Risk of progression from pre‐diabetes to type 2 diabetes in a large UK adult cohort

Michael P. Gardner, Jingya Wang, Jonathan M. Hazlehurst, Chris Sainsbury, Jacqueline Blissett, Krishnarajah Nirantharakumar, Neil Thomas, Srikanth Bellary

Research output: Contribution to journalArticlepeer-review


Aims:  People with pre-diabetes are at high risk of progressing to type 2 diabetes. This progression is not well characterised by ethnicity, deprivation and age, which we describe in a large cohort of individuals with pre-diabetes.

Methods:  A retrospective cohort study with The Health Improvement Network (THIN) database was conducted. Patients aged 18 years and over and diagnosed with pre-diabetes (HbA1c 42 mmol/mol (6.0%) to 48 mmol/mol (6.5% were included. Cox proportional hazards regression was used to calculate adjusted hazard rate ratios (aHR) for the risk of progression from pre-diabetes to type 2 diabetes for each of the exposure categories (ethnicity, deprivation (Townsend), age and body mass index (BMI)) separately.

Results:  Of the baseline population with pre-diabetes (n=397853), South Asian (aHR 1.31; 95% CI 1.26-1.37) or Mixed-Race individuals (aHR 1.22; 95% CI 1.11-1.33) had an increased risk of progression to type 2 diabetes compared with those of white European ethnicity. Likewise, deprivation (aHR 1.17; 95% CI 1.14-1.20; most vs. least deprived) was associated with an increased risk of progression. Both younger (aHR 0.63; 95% CI 0.58-0.69; 18 to <30 years) and older individuals (aHR 0.85; 95% CI 0.84-0.87; ≥65 years) had a slower risk of progression from pre-diabetes to type 2 diabetes, than middle-aged (40 to <65 years) individuals.

Conclusions:  South Asian or Mixed-Race individuals and people with social deprivation had an increased risk of progression from pre-diabetes to type 2 diabetes. Clinicians need to recognise the differing risk across their patient populations to implement appropriate prevention strategies.
Original languageEnglish
JournalDiabetic medicine
Early online date29 Oct 2022
Publication statusE-pub ahead of print - 29 Oct 2022

Bibliographical note

© 2022 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License [https://creativecommons.org/licenses/by-nc/4.0/], which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Funding statement: This study was funded by both the Type 2 Diabetes in the Youth (T2DMY) project and West Midlands NIHR
Clinical Research Network (CRN).


  • epidemiology
  • incidence
  • pre-diabetes
  • progression
  • type 2 diabetes


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