Cardiovascular risk in prediabetes

​From debate about disease categories to a future with precision medicine.
EASD, 30 September 2021


In this presentation on cardiovascular risk in prediabetes, Professor Kristine Færch will discuss how we may see prediabetes in the future. She will highlight novel statistical methods that have been applied to develop new categories of prediabetes over the past years. But are these classifications better than the original ones? Or are there other opportunities?

"The novel data-driven statistical approaches have been a breakthrough in working with risk profiles but are they better than the more simplified ones?" questions Prof. Færch. "Despite great progress with some of these methods, we still put people with different risk profiles into simplified categories," she adds.

"Optimally, we should move away from categorising individuals into subtypes of prediabetes and diabetes and instead look at the individual's clinical characteristics, lifestyle, behaviours, and preferences as well as changes in these factors over time," explains Kristine Færch. "In this way, we can quantify a person's absolute risk for e.g. cardiovascular disease and target interventions accordingly." 

Still no consensus on cut-point for high-risk HbA1c

Kristine Færch will draw attention to some of the landmark studies from the beginning of this millennium, which focused on the difference between fasting and 2-hour glucose measurements, i.e. the prediabetes subtypes 'impaired fasting glycaemia' and 'impaired glucose tolerance'. She will discuss what we have learned from these studies and whether they are still relevant.

Next, Kristine Færch will highlight the introduction of HbA1c as a diagnostic tool for identifying people with prediabetes/high risk. What are the benefits vs. the disadvantages? And how do we balance feasibility and convenience versus evidence and science?

"In 2009, it was recommended by the International Expert Committee to phase out the prediabetes categories 'impaired fasting glycaemia' and 'impaired glucose tolerance' and replace glucose with HbA1c measurements," says Kristine Færch. "However, there is still a lack of international consensus on the optimal cut-point for high-risk HbA1c concentrations. There is also a need for clinical trials showing long-term improvements in HbA1c in people without diabetes" continues Prof. Færch. Prof. Færch concludes: "When we use HbA1c instead of glucose measurements, we identify a different segment of the population, and it is still not entirely clear whether lifestyle interventions can improve HbA1c to the same extent that it improves 2-hour glucose in people without diabetes." 


Prof. Kristine Færch, MSc PhD MBA
Clinical Prevention Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
Phone: +45 30 91 30 61

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