Institute for Biometrics and Epidemiology, German Diabetes Center (Deutsches Diabetes-Zentrum/DDZ), Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
German Center for Diabetes Research (DZD), Partner Düsseldorf, Düsseldorf, Germany.
Diabetologia. 2022 Feb;65(2):275-285. doi: 10.1007/s00125-021-05592-3. Epub 2021 Oct 31.
AIMS/HYPOTHESIS: The term prediabetes is used for individuals who have impaired glucose metabolism whose glucose or HbA levels are not yet high enough to be diagnosed as diabetes. Prediabetes may already be associated with an increased risk of chronic 'diabetes-related' complications. This umbrella review aimed to provide a systematic overview of the available evidence from meta-analyses of prospective observational studies on the associations between prediabetes and incident diabetes-related complications in adults and to evaluate their strength and certainty.
For this umbrella review, systematic reviews with meta-analyses reporting summary risk estimates for the associations between prediabetes (based on fasting or 2 h postload glucose or on HbA) and incidence of diabetes-related complications, comorbidities and mortality risk were included. PubMed, Web of Science, the Cochrane Library and Epistemonikos were searched up to 17 June 2021. Summary risk estimates were recalculated using a random effects model. The certainty of evidence was evaluated by applying the GRADE tool. This study is registered with PROSPERO, CRD42020153227.
Ninety-five meta-analyses from 16 publications were identified. In the general population, prediabetes was associated with a 6-101% increased risk for all-cause mortality and the incidence of cardiovascular outcomes, CHD, stroke, heart failure, atrial fibrillation and chronic kidney disease, as well as total cancer, total liver cancer, hepatocellular carcinoma, breast cancer and all-cause dementia with moderate certainty of evidence. No associations between prediabetes and incident depressive symptoms and cognitive impairment were observed (with low or very low certainty of evidence). The association with all-cause mortality was stronger for prediabetes defined by impaired glucose tolerance than for prediabetes defined by HbA.
CONCLUSIONS/INTERPRETATION: Prediabetes was positively associated with risk of all-cause mortality and the incidence of cardiovascular outcomes, CHD, stroke, chronic kidney disease, cancer and dementia. Further high-quality studies, particularly on HbA-defined prediabetes and other relevant health outcomes (e. g. neuropathy) are required to support the evidence.
目的/假设：糖尿病前期用于指葡萄糖代谢受损但血糖或糖化血红蛋白水平尚未高到足以被诊断为糖尿病的个体。糖尿病前期可能已经与慢性“与糖尿病相关”并发症的风险增加有关。本综述旨在提供对基于空腹或餐后 2 小时血糖或糖化血红蛋白的糖尿病前期与成年人糖尿病相关并发症发生率之间关联的前瞻性观察性研究的荟萃分析的系统综述，评估其强度和确定性。
对于本综述，纳入了系统综述和荟萃分析，报告了糖尿病前期（基于空腹或餐后 2 小时血糖或糖化血红蛋白）与糖尿病相关并发症、合并症和死亡率风险之间关联的汇总风险估计值。检索了 PubMed、Web of Science、Cochrane 图书馆和 Epistemonikos，检索日期截至 2021 年 6 月 17 日。使用随机效应模型重新计算汇总风险估计值。使用 GRADE 工具评估证据的确定性。本研究在 PROSPERO 注册，CRD42020153227。
从 16 篇文献中确定了 95 项荟萃分析。在一般人群中，糖尿病前期与全因死亡率和心血管结局、冠心病、中风、心力衰竭、心房颤动和慢性肾脏病的发生率增加 6-101%相关，具有中度确定性证据。也有证据表明，糖尿病前期与抑郁症状和认知障碍的发生率之间没有关联（证据确定性为低或极低）。与糖化血红蛋白定义的糖尿病前期相比，以葡萄糖耐量受损定义的糖尿病前期与全因死亡率的相关性更强。
结论/解释：糖尿病前期与全因死亡率以及心血管结局、冠心病、中风、慢性肾脏病、癌症和痴呆的发生率呈正相关。需要进一步进行高质量的研究，特别是针对糖化血红蛋白定义的糖尿病前期和其他相关健康结局（如神经病），以支持证据。
