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Estimating the attributable risk of vascular disorders in different ranges of fasting plasma glucose and assessing the effectiveness of anti-diabetes agents on risk reduction; questioning the current diagnostic criteria

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Abstract

Introduction

Attributable risk of cardiovascular disorders (CVDs) and chronic kidney disease (CKD) in association with diabetes and pre-diabetes is under debate. Moreover, the role of anti-diabetes agents in risk reduction of such conditions is obscure. The purpose of this work is to define the population attributable fraction (PAF) of CVDs and CKD in different rages of plasma glucose.

Method

Iranian stepwise approach for surveillance of non-communicable disease risk factors (STEPs) was used to calculate PAF in four subsequent phases. Phase 0: whole population regardless of diagnosis; Phase I: in three CVD risk groups: minimal risk (FPG < 100 mg/dL), low risk (FPG 100–126 mg/dL), and high risk (FPG ≥ 126 mg/dL) groups; Phase II: three diagnostic groups: normal, pre-diabetes, and diabetes; Phase III: diabetes patients either receiving or not receiving anti-diabetes agents.

Result

A total of 19,503 participants [female-to-male ratio 1.17:1] had at least one FPG measurement and were enrolled. Phase 0: PAF of young adults was lower in the general population (PAF range for CVDs 0.05 ─ 0.27 [95% CI 0.00 ─ 0.32]; CKD 0.03 ─ 0.41 [0.00 ─ 0.62]). Phase I: High-risk group comprised the largest attributable risks (0.46 ─ 0.97 [0.32 ─ 1]; 0.74 ─ 0.95 [0.58 ─ 1]) compared to low-risk (0.16 ─ 0.41 [0.04 ─ 0.66]; 0.29 ─ 0.35 [0.07 ─ 0.5]) and minimal risk groups (negligible estimates) with higher values in young adults. Phase II: higher values were detected in younger ages for diabetes (0.38 ─ 0.95 [0.29 ─ 1]; 0.65 ─ 0.94 [0.59 ─ 1] and pre-diabetes patients (0.15 ─ 0.4 [0.13 ─ 0.45]; 0.26 ─ 0.35 [0.22 ─ 0.4]) but not normal counterparts (negligible estimates). Phase III: Similar estimates were found in both treatment (0.31 ─ 0.98 [0.17 ─ 1]; 0.21 ─ 0.93 [0.12 ─ 1]) and drug-naïve (0.39 ─ 0.9 [0.27 ─ 1]; 0.63 ─ 0.97 [0.59 ─ 1]) groups with larger values for younger ages.

Conclusion

Globalized preventions have not effectively controlled the burden of vascular events in Iran. CVDs and CKD PAFs estimated for pre-diabetes were not remarkably different from normal and diabetes counterparts, arguing current diagnostic criteria. Treatment strategies in high-risk groups are believed to be more beneficial. However, the effectiveness of medical interventions for diabetes in controlling CVDs and CKD burden in Iran is questionable.

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Acknowledgements

The authors thank the other investigators, the staff, and the participants of STEPs 2016 study for the valuable contribution.

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Author notes

  1. Esmaeil Mohammadi, Fatemeh Sadeghi Morasa, and Shahin Roshani contributed equally to this work. Bagher Larijani and Farshad Farzadfar are co-correspondent authors of this work.

Authors and Affiliations

  1. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, No. 10, Al-e-Ahmad and Chamran Highway intersection, Tehran, Iran

    Esmaeil Mohammadi, Shahin Roshani, Negar Rezaei, Sina Azadnajafabad, Sahar Saeedi Moghaddam, Mehrdad Azmin, Nima Fattahi, Kosar Jamshidi, Narges Ebrahimi, Mahtab Rouhifard Khalilabad, Shohreh Naderimagham & Farshad Farzadfar

  2. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Third Floor, No.10, Jalal Al-e-Ahmad Highway, Tehran, Iran

    Fatemeh Sadeghi Morasa, Maryam Karimian, Bagher Larijani & Farshad Farzadfar

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  1. Esmaeil Mohammadi
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Contributions

EM performed statistical analysis, interpreted the data and drafted the manuscript. FSM reviewed the literature. SR performed statistical analysis. SA, MA, EG, SSM, MK, and NR critically revised the manuscript and interpreted the data. NF, KJ, and SN reviewed the literature and revised the manuscript. NE and MRK prepared tables and figures and critically revised the manuscript. BL and FF conceptualized the study and are guarantor of this work and had full access to all the data and take responsibility for the integrity and accuracy of all steps.

Corresponding authors

Correspondence to Bagher Larijani or Farshad Farzadfar.

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This study has been approved by the ethics committee of Tehran University of Medical Sciences.

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Mohammadi, E., Morasa, F.S., Roshani, S. et al. Estimating the attributable risk of vascular disorders in different ranges of fasting plasma glucose and assessing the effectiveness of anti-diabetes agents on risk reduction; questioning the current diagnostic criteria. J Diabetes Metab Disord 19, 1423–1430 (2020). https://doi.org/10.1007/s40200-020-00663-5

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