Objective The associated risk of vascular disease following diagnosis of type 2 diabetes
in people previously identified as having pre-diabetes in real-world settings is unknown.
We examined the presence of microvascular and macrovascular disease in individuals
with newly diagnosed type 2 diabetes by glycemic status within 3 years before diagnosis.
Research design and methods We identified 159736 individuals with newly diagnosed
type 2 diabetes from the UK Clinical Practice Research Datalink database in England
between 2004 and 2017. We used logistic regression models to compare presence of microvascular
(retinopathy and nephropathy) and macrovascular (acute coronary syndrome, cerebrovascular
and peripheral arterial disease) disease at the time of type 2 diabetes diagnosis
by prior glycemic status. Results Half of the study population (49.9%) had at least
one vascular disease, over one-third (37.4%) had microvascular disease, and almost
a quarter (23.5%) had a diagnosed macrovascular disease at the time of type 2 diabetes
diagnosis. Compared with individuals with glycemic values within the normal range,
those detected with pre-diabetes before the diagnosis had 76% and 14% increased odds
of retinopathy and nephropathy (retinopathy: adjusted OR (AOR) 1.76, 95%CI 1.69 to
1.85; nephropathy: AOR 1.14, 95%CI 1.10 to 1.19), and 7% higher odds of the diagnosis
of acute coronary syndrome (OR 1.07, 95%CI 1.03 to 1.12) in fully adjusted models
at time of diabetes diagnosis. Conclusions Microvascular and macrovascular diseases
are detected in 37%-24% of people with newly diagnosed type 2 diabetes. Pre-diabetes
before diagnosis of type 2 diabetes is associated with increased odds of microvascular
disease and acute coronary syndrome. Detection of pre-diabetes might represent an
opportunity for reducing the burden of microvascular and macrovascular disease through
heightened attention to screening for vascular complications.
