Microvascular complications in prediabetes: a systematic review & meta-analysis

Area of Science:

• Endocrinology
• Ophthalmology
• Nephrology

Background:

• Rising prediabetes prevalence increases microvascular complication risk.
• Discrepancies exist between ADA (HbA1c 5.7-6.4%) and IEC (HbA1c 6.0-6.4%) prediabetes definitions.
• Identifying optimal prediabetes screening criteria for microvascular complications is crucial.

Purpose of the Study:

• To determine if a specific prediabetes hemoglobin A1c (HbA1c) or fasting blood glucose (FBG) threshold increases microvascular complications.
• To compare the efficacy of ADA versus IEC criteria in identifying retinopathy risk.

Main Methods:

• Systematic review of prediabetes studies (1990-May 2023) in major databases.
• Included studies reporting retinopathy, nephropathy, and/or neuropathy.
• Analyzed 35 studies out of 21,215 identified.

Main Results:

• ADA criteria identified significantly higher prevalence and incidence of retinopathy compared to IEC criteria.
• Receiver Operator Curve analysis showed better performance for IEC criteria in retinopathy detection (AUC 0.88) versus ADA criteria (AUC 0.73).
• Limited data available for nephropathy and neuropathy prevalence in prediabetes.

Conclusions:

• ADA prediabetes criteria (HbA1c 5.7-6.4%) are more sensitive for detecting retinopathy than IEC criteria (HbA1c 6.0-6.4%).
• Clinical retinal screening may be beneficial for individuals with HbA1c ≥ 5.7%.
• Further research is needed on nephropathy and neuropathy prevalence in prediabetes.