title: Regression from prediabetes to normal glucose regulation is associated with reduction in cardiovascular risk: results from the Diabetes Prevention Program outcomes study.
abstract: OBJECTIVE
  Restoration of normal glucose regulation (NGR) in people with prediabetes significantly decreases the risk of future diabetes. We sought to examine whether regression to NGR is also associated with a long-term decrease in cardiovascular disease (CVD) risk.
  
  
  METHODS
  The Framingham (2008) score (as an estimate of the global 10-year CVD risk) and individual CVD risk factors were calculated annually for the Diabetes Prevention Program Outcomes Study years 1-10 among those patients who returned to NGR at least once during the Diabetes Prevention Program (DPP) compared with those who remained with prediabetes or those in whom diabetes developed during DPP (N = 2,775).
  
  
  RESULTS
  The Framingham scores by glycemic exposure did not differ among the treatment groups; therefore, pooled estimates were stratified by glycemic status and were adjusted for differences in risk factors at DPP baseline and in the treatment arm. During 10 years of follow-up, the mean Framingham 10-year CVD risk scores were highest in the prediabetes group (16.2%), intermediate in the NGR group (15.5%), and 14.4% in people with diabetes (all pairwise comparisons P < 0.05), but scores decreased over time for those people with prediabetes (18.6% in year 1 vs. 15.9% in year 10, P < 0.01). The lower score in the diabetes group versus other groups, a declining score in the prediabetes group, and favorable changes in each individual risk factor in all groups were explained, in part, by higher or increasing medication use for lipids and blood pressure.
  
  
  CONCLUSIONS
  Prediabetes represents a high-risk state for CVD. Restoration of NGR and/or medical treatment of CVD risk factors can significantly reduce the estimated CVD risk in people with prediabetes.
authors: Anschutz Medical Campus, University of Colorado, Aurora, CO leigh.perreault@ucdenver.edu.
authors: Leigh
authors: L
authors: Perreault
authors: The Biostatistics Center, George Washington University, Rockville, MD.
authors: Marinella
authors: M
authors: Temprosa
authors: Indiana University School of Medicine, Indianapolis, IN.
authors: Kieren J
authors: KJ
authors: Mather
authors: Joslin Diabetes Center, Boston, MA.
authors: Ed
authors: E
authors: Horton
authors: University of Tennessee, Memphis, TN.
authors: Abbas
authors: A
authors: Kitabchi
authors: Massachusetts General Hospital, Boston, MA.
authors: Mary
authors: M
authors: Larkin
authors: University of Texas Health Science Center at San Antonio, San Antonio, TX.
authors: Maria G
authors: MG
authors: Montez
authors: Medstar Health Research Institute, Hyattsville, MD.
authors: Debra
authors: D
authors: Thayer
authors: University of Pittsburgh, Pittsburgh, PA.
authors: Trevor J
authors: TJ
authors: Orchard
authors: Colorado School of Public Health, Aurora, CO.
authors: Richard F
authors: RF
authors: Hamman
authors: Miller School of Medicine, University of Miami, Miami, FL.
authors: Ronald B
authors: RB
authors: Goldberg
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008055:Lipids / Q000032:analysis; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D011236:Prediabetic State / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D008055:Lipids