Type 2 diabetes (T2D) is a disease with a greatly varying course. People with prediabetes already have an increased risk of diabetes and atherosclerotic cardiovascular disease (ASCVD). Obesity, a history of gestational diabetes and a family history contribute differently to the risk of T2D complications. Studies suggest that the risk of cardiovascular disease increases with higher fasting glucose levels and elevated blood sugar levels after eating. Recent studies have also shown that even in patients with prediabetes who do not develop type 2 diabetes at a later point, every 1 mmol/l increase in fasting plasma glucose levels increases the risk of cardiovascular events, such as heart attacks, by 26%. These results underline the importance of more accurate predictions and diagnoses for people with slightly elevated blood sugar level and a risk of cardiovascular disease.

Subtypes of Prediabetes

“With the help of data from the Tübingen Diabetes Families (TUEF) study, researchers at the German Center for Diabetes Research (DZD) led by Robert Wagner (currently DDZ Düsseldorf) and Andreas Fritsche (IDM Tübingen) have succeeded in identifying six different subtypes of prediabetes,” reports Prof. Dr. Andreas Birkenfeld, Medical Director of the Medical Clinic IV of the University of Tübingen and Scientific Director of the Institute for Diabetes Research and Metabolic Diseases (IDM) of Helmholtz Munich at Eberhard Karls University of Tübingen. The subtype (cluster) makes a big difference for people suffering from prediabetes: Three of the newly identified clusters are characterized by a low risk (clusters 1, 2 and 4) and three by an increased risk of developing diabetes, fatty liver, cardiovascular disease or kidney damage. People in cluster 5 have a significantly higher risk of T2D, ASCVD and mortality. “The early identification of high-risk individuals can enable precise prevention strategies,” emphasizes Birkenfeld.

Remission of Prediabetes

Analyses of the Prediabetes Lifestyle Intervention Study (PLIS) show that, in addition to weight reduction, normalization of glucose regulation (remission of prediabetes) in particular significantly reduces the risk of T2D. The study found that targeted remission of prediabetes to normal glucose regulation plus weight loss reduces the risk of T2D more effectively than the weight loss alone recommended by the treatment guidelines. Key factors are a significant improvement in insulin resistance and a reduction in visceral fatty tissue.

Precise Prevention for People at Particularly High Risk

The authors argue that precision prevention in individuals at high risk of diabetes and ASCVD should focus on accurately identifying those at highest risk. This could lead to early remission and thus prevent complications in the long term.

Original publication:
Birkenfeld, Andreas L. et al. : Precision Medicine in People at Risk for Diabetes and Atherosclerotic Cardiovascular Disease: A Fresh Perspective on Prevention. Circulation (2024). DOI: 10.1161/CIRCULATIONAHA.124.070463