OSA) compared with patients with type 2 diabetes without a diagnosis of OSA.

RESEARCH DESIGN AND METHODS

This age-, sex-, BMI-, and diabetes duration–matched cohort study used data from a U.K. primary care database from 1 January 2005 to 17 January 2018. Participants aged ≥16 years with type 2 diabetes were included. Exposed participants were those who developed OSA after their diabetes diagnosis; unexposed participants were those without diagnosed OSA. Outcomes were composite CVD (ischemic heart disease [IHD], stroke/transient ischemic attack [TIA], heart failure [HF]), peripheral vascular disease (PVD), atrial fibrillation (AF), peripheral neuropathy (PN), diabetes-related foot disease (DFD), referable retinopathy, chronic kidney disease (CKD), and all-cause mortality. The same outcomes were explored in patients with preexisting OSA before a diagnosis of type 2 diabetes versus diabetes without diagnosed OSA.

RESULTS

A total of 3,667 exposed participants and 10,450 matched control participants were included. Adjusted hazard ratios for the outcomes were as follows: composite CVD 1.54 (95% CI 1.32, 1.79), IHD 1.55 (1.26, 1.90), HF 1.67 (1.35, 2.06), stroke/TIA 1.57 (1.27, 1.94), PVD 1.10 (0.91, 1.32), AF 1.53 (1.28, 1.83), PN 1.32 (1.14, 1.51), DFD 1.42 (1.16, 1.74), referable retinopathy 0.99 (0.82, 1.21), CKD (stage 3–5) 1.18 (1.02, 1.36), albuminuria 1.11 (1.01, 1.22), and all-cause mortality 1.24 (1.10, 1.40). In the prevalent OSA cohort, the results were similar, but some associations were not observed.

CONCLUSIONS

Patients with type 2 diabetes who develop OSA are at increased risk of CVD, AF, PN, DFD, CKD, and all-cause mortality compared with patients without diagnosed OSA. Patients with type 2 diabetes who develop OSA are a high-risk population, and strategies to detect OSA and prevent cardiovascular and microvascular complications should be implemented.




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Screening and Treatment Outcomes in Adults and Children With Type 1 Diabetes and Asymptomatic Celiac Disease: The CD-DIET Study

OBJECTIVE

To describe celiac disease (CD) screening rates and glycemic outcomes of a gluten-free diet (GFD) in patients with type 1 diabetes who are asymptomatic for CD.

RESEARCH DESIGN AND METHODS

Asymptomatic patients (8–45 years) were screened for CD. Biopsy-confirmed CD participants were randomized to GFD or gluten-containing diet (GCD) to assess changes in HbA1c and continuous glucose monitoring over 12 months.

RESULTS

Adults had higher CD-seropositivity rates than children (6.8% [95% CI 4.9–8.2%, N = 1,298] vs. 4.7% [95% CI 3.4–5.9%, N = 1,089], P = 0.035) with lower rates of prior CD screening (6.9% vs. 44.2%, P < 0.0001). Fifty-one participants were randomized to a GFD (N = 27) or GCD (N = 24). No HbA1c differences were seen between the groups (+0.14%, 1.5 mmol/mol; 95% CI –0.79 to 1.08; P = 0.76), although greater postprandial glucose increases (4-h +1.5 mmol/L; 95% CI 0.4–2.7; P = 0.014) emerged with a GFD.

CONCLUSIONS

CD is frequently observed in asymptomatic patients with type 1 diabetes, and clinical vigilance is warranted with initiation of a GFD.




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The Association of Energy and Macronutrient Intake at Dinner Versus Breakfast With Disease-Specific and All-Cause Mortality Among People With Diabetes: The U.S. National Health and Nutrition Examination Survey, 2003-2014

OBJECTIVE

This study aims to evaluate the association of energy and macronutrient intake at dinner versus breakfast with disease-specific and all-cause mortality in people with diabetes.

RESEARCH DESIGN AND METHODS

A total of 4,699 people with diabetes who enrolled in the National Health and Nutrition Examination Survey from 2003 to 2014 were recruited for this study. Energy and macronutrient intake was measured by a 24-h dietary recall. The differences () in energy and macronutrient intake between dinner and breakfast ( = dinner – breakfast) were categorized into quintiles. Death information was obtained from the National Death Index until 2015. Cox proportional hazards regression models were developed to evaluate the survival relationship between and diabetes, cardiovascular disease (CVD), and all-cause mortality.

RESULTS

Among the 4,699 participants, 913 deaths, including 269 deaths due to diabetes and 314 deaths due to CVD, were documented. After adjustment for potential confounders, compared with participants in the lowest quintile of in terms of total energy and protein, participants in the highest quintile were more likely to die due to diabetes (hazard ratio [HR]energy 1.92, 99% CI 1.08–3.42; HRprotein 1.92, 99% CI 1.06–3.49) and CVD (HRenergy 1.69, 99% CI 1.02–2.80; HRprotein 1.96, 99% CI 1.14–3.39). The highest quintile of total fat was related to CVD mortality (HR 1.67, 99% CI 1.01–2.76). Isocalorically replacing 5% of total energy at dinner with breakfast was associated with 4% and 5% lower risk of diabetes (HR 0.96, 95% CI 0.94–0.98) and CVD (HR 0.95, 95% CI 0.93–0.97) mortality, respectively.

CONCLUSIONS

Higher intake of energy, total fat, and protein from dinner than breakfast was associated with greater diabetes, CVD, and all-cause mortality in people with diabetes.




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Continuous Positive Airway Pressure Treatment, Glycemia, and Diabetes Risk in Obstructive Sleep Apnea and Comorbid Cardiovascular Disease

OBJECTIVE

Despite evidence of a relationship among obstructive sleep apnea (OSA), metabolic dysregulation, and diabetes, it is uncertain whether OSA treatment can improve metabolic parameters. We sought to determine effects of long-term continuous positive airway pressure (CPAP) treatment on glycemic control and diabetes risk in patients with cardiovascular disease (CVD) and OSA.

RESEARCH DESIGN AND METHODS

Blood, medical history, and personal data were collected in a substudy of 888 participants in the Sleep Apnea Cardiovascular End Points (SAVE) trial in which patients with OSA and stable CVD were randomized to receive CPAP plus usual care, or usual care alone. Serum glucose and glycated hemoglobin A1c (HbA1c) were measured at baseline, 6 months, and 2 and 4 years and incident diabetes diagnoses recorded.

RESULTS

Median follow-up was 4.3 years. In those with preexisting diabetes (n = 274), there was no significant difference between the CPAP and usual care groups in serum glucose, HbA1c, or antidiabetic medications during follow-up. There were also no significant between-group differences in participants with prediabetes (n = 452) or in new diagnoses of diabetes. Interaction testing suggested that women with diabetes did poorly in the usual care group, while their counterparts on CPAP therapy remained stable.

CONCLUSIONS

Among patients with established CVD and OSA, we found no evidence that CPAP therapy over several years affects glycemic control in those with diabetes or prediabetes or diabetes risk over standard-of-care treatment. The potential differential effect according to sex deserves further investigation.




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Electrolyte disorders in a young female following short-term omeprazole therapy

A 29 years old female presented to us in the metabolic clinic of the University of Port Harcourt Teaching Hospital (UPTH) on account of a week history of easy fatigability, weakness, and lower extremity muscle cramps associated with numbness and tingling sensation in the peri-oral area, fingers and toes. Two weeks prior to the onset of her presenting symptoms, she had visited a local pharmaceutical shop on account of a distressing epigastric discomfort and was subsequently placed on daily oral omeprazole 20mg daily for a month by a pharmacist. She had been on the omeprazole medication for two weeks before her present symptoms manifested. Her past medical history was not suggestive of hypoparathyroidism nor pancreatitis. She was married with three children and has an uneventful family, social and obstetric histories. On examination, she was a healthy well-oriented young female with positive Trousseau’s, Chvostek’s and epigastric tenderness signs. Further Laboratory evaluation revealed she had low plasma magnesium, low plasma albumin-corrected calcium, and low serum parathyroid hormone levels, while other laboratory parameters were essentially normal. A diagnosis of omeprazole-induced electrolyte disorders (hypomagnesaemia and hypocalcaemia) associated with hypoparathyroidism was made following the review of her clinical examination and laboratory findings. She was subsequently managed with oral magnesium supplements following the withdrawal of the omeprazole medication (replaced with oral ranitidine), monitored weekly, and full recovery was achieved after three weeks.




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Global warming fuels algal bloom disrupting fisheries in Arabian Sea

A new scientific study published Monday found that global warming is fueling a destructive algal bloom that is disrupting fisheries in the Arabian sea.




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Trade can spread economic toll of local disasters globally, study finds

Damage from a natural disaster in one place can spread globally due to urban trade networks, a Yale study said Monday.




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Tests show heating is the best way to disinfect N95 masks for reuse

Test results suggest N95 masks can be safely disinfected through heating 50 times before their filtration efficiency begins to decline.




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Disabled flies sleep more as they learn to adapt

New research suggests flies that are unable to fly sleep more as they learn to adapt to their disability.




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Leadership Visions: A Discussion with Mexican Foreign Minister Claudia Ruiz-Massieu

An MPI Leadership Visions discussion with the Foreign Minister of Mexico, Claudia Ruiz-Massieu, for her first public appearance in Washington, DC. 




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Ask Ariely: On Doing Dishes, Curbing Consumerism, and Reducing Regret

Here’s my Q&A column from the WSJ this week — and if you have any questions for me, you can tweet them to @danariely with the hashtag #askariely, post a comment on my Ask Ariely Facebook page, or email them to AskAriely@wsj.com. ___________________________________________________ Dear Dan, When I host friends for dinner,...




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Judge declines to dismiss Lori Loughlin, Mossimo Giannulli's college admissions case

A federal judge on Friday declined to dismiss charges filed against Lori Loughlin and 13 others in a national college admissions case based in Massachusetts.




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[ Women's Health ] Open Question : Ovulation like discharge before period?

I have a 23 day cycle and around day 19 up until my period I produce a ovulation like discharge, it’s clear/ white and super stretchy. I don’t get this during the “ovulation” time frame, it tends to be thick and cloudy then. Why? And when am I ovulating?




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[ Politics ] Open Question : Trump supporters: Do you watch Disney and Pixar movies even though they carry hidden liberal agendas?

Do you let your kids watch Disney and Pixar movies? They're all created by liberals.




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Why Women May Be More Susceptible to Mood Disorders

New research in mice suggests that a pregnancy hormone contributes to brain and behavioral changes caused by childhood adversity

-- Read more on ScientificAmerican.com




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Menopause Predisposes a Fifth of Women to Alzheimer's

Being female is a risk factor for Alzheimer’s. Why?

-- Read more on ScientificAmerican.com




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How Deep a Distaste for Politicians Who Waffle?

When George W. Bush takes the podium tomorrow night to deliver his sixth State of the Union address, what are the chances he will say this? "The war in Iraq has been one gigantic mistake. I am sorry I got us into this mess. I am going to bring the troops home right away."




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Disagree About Iraq? You're Not Just Wrong -- You're Evil.

The conviction of I. Lewis "Scooter" Libby last week gave Americans a chance to pick at the scab of what has become a favored obsession -- the debate over the motives of the Bush administration in the run-up to the war in Iraq.




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When Seeing Is Disbelieving

Four years ago tomorrow, President Bush landed on the USS Abraham Lincoln and dramatically strode onto the deck in a flight suit, a crash helmet tucked under one arm. Even without the giant banner that hung from the ship's tower, the president's message about the progress of the war in Iraq was u...




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When Disadvantages Collide

One hundred forty-three years ago, women's suffrage advocate Elizabeth Cady Stanton faced a conundrum: With the Civil War over, Stanton had to decide whether to support the 14th and 15th amendments to the Constitution, which enabled black men to vote -- at a time when white women such as herself...




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Immigrant Workers: Vital to the U.S. COVID-19 Response, Disproportionately Vulnerable

Six million immigrant workers are at the frontlines of keeping U.S. residents healthy and fed during the COVID-19 pandemic, representing disproportionate shares of physicians, home health aides, and retail-store pharmacists, for example. They also are over-represented in sectors most immediately devastated by mass layoffs, yet many will have limited access to safety-net systems and to federal relief, as this fact sheet details.




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Discipline and Punish, by Michel Foucault


Discipline and Punish (1975), is a genealogy of power based on particulars of penal history, and is considered Foucault’s “out-of-the-ordinary,” “intellectually charismatic,” and “soundly subversive” work, in which he also reveals his passionate empathy for the disenfranchised and the dispossessed, and a desire to trace the overt and covert networks of power, which underlie modern societies. Highly interdisciplinary and thought-provoking in its content, the book is at once a work of history, sociology, philosophy, penology, legal analysis and cultural criticism, therby making it difficult to categorize in any given literature or tradition.
Foucault, who is hailed as a “theorist of paradox” by highly acclaimed critics, was influenced by some of the greatest European philosophers such as Maurice Merleau-Ponty, Jean Beaufret—Martin Heidegger’s major interpreter in France—and Louis Althusser. He earned his License de philosophie in 1948 and Diplôme de psycho-pathologie in 1952, and taught in Sweden, Poland, and Germany before his appointment as the head of the philosophy department at the University of Clermont-Ferrand. The range of his creative (and massively subversive) thought knows no bounds but throughout his many studies, on subjects as varied as madness, medicine, modern discourse, sexuality, there is a definite tendency to reverse “taken-for-granted” understandings and to discover, not unlike Freud, the latent behind the manifest--especially when it come to the nature of power and its pervasive effects in the human condition.
Moreover, Foucault in his major works, has undertaken a sustained assault upon what he regards as the myths of "the Enlightenment," "Reason," "science," "freedom," "justice," and "democracy"--all these salient features of modern civilization, and has exposed their “hidden side.” Foucault has also argued that the hidden side usually stays hidden because the “production of discourse” in modern societies is controlled, selected, and organized according to certain behind-the-scenes procedures. He suggests that when an idea appears before us repeatedly through different modalities, we are unaware of the prodigious machinery behind, which is diligently doing discourse selection and dissemination.
To make sense of this incredibly crucial work for our times, please join us at Brooklyn Book Talk and share your views about matters of power and punishment, and their subtle manifestations, which ought to concern us all, if we are to leave this world a little better than the way we found it.




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Immigrant Workers Are Vital to the U.S. Coronavirus Pandemic Response, But Disproportionately Vulnerable

WASHINGTON — Six million immigrant workers are at the frontlines of keeping U.S. residents healthy, safe and fed during the COVID-19 pandemic, according to a Migration Policy Institute (MPI) analysis of U.S. Census Bureau data issued today. While the foreign born represented 17 percent of the 156 million civilians working in 2018, they account for larger shares in pandemic-response frontline occupations: 29 percent of all physicians in the United States, 38 percent of home health aides and 23 percent of retail-store pharmacists, for example.




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Arroz de Marisco (Portugeuse rice dish)

The Portuguese have a double gene for flavours. They keep it simple, they rely on extremely good produce. This dish has such a unique flavour. It's ideal with all wines. A good Lisbon paste is the trick!




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Swedish meatballs

400g pork/beef mince 1 egg 1 onion, grated 1/4 cups fresh breadcrumbs 1/2 tsp. allspice 1/4 tsp. ground cloves Pinch of nutmeg 1 tbsp. olive oil 20g butter 150ml beef stock 2 tbsp. brown sugar Lingonberry sauce, sour cream, dill and parsley potatoes, baby cos leaves and cucumber wedges to serve





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Glycated Hemoglobin, Prediabetes, and the Links to Cardiovascular Disease: Data From UK Biobank

OBJECTIVE

HbA1c levels are increasingly measured in screening for diabetes; we investigated whether HbA1c may simultaneously improve cardiovascular disease (CVD) risk assessment, using QRISK3, American College of Cardiology/American Heart Association (ACC/AHA), and Systematic COronary Risk Evaluation (SCORE) scoring systems.

RESEARCH DESIGN AND METHODS

UK Biobank participants without baseline CVD or known diabetes (n = 357,833) were included. Associations of HbA1c with CVD was assessed using Cox models adjusting for classical risk factors. Predictive utility was determined by the C-index and net reclassification index (NRI). A separate analysis was conducted in 16,596 participants with known baseline diabetes.

RESULTS

Incident fatal or nonfatal CVD, as defined in the QRISK3 prediction model, occurred in 12,877 participants over 8.9 years. Of participants, 3.3% (n = 11,665) had prediabetes (42.0–47.9 mmol/mol [6.0–6.4%]) and 0.7% (n = 2,573) had undiagnosed diabetes (≥48.0 mmol/mol [≥6.5%]). In unadjusted models, compared with the reference group (<42.0 mmol/mol [<6.0%]), those with prediabetes and undiagnosed diabetes were at higher CVD risk: hazard ratio (HR) 1.83 (95% CI 1.69–1.97) and 2.26 (95% CI 1.96–2.60), respectively. After adjustment for classical risk factors, these attenuated to HR 1.11 (95% CI 1.03–1.20) and 1.20 (1.04–1.38), respectively. Adding HbA1c to the QRISK3 CVD risk prediction model (C-index 0.7392) yielded a small improvement in discrimination (C-index increase of 0.0004 [95% CI 0.0001–0.0007]). The NRI showed no improvement. Results were similar for models based on the ACC/AHA and SCORE risk models.

CONCLUSIONS

The near twofold higher unadjusted risk for CVD in people with prediabetes is driven mainly by abnormal levels of conventional CVD risk factors. While HbA1c adds minimally to cardiovascular risk prediction, those with prediabetes should have their conventional cardiovascular risk factors appropriately measured and managed.