Cardiovascular disease, heart failure, chronic kidney disease and depression independently increase the risk of incident diabetes.
OBJECTIVE
Diabetes increases the risk of cardiovascular disease (CVD) and heart failure, as well as other serious complications, such as renal disease and depression. However, these conditions are often present prior to diabetes diagnosis. We sought to determine whether they increase the risk of developing diabetes independent of other risk factors.


METHODS
We identified 58,056 non-diabetic adults aged ≥30 years with no evidence of diabetes. Using electronic medical records, we identified the presence of four conditions at baseline (CVD, heart failure, renal disease and depression) and then estimated diabetes incidence over 5 years separately for patients with and without each of these conditions. Each incidence estimate was adjusted for baseline values of age, sex, fasting glucose, body mass index, systolic blood pressure, triacylglycerol, HDL-cholesterol, smoking and the presence of the other three conditions.


RESULTS
Patients with CVD were 35% (95% CI 23-48%) more likely to develop diabetes after controlling for other risk factors. Heart failure was independently associated with an increase in diabetes incidence of 48% (95% CI 27-73%), and depression was associated with a 10% (95% CI 2-20%) increase. Chronic kidney disease was associated with a non-significant risk increase of 10% (95% CI -2-25%).


CONCLUSIONS
Complications of diabetes are more prevalent among patients who will ultimately develop diabetes, and increase the risk of diabetes independently of other known risk factors. The apparent bidirectional relationships suggest that primary prevention of CVD may also help prevent diabetes.
Kaiser Permanente Center for Health Research, 3800 N. Interstate Avenue, Portland, OR, USA. greg.nichols@kpchr.org
G A
GA
Nichols
E J
EJ
Moler
D002318:Cardiovascular Diseases / Q000150:complications / Q000453:epidemiology*; D003863:Depression / Q000150:complications / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors