Introdução: Glicemia de jejum alterada tem sido associada a maior risco de desenvolver diabetes, comparando a indivíduos normoglicêmicos. Apesar de diabetes ser relacionado a aterosclerose e a piores desfechos cardiovasculares, os dados de literatura relacionando glicemia de jejum alterada à doença aterosclerótica são conflitantes. Os objetivos deste trabalho foram determinar (a) a incidência de diabetes em indivíduos com glicemia de jejum normal ou alterada em 1998 após um seguimento de até 12 anos; (b) se a glicemia de jejum alterada em 1998 e/ou diabetes incidente estiveram associados com aterosclerose subclínica no Estudo Longitudinal da Saúde do Adulto (ELSA-Brasil) ou à variável combinada de eventos clínicos não-fatais e escore de cálcio coronariano maior ou igual a 400. Métodos: Avaliamos 1.536 trabalhadores da Universidade de São Paulo, que participaram de um programa de avaliação em 1998 (idade 23-63 anos) e da linha de base do ELSA-Brasil (2008-2010). Apresentamos as taxas de incidência de diabetes brutas e ajustadas para todos os indivíduos e também estratificados por gênero e por índice de massa corpórea (IMC) em 1998. Utilizamos modelos de regressão brutos e ajustados para estimar a associação entre glicemia de jejum alterada em 1998 ou diabetes incidente com a espessura de íntima-média de carótidas (EIMC), escore de cálcio coronariano (CACS, do inglês Coronary Artery Calcium Score) e a variável composta CACS >= 400 ou eventos cardiovasculares incidentes (infarto do miocárdio ou revascularização). Resultados: Encontramos diabetes incidente em 177 indivíduos. A incidência de diabetes em nossa amostra foi de 9,8/1.000 pessoas-ano (Intervalo de confiança de 95% [IC95%]: 7,7-13,6). A incidência foi mais elevada entre os homens (11,2/1.000 pessoas-ano, IC95%: 8,6-15,0) do que entre as mulheres (8,5/1.000 pessoas-ano, IC95%: 5,3-15,3). Glicemia de jejum alterada em 1998 mostrou associação com maior risco de progressão para diabetes ao longo do seguimento (hazard ratio [HR]: 3,17; IC95%: 2,14-4,68) e HR: 7,42; IC95%: 4,75-11,57 para glicemias de jejum entre 100 e 109mg/dl e entre 110 e 125mg/dl, respectivamente). Glicemias entre 110 e 125mg/dl em 1998 foram associadas a maiores valores de EIMC (beta=+0,028; IC95%: 0,003 a 0,053) na linha de base do ELSA-Brasil. Ao excluir da análise aqueles com diabetes incidente, houve associação limítrofe, não-significativa, entre maiores valores de EIMC e glicemia de jejum entre 110 e 125mg/dl em 1998 (?=0,030; IC95%: -0,005 a 0,065). Ambos os níveis de glicemia de jejum alterada em 1998 não se mostraram associados ao CACS ou à variável composta de CACS >= 400 ou eventos cardiovasculares incidentes nos modelos de ajuste completo. Diabetes incidente foi associado a maiores valores de EIMC (em milímetros) (?=0,034; IC95%: 0,015 a 0,053), a CACS >= 400 (Razão de chances=2,84; IC95%: 1,17-6,91) e ao desfecho combinado de CACS >= 400 ou eventos cardiovasculares incidentes (Razão de chances=3,50; IC95%: 1,60-7,65). Conclusões: Glicemia de jejum alterada em 1998, especialmente nos valores mais próximos dos limiares de corte para diabetes, foram associados a maior incidência de diabetes ao longo do seguimento e a maiores valores de EIMC quando da avaliação inicial do ELSA-Brasil. Diabetes incidente entre as avaliações foi associado a maior risco cardiovascular / Introduction: Impaired fasting glucose has been associated with higher risk of incident diabetes, compared to normoglycemic individuals. Although diabetes mellitus is related to atherosclerosis and higher long-term cardiovascular burden, there are conflicting data about the association between impaired fasting glucose and atherosclerotic disease. We aimed (a) to determine diabetes incidence rates in individuals with normal or impaired fasting glucose in 1998 after follow-up of up to 12 years, (b) whether impaired fasting glucose in 1998 and/or incident diabetes were associated with subclinical atherosclerosis in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) or the combined variable of non-fatal clinical events or a coronary calcium score >= 400. Methods: We evaluated 1,536 civil servants from the University of São Paulo, who participated in both 1998 (aged 23-63 years) and ELSA-Brasil baseline (2008-2010) assessments and had complete data. We presented crude and adjusted diabetes incident rates for all individuals and then stratified by sex and body mass index (BMI) in 1998. We used crude and adjusted regression models to estimate the association between impaired fasting glucose in 1998 or incident diabetes and coronary intima-media thickness (CIMT), coronary artery calcium score (CACS) and the composite variable of a CACS?400 or incident cardiovascular events (myocardial infarction or revascularization). Results: We found incident diabetes in 177 individuals. Diabetes incidence in our sample was 9.8/1,000 person-years (95% confidence interval [95%CI]:7.7-13.6). Diabetes incidence was higher in men (11.2/1,000 person-years, 95%CI: 8.6-15.0) than women (8.5/1,000 person-years, 95%CI: 5.3 to 15.3). Impaired fasting glucose in 1998 was associated with a higher risk of progression to diabetes during follow-up (hazard ratio [HR]: 3.17; 95%CI: 2.14-4.68 and HR: 7.42; 95%CI: 4.75-11.57 for a fasting plasma glucose between 100 to 109mg/dl and 110 to 125 mg/dl, respectively). Fasting plasma glucose levels between 110 to 125 mg/dl in 1998 were associated with higher CIMT (beta=+0.028; 95%CI: 0.003 to 0.053) in ELSA-Brasil baseline. Excluding those with incident diabetes, there was a non-significant borderline association between higher CIMT (in mm) and fasting plasma glucose 110 to 125mg/dl (beta=0.030; 95%CI: -0.005 to 0.065). Fasting plasma glucose levels in 1998 were not associated with CACS or the composite variable of a CACS ? 400 or incident cardiovascular events in full-adjusted models. Incident diabetes was associated with higher CIMT (in mm) (beta=0.034; 95%CI: 0.015 to 0.053), CACS >= 400 (OR=2.84; 95%CI: 1.17-6.91) and the combined outcome of a CACS >= 400 or incident cardiovascular event (OR=3.50; 95%CI: 1.60-7.65). Conclusions: Elevated fasting plasma glucose in 1998, especially those near diabetes diagnosis limits were associated with higher diabetes incidence during follow-up and higher CIMT in ELSA-Brasil baseline assessment. Incident diabetes between assessments was associated with higher cardiovascular burden

Pre-diabetes is a serious health problem in the United States. Distinguished by plasma glucose levels that are above the normal threshold, patients with pre-diabetes are 10 times more likely to develop type 2 diabetes. Patients with pre-diabetes suffer the same complications as patients with diabetes including diabetic retinopathy, nephropathy, and microalbuminuria. There is considerable evidence to support the idea that early identification and aggressive treatment of pre-diabetes has the potential to delay disease progression. The American Diabetes Association’s clinical practice guideline recommends management of with lifestyle modification and metformin for patients who are at risk for developing type 2 diabetes. The purpose of this project was to evaluate the implementation of the 2012 ADA clinical practice guidelines regarding the management of patients with pre-diabetes by the health care providers at a volunteer-run clinic located in a large metropolitan area in the southeastern United States. This study, even with a small sample size (n=26) revealed that the providers at the clinic had not implemented the 2012 ADA clinical practice guidelines. Clinical practice guidelines promote health care interventions that have proven benefits and improve the consistency of care provided to patients. The greatest benefits of implementing clinical practice guidelines for patients with pre-diabetes are early diagnosis and aggressive disease management. This would improve patient outcomes and in the long run, decrease the cost of medical care.