Prediabetes and Risk of All-Cause and Cause-Specific Mortality: A Prospective Study of 114062 Adults in Mexico City
Fermín-Martínez CA., Bello-Chavolla OY., Paz-Cabrera CD., Ramírez-García D., Perezalonso-Espinosa J., Fernández-Chirino L., Vargas-Vázquez A., Díaz-Sánchez JP., Méndez-Labra PN., Núñez-Luna A., Basile-Alvarez MR., Sánchez-Castro P., Bragg F., Friedrichs LG., Aguilar-Ramírez D., Emberson JR., Berumen J., Kuri-Morales P., Tapia-Conyer R., Alegre-Díaz J., Seiglie JA., Antonio-Villa NE.
Background Prediabetes has been associated with increased all-cause and cardiovascular mortality. However, no large-scale studies have been conducted in Mexico or Latin America examining these associations. Methods We analyzed data from 114062 adults without diabetes (diagnosed or undiagnosed) from the Mexico City Prospective Study. Participants were followed until January 1, 2021, for cause-specific mortality. We defined prediabetes according to the American Diabetes Association (ADA; HbA1c ≥ 5.7% to <6.5%) and the International Expert Committee (IEC; HbA1c ≥ 6.0 to <6.5%) definitions. Cox regression adjusted for confounders was used to estimate all-cause and cause-specific mortality rate ratios (RR) for deaths occurring at ages 35 to 74 years associated with prediabetes. Results After median 18.4 (IQR 17.6-19.7) years of follow-up, individuals with prediabetes had higher risk of all-cause mortality at ages 35 to 74 compared to those without prediabetes (RR 1.13 [1.07-1.20] for ADA-defined and 1.27 [1.17-1.38] for IEC-defined prediabetes), as well as higher risk of cardiovascular (RR 1.23 [1.11-1.37] and 1.44 [1.24-1.67], respectively), renal (RR 1.33 [1.06-1.66] and 1.62 [1.18-2.23], respectively), and acute diabetic deaths (RR 2.62 [1.75-3.93] and 3.42 [2.09-5.61], respectively). The absolute excess risk associated with ADA-defined prediabetes at ages 35 to 74 accounted for 7% of cardiovascular, 9% of renal, and 31% of acute diabetic deaths. IEC-defined prediabetes accounted for 4%, 5% and 14% of cardiovascular, renal, and acute diabetic deaths. Prediabetes-associated excess mortality risks were, at least in part, explained by adiposity. Conclusion Prediabetes is a significant risk factor for all-cause, cardiovascular, renal, and acute diabetic deaths in Mexican adults. Early identification and timely management of prediabetes among individuals at risk of this condition could reduce premature mortality in this population.