Cardiovascular Risk Profile in Subjects With Prediabetes and New- Onset Type 2 Diabetes Identified by HbA1c According to American Diabetes Association Criteria

OBJECTIVEWe investigated the cardiovascular risk profile in subjects with prediabetes and new-onset type 2 diabetes identified by glycated hemoglobin A(1c) (HbA(1c)) according to the new American Diabetes Association criteria.RESEARCH DESIGN AND METHODSArterial stiffness, intima-media thickness (IMT), soluble receptor for advanced glycation end products (sRAGEs), and oral glucose tolerance test (OGTT) were evaluated in 274 subjects without a previous history of diabetes. The subjects were stratified into three groups according to the HbA(1c) levels.RESULTSThe subjects with prediabetes (n = 117, HbA(1c) 5.7-6.4% [39-46 mmol/mol]) showed a higher augmentation (Aug), augmentation index (AugI), and IMT compared with those with lower HbA(1c); however, these values were similar to those of subjects with HbA(1c) >6.5% (48 mmol/mol). When we further analyzed the subjects with prediabetes but included only subjects with normal glucose tolerance (NT) in the analysis, AugI and IMT still remained significantly higher than their levels in control subjects with HbA(1c) <5.7% (39 mmol/mol). After multiple regression analyses including several cardiovascular risk factors, only HbA(1c), age, and sRAGE were significantly correlated with the IMT, whereas age and 1-h postload glucose were the major determinants of AugI.CONCLUSIONSOur data show that subjects with prediabetes according to HbA(1c), but with both NT according to the OGTT and normal fasting glycemia, have an altered IMT and AugI. These data suggest that a simple, reproducible, and less expensive marker such as HbA(1c) may be better able to identify prediabetic subjects at high cardiovascular risk compared with fasting glycemia or OGTT alone.