They’re sicker than we think: an exploratory study profiling the cardio-metabolic health in a sample of adults with pre-diabetes in Aotearoa New Zealand
Christine Barthow
1 * , Sue Pullon 2 , Mark Weatherall 1 , Jeremy Krebs 1
+ Author Affiliations
- Author Affiliations
1 Department of Medicine, University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand.
2 Department of Primary Health Care & General Practice, University of Otago, Wellington, PO Box 7343, Wellington South 6242, New Zealand.
Journal of Primary Health Care 14(3) 221-228 https://doi.org/10.1071/HC22068
Published: 30 August 2022
© 2022 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Introduction: Type 2 diabetes mellitus (T2DM) is a highly prevalent and potentially preventable condition associated with significant health, social, and economic costs. The detection and management of pre-diabetes is an important opportunity to prevent or delay the onset of T2DM and associated morbidities; however, its importance is controversial as the health risks associated with pre-diabetes are poorly understood.
Aim: To understand the cardio-metabolic health profile of a sample of adults with pre-diabetes in Aotearoa New Zealand.
Methods: Secondary analyses of baseline data from all 153 adults recruited to an intervention trial for adults with pre-diabetes were carried out. A profile of cardio-metabolic risk was measured by describing the proportion with metabolic syndrome (MetS) calculated using Adult Treatment Panel III criteria, which includes blood pressure, lipids, and obesity in addition to glycaemic measures. The severity of MetS was calculated as MetS Z-scores. Subgroup analyses for sex, ethnicity and glycated haemoglobin (HbA1c) were performed.
Results: Overall, 74% of this study population had MetS, and the proportion varied according to ethnicity and HbA1c level. The severity of MetS was highly variable, with MetS-Z-scores ranging from −1.0 to 2.8. Although mean MetS Z-scores differed according to ethnicity and HbA1c level, all subgroups included individuals with widely differing severity of MetS, suggesting likely quite different risks for progression to diabetes or cardiovascular disease across the range of pre-diabetes defined by HbA1c.
Discussion: Single biochemical markers of glycaemia are insufficient to ascertain overall cardio-metabolic risk when prioritising clinical efforts for those with pre-diabetes, particularly in primary care, where the potential for preventing or delaying the onset of type 2 diabetes mellitus (T2DM) is significant. Findings indicate the importance of attending to all cardio-metabolic risk factors when caring for people with pre-diabetes. The development of tools using multiple relevant variables and predicting a comprehensive range of outcomes would improve timely risk stratification and treatment effect monitoring of pre-diabetes populations.
Keywords: cardiometabolic risk factors, cardiovascular disease, glycated haemoglobin, metabolic syndrome, prediabetic state, primary health care, progression, renal disease, risk assessment, type 2 diabetes mellitus.
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