Broader definitions of prediabetes identified populations with much lower diabetes incidence rates and greater estimated NNT to prevent a case of diabetes compared to strict DPP criteria.
Cohort
Yes
Do different definitions of prediabetes affect the estimated diabetes incidence and NNT for prevention interventions in US adults?
Extrapolating the benefits of diabetes prevention interventions from the DPP trial to the broader prediabetes population may be unwarranted due to lower baseline incidence rates and higher NNT.
Introduction and Objective: We estimate impacts of different selection strategies for individuals with prediabetes for prevention interventions in US adults ≥25 years old. Methods: Using ADA criteria with OGTT, we defined 4 groups: normoglycemia (N), prediabetes (P: IFG, IGT, or HbA1c≥5.7%), modified National DPP eligibility criteria (BMI≥25 kg/m2 and P), and modified DPP trial inclusion criteria (BMI≥25 kg/m2, IFG, and IGT). We estimated prevalence of each group in 2005-2016 NHANES data. We compared diabetes incidence rate differences (RD) and hazard ratios (HR) between groups in three US longitudinal cohorts. We calculated numbers needed to treat (NNT) to prevent 1 diabetes case in 3 years by an intervention that reduced incidence rates by 50%. Results: Estimated percentages (~number in millions) of people in groups P, National DPP, and DPP were 56.1% (98.8), 42.6% (75.1), and 9.5% (16.6), respectively. Each group had significantly higher diabetes incidence than N, Figure 1. DPP vs. N had the highest HR and RD and lowest NNT. We obtained similar results using ADA criteria without an OGTT. Conclusion: People who met broader definitions of prediabetes had much lower diabetes incidence rates and greater estimated NNT to prevent a case of diabetes than did those who met DPP criteria. Extrapolating DPP benefits to the larger prediabetes population may be unwarranted. Disclosure E. Vazquez Arreola: None. R.L. Hanson: None. W. Knowler: None.
Arreola et al. (Fri,) conducted a cohort in Prediabetes. Broader prediabetes definitions (ADA criteria or modified National DPP) vs. Strict DPP trial inclusion criteria or normoglycemia was evaluated on Diabetes incidence. Broader definitions of prediabetes identified populations with much lower diabetes incidence rates and greater estimated NNT to prevent a case of diabetes compared to strict DPP criteria.
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