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The Science Behind the Boston Heart Prediabetes Assessment®
Diabetes is a major risk factor for heart disease and stroke. The U.S. Centers for Disease Control and Prevention estimates that about 70% of diabetics will die of heart disease and about 15% from stroke.1
Knowing whether a prediabetic individual may progress to diabetes before they actually do can help prevent some of the serious complications that are associated with diabetes and inherently reduce their risk for heart disease.
The Boston Heart Prediabetes Assessment was developed using the results of over 2500 patients enrolled in the Framingham Offspring Study. The mean age of the population set was 58 years; all were nondiabetic at the beginning of the study. Complete follow-up information including coronary heart disease status (CHD) over ten years was available.
The assessment includes the variables that were statistically significant: fasting serum glucose, fasting trigylcerides, adiponectin, glycated serum protein, albumin, statin/niacin therapy, BMI and parental history of diabetes.
Prediabetes Assessment Predicts Diabetes
The Boston Heart Prediabetes Assessment has an overall C statistic of 0.92. This is a higher accuracy level than traditional methods of determining risk for diabetes. Standard two-hour glucose test has C-statistic of 0.76 while the Homeostasis Model of Insulin Resistance (HOMA-IR) has an C-statistic of 0.75.3 Other studies (San Antonio Heart Study and the Framingham Offspring Study) have shown that the two-hour glucose tolerance test does not add greatly in the prediction of diabetes.4,5
Treatment for Borderline or High Risk Prediabetics
For prediabetic subjects with borderline or high risk of developing diabetes, a structured lifestyle program that includes weight loss and exercise, has been shown to reduce the risk of developing diabetes by 58% over 3 years in more than 3,000 subjects with prediabetes compared to usual care. In this same study, the use of metformin reduced this risk by 31% as compared to the usual care group, provided kidney function was normal in the patient.6
"… a structured lifestyle program including weight loss and exercise, has shown to reduce the risk of developing diabetes by 58% over 3 years”
- Knowler, Diabetes Prevention Program Research (2002)6
The Diabetes Epidemic
Since 1980, the annual diagnosis of diabetes has more than tripled.7 The Centers for Disease Control and Prevention estimates that by 2050, one in three Americans will be diagnosed with diabetes.1
Diabetes is costly. The cost of medical care is about 2.3 times higher in diabetic subjects than non-diabetics. The total yearly medical cost of diabetes in the US is about $174 million.1
1. Centers for Disease Control and Prevention. National Diabetes Fact Sheet: National Estimates and General Information on Diabetes and Prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011.
2. Schaefer EJ, White CC, Ai M, Otokozawa S, Horvath K, Asztalos BF, Wilson PW. Cupples LA. A new model for the prediction of diabetes mellitus: results from the Framingham Offspring Study (manuscript in preparation).
3. Lyssenko V, Jørgensen T, Gerwien RW, et al. Validation of a multi-marker model for the prediction of incident type 2 diabetes mellitus: combined results of the Inter99 and Botnia studies. Diab Vasc Dis Res. 2012;9(1):59-67.
4. Stern MP, Williams K, Haffner SM. Identification of persons at high risk for type 2 diabetes mellitus: do we need the oral glucose tolerance test? Ann Intern Med. 2002;136(8):575-581.
5. Wilson PW, Meigs JB, Sullivan L, Fox CS, Nathan DM, D’Agostino RB Sr. Prediction of incident Diabetes mellitus in middle-aged adults: the Framingham Offspring Study. Arch Intern Med. 2007;167(10):1068- 1074
6. Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393-403.
7. Number (in Millions) of Civilian, Noninstitutionalized Adults with Diagnosed Diabetes, United States, 1980–2011. Data Source: Centers for Disease Control and Prevention, National Center for Health Statistics, Division of Health Interview Statistics, data from the National Health Interview Survey. Statistical analysis by the Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation.
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