Reversing Prediabetes May Be a Heart Saver

Diabetes and heart disease risk drops in prediabetes patients who regain normal blood sugar

(RxWiki News) Blood sugar levels that are high but not high enough to be diabetes pose a health risk. Taking steps to reverse the condition may significantly cut the odds of getting heart disease and diabetes.

With diabetes, cells in the body are not processing blood sugar normally. In time, too much blood sugar in the system can damage blood vessels and nerves. This can heighten the risk of heart disease.

Those who have prediabetes have a chance to return blood sugar levels to normal before the condition becomes full-on diabetes. A new study has found that early and aggressive treatment of blood fats, blood pressure and blood sugar can make a big impact on reducing the long-term likelihood of developing cardiovascular disease.

"Take steps to lower blood sugar to reduce heart disease risk."

Leigh Perreault, MD, associate professor of medicine at the University of Colorado Anschutz Medical Campus in Aurora, led the investigation.

She and her colleagues analyzed data on 2,775 persons who had prediabetes. The patients took part in the Diabetes Prevention Program (DPP) Outcomes Study.

There are three major tests used to determine blood glucose (sugar) levels and diabetes status, according to the American Diabetes Association.

The A1C test measures average blood glucose for the past two to three months. Less than 5.7 percent is normal. Prediabetes is 5.7 to 6.4 percent. Diabetes is 6.5 percent or higher.

The fasting plasma glucose (fpg) test check glucose after not having anything to eat or drink (except water) for at least eight hours prior to the exam. Normal is less than 100 mg/dL (milligrams per deciliter). Prediabetes is 100 to 125 mg/dL. Diabetes is 126 mg/dL or greater.

The Oral Glucose Tolerance Test (OGTT) checks blood glucose levels before and two hours after you drink a special sweet drink.  Normal is less than 140 mg/dL. Prediabetes is 140 to 199 mg/dL. Diabetes is 200 mg/dL or higher.

After an average 3.2 years, 1,509 (54 percent) had returned at least once to normal glucose levels. This is called normal glucose restoration (NGR).  A total of 496 (18 percent ) remained with prediabetes and 770 (28 percent) developed diabetes.

Researchers calculated CVD risk factors (such as cholesterol and blood pressure levels) annually.

CVD risk scores were highest for those who continued to have prediabetes. The mean estimated CVD risk was 16.2 percent for these participants.

People who reached NGR had the second highest risk score of 15.5 percent. Those who eventually developed diabetes had the lowest score of 14.4 percent.

The authors suspected that CVD risk was lowest among the diabetes patients because of “aggressive risk factor management.”  They explained that this “likely reflects their increased medication usage, at least in part.”

Investigators underscored that reversing diabetes, even temporarily, brought positive health effects.

“Prediabetes represents a high-risk state for CVD,” wrote the authors. “Restoration of NGR and/or medical treatment of CVD risk factors can significantly reduce the estimated CVD risk in people with prediabetes.”

In their conclusion, Dr. Perreault and her colleagues added, “These findings support a shift to earlier and more aggressive treatment of lipid [blood fat] levels and blood pressure, as well as glucose levels, in people with prediabetes.”

The study was published in the September 2014 issues of Diabetes Care. The work was supported by National Institutes of Health (NIH). Dr. Perreault served on advisory boards for Merck, Boehringer Ingelheim and Liposcience, and she served as a speaker for Merck, Boehringer Ingelheim, and Novo Nordisk. Other coauthors acknowledged ties with Amgen, Amylin, AstraZeneca, Bristol-Myers Squibb, Gilead, Janssen, Lilly, Merck, Sanofi and Vivus.

Review Date: 
August 23, 2014