Introduction
Methods
Study design
Data assessment
Definitions for phenotypes of the glucose metabolism
Statistical analyses
Results
Prevalence of diabetic phenotypes in the general population
35–44 years | 45–54 years | 55–64 years | 65–74 years | |
---|---|---|---|---|
A. Prevalence of prediabetes and T2DM according to age decades in the GHS study cohort | ||||
Euglycaemia | 96.4% (n = 3142) | 88.6% (n = 3497) | 76.9% (n = 3031) | 66.2% (n = 2451) |
Prediabetes | 2.3% (n = 75) | 7.0% (n = 277) | 11.7% (n = 463) | 16.2% (n = 600) |
Diabetes | 1.3% (n = 44) | 4.3% (n = 171) | 11.3% (n = 447) | 17.7% (n = 654) |
GHS Study sample | Population of Mainz and Mainz-Bingen, Germany | Population of Germany | European standard population | |
---|---|---|---|---|
B. Prevalence of prediabetes and T2DM in the GHS study sample and weighted for the population of Mainz/Mainz-Bingen, the population of Germany and the European standard population of 1976 | ||||
Euglycaemia | 81.6% (n = 12,121) | 84.2% (n = 12,505) | 83.5% (n = 12,404) | 85.0% (n = 12,625) |
Prediabetes | 9.5% (n = 1415) | 8.4% (n = 1250) | 8.7% (n = 1299) | 8.1% (n = 1197) |
Diabetes | 8.9% (n = 1316) | 7.4% (n = 1102) | 7.8% (n = 1154) | 7.0% (n = 1037) |
Diabetic phenotype and cardiovascular risk factors
Euglycaemia (n = 12,121) | Prediabetes (n = 1415) | Diabetes (n = 1316) | P value | |
---|---|---|---|---|
Age, mean (SD), years | 53.4 ± 11.0 | 61.1 ± 9.0 | 63.0 ± 8.3 | < 0.0001 |
Female sex | 50.4% (6,110) | 52.0% (736) | 38.2% (503) | < 0.0001 |
BMI, median (IQR), kg/m2 | 26.1 (23.5/29.2) | 28.4 (25.4/32.0) | 30.7 (27.3/34.6) | < 0.0001 |
Traditional cardiovascular risk factors | ||||
Current smoking | 19.3% (2336) | 23.8% (336) | 16.1% (210) | 0.36 |
Dyslipidaemia | 29.9% (3616) | 49.2% (695) | 61.8% (810) | < 0.0001 |
Family history of MI and/or stroke | 21.0% (2546) | 26.5% (375) | 27.5% (362) | < 0.0001 |
Hypertension | 44.5% (5386) | 65.9% (932) | 80.2% (1,056) | < 0.0001 |
Obesity | 20.4% (2477) | 37.5% (530) | 55.3% (727) | < 0.0001 |
Cardiovascular comorbidities | ||||
Atrial fibrillation | 2.3% (273) | 3.9% (55) | 5.8% (76) | < 0.0001 |
Congestive heart failure | 1.0% (121) | 2.2% (31) | 3.4% (44) | < 0.0001 |
Coronary artery disease | 2.9% (354) | 7.2% (102) | 13.5% (177) | < 0.0001 |
Myocardial infarction | 1.9% (236) | 5.3% (75) | 9.5% (125) | < 0.0001 |
Peripheral artery disease | 2.6% (313) | 5.1% (72) | 8.1% (107) | < 0.0001 |
Stroke | 1.4% (166) | 2.9% (41) | 4.9% (64) | < 0.0001 |
Laboratory parameters of glucose metabolism | ||||
Glucose, median (IQR), mg/dl | 90.0 (85.0/95.0) | 97.0 (91.0/104.0) | 112.2 (99.0/131.2) | < 0.0001 |
Glucose (fasting), median (IQR), mg/dl | 91.0 (85.0/97.0) | 98.0 (92.0/105.0) | 117.2 (103.0/139.0) | < 0.0001 |
Glucose (non-fasting), median (IQR), mg/dl | 89.0 (84.0/94.0) | 94.0 (89.2/100.0) | 102.0 (93.9/117.0) | < 0.0001 |
Fasting period ≥ 8 h | 70.7% (8567) | 72.6% (1027) | 68.5% (901) | 0.37 |
HbA1c, median (IQR), % | 5.40 (5.10/5.60) | 6.10 (6.00/6.20) | 6.70 (6.30/7.20) | < 0.0001 |
Prediabetes (n = 13,491) | Diabetes (n = 13,382) | |||
---|---|---|---|---|
Prevalence ratio (95% CI) | P value | Prevalence ratio (95% CI) | P value | |
Age [10 years] | 1.76 (1.67; 1.85) | < 0.0001 | 1.85 (1.75; 1.96) | < 0.0001 |
Sex (female) | 1.14 (1.04; 1.26) | 0.0073 | 0.76 (0.68; 0.84) | < 0.0001 |
Dyslipidaemia | 1.51 (1.36; 1.66) | < 0.0001 | 1.88 (1.69; 2.09) | < 0.0001 |
Family history of MI and/or stroke | 1.21 (1.09; 1.35) | 0.0005 | 1.26 (1.14; 1.40) | < 0.0001 |
Hypertension | 1.27 (1.13; 1.42) | < 0.0001 | 1.93 (1.68; 2.22) | < 0.0001 |
Obesity | 1.78 (1.61; 1.97) | < 0.0001 | 2.73 (2.47; 3.02) | < 0.0001 |
Smoking | 1.83 (1.63; 2.06) | < 0.0001 | 1.37 (1.20; 1.58) | < 0.0001 |
Diabetic phenotype, subclinical and clinical cardiovascular disease
Cardiovascular risk and mortality
Model 1: crude analysis | Model 2: age, sex | Model 3: add. traditional CVRF | ||||
---|---|---|---|---|---|---|
Hazard ratio (95% CI) | P value | Hazard ratio (95% CI) | P value | Hazard ratio (95% CI) | P value | |
A. Multivariable Cox regression analysis for all-cause mortality | ||||||
Prediabetes | 2.10 (1.76; 2.51) | < 0.0001 | 1.30 (1.09; 1.55) | 0.0038 | 1.17 (0.98; 1.40) | 0.09 |
Diabetes | 4.28 (3.73; 4.92) | < 0.0001 | 2.16 (1.88; 2.50) | < 0.0001 | 1.89 (1.63; 2.20) | < 0.0001 |
Hazard ratio (95% CI) | P value | Hazard ratio (95% CI) | P value | Hazard ratio (95% CI) | P value | |
---|---|---|---|---|---|---|
B. Competing risk analyses of prediabetes and type 2 diabetes mellitus with all-cause death as competing risk | ||||||
Cardiac death | ||||||
Prediabetes | 1.529 (0.781; 2.995) | 0.02 | 0.907 (0.455; 1.810) | 0.78 | 0.752 (0.379; 1.492) | 0.41 |
Diabetes | 7.275 (4.875; 10.858) | < 0.0001 | 3.434 (2.263; 5.212) | < 0.0001 | 2.599 (1.697; 3.979) | < 0.0001 |
Cardiovascular disease | ||||||
Prediabetes | 1.919 (1.574; 2.339) | < 0.0001 | 1.189 (0.971; 1.455) | 0.09 | 1.021 (0.833; 1.252) | 0.84 |
Diabetes | 3.835 (3.250; 4.525) | < 0.0001 | 1.878 (1.579; 2.234) | < 0.0001 | 1.458 (1.217; 1.746) | < 0.0001 |
Myocardial infarction | ||||||
Prediabetes | 1.744 (1.105; 2.754) | 0.02 | 1.296 (0.808; 2.079) | 0.28 | 1.047 (0.647; 1.693) | 0.85 |
Diabetes | 2.711 (1.802; 4.079) | < 0.0001 | 1.602 (1.030; 2.490) | 0.04 | 1.233 (0.780; 1.949) | 0.37 |
Heart failure | ||||||
Prediabetes | 2.937 (2.064; 4.178) | < 0.0001 | 1.875 (1.299; 2.707) | 0.0008 | 1.528 (1.061; 2.201) | 0.023 |
Diabetes | 3.857 (2.748; 5.412) | < 0.0001 | 2.142 (1.505; 3.050) | < 0.0001 | 1.465 (1.015; 2.116) | 0.042 |
Stroke | ||||||
Prediabetes | 1.850 (1.212; 2.825) | 0.0044 | 1.162 (0.757; 1.783) | 0.49 | 1.069 (0.700; 1.631) | 0.76 |
Diabetes | 3.005 (2.081; 4.340) | < 0.0001 | 1.526 (1.042; 2.236) | 0.03 | 1.256 (0.841; 1.877) | 0.27 |
Atrial fibrillation | ||||||
Prediabetes | 1.785 (1.305; 2.443) | 0.0003 | 1.123 (0.818; 1.542) | 0.47 | 1.050 (0.761; 1.448) | 0.77 |
Diabetes | 3.158 (2.420; 4.119) | < 0.0001 | 1.644 (1.247; 2.166) | 0.0004 | 1.427 (1.068; 1.905) | 0.016 |
Cardiac death and myocardial infarction | ||||||
Prediabetes | 1.694 (1.154; 2.486) | 0.0071 | 1.149 (0.772; 1.708) | 0.49 | 0.923 (0.619; 1.377) | 0.70 |
Diabetes | 4.377 (3.297; 5.812) | < 0.0001 | 2.342 (1.734; 3.164) | < 0.0001 | 1.731 (1.265; 2.369) | 0.0006 |
Cardiac death and heart failure | ||||||
Prediabetes | 2.560 (1.876; 3.493) | < 0.0001 | 1.579 (1.143; 2.181) | 0.0056 | 1.278 (0.927; 1.762) | 0.13 |
Diabetes | 4.849 (3.735; 6.296) | < 0.0001 | 2.501 (1.905; 3.284) | < 0.0001 | 1.723 (1.301; 2.282) | 0.0002 |
Cardiac death and stroke | ||||||
Prediabetes | 1.765 (1.234; 2.525) | 0.0019 | 1.083 (0.752; 1.560) | 0.67 | 0.954 (0.665; 1.368) | 0.80 |
Diabetes | 4.297 (3.285; 5.622) | < 0.0001 | 2.116 (1.601; 2.796) | < 0.0001 | 1.705 (1.278; 2.275) | 0.0003 |
Cardiac death and atrial fibrillation | ||||||
Prediabetes | 1.749 (1.316; 2.324) | 0.0001 | 1.079 (0.808; 1.440) | 0.61 | 0.972 (0.726; 1.301) | 0.85 |
Diabetes | 3.797 (3.039; 4.745) | < 0.0001 | 1.903 (1.510; 2.398) | < 0.0001 | 1.577 (1.241; 2.003) | 0.0002 |
Cardiac death and venous thromboembolism | ||||||
Prediabetes | 1.916 (1.300; 2.823) | 0.001 | 1.242 (0.833; 1.852) | 0.29 | 1.023 (0.683; 1.531) | 0.91 |
Diabetes | 3.516 (2.548; 4.850) | < 0.0001 | 1.948 (1.402; 2.705) | < 0.0001 | 1.452 (1.036; 2.035) | 0.03 |