Association between preDM, defined by HbA1c or FPG alone, and CVD has remained controversial whereas impaired glucose tolerance (IGT) defined according to 2-h blood glucose level in the oral glucose tolerance test has been consistently associated with CVD. However, a glucose tolerance test is not practical in all persons. Thus, we attempted to identify a high-risk group for CVD in those with PreDM using HbA1c and FPG combinations. We analyzed data from a nationwide claims database on 1,140,096 Japanese with no CVD history or glucose abnormality from 2008 to 2022. Multivariate Cox regression analysis showed that compared with normal HbA1c (≤5.6%), CVD risk increased significantly and linearly from HbA1c 5.9% to HbA1c 6.8% in the diabetic range. Conversely, compared with normal FPG (70-99 mg/dl), CVD risk did not increase in the preDM range at each FPG level. Analysis of combinations of HbA1c and FPG showed that with FPG levels 70-99 mg/dl compared with HbA1c ≤5.6%, those with HbA1c 6.0-6.4% had an increased risk of CVD. Risk was higher than with HbA1c 6.5-6.8% (hazard ratio [HR] 1.30 [95% CI 1.11-1.52], 1.11 [0.63-1.96]) (Table). Results suggest that preDM with high HbA1c and normal FPG might have potential postprandial hyperglycemia or lack treatment interventions due to undiagnosed diabetes, which could increase risk of CVD. Disclosure K.Murai: None. M.Iwanaga: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. K.Fujihara: None. Y.Yaguchi: None. M.H.Yamada: None. Y.Matsubayashi: None. M.Kitazawa: None. M.Yamamoto: None. T.Yamada: None. S.Kodama: None.

Breslow’s Health Practice Index (HPI) includes recommendations for a healthy lifestyle and is composed of 7 simple lifestyle factors (never smoking, regular physical activity, moderate or no use of alcohol, 7-8 hours sleep regularly, maintaining proper weight, eating breakfast, and not eating between meals). Cardiovascular health metrics (CVHMs), defined by the American Heart Association are composed of lifestyle factors and clinical laboratory values (smoking, weight, physical activity, diet, cholesterol, blood pressure, and blood glucose). To clarify the impact of HPI or CVHMs on incident HD according to DM, we analyzed a nationwide claims-based database of 294,647 people included from 2008-16 (DM- 277,935, DM 16,712). Risk for HD were analyzed according to DM and HPI/CVHMs based on the number of unfavorable lifestyle factors in the HIP and unfavorable lifestyle factors and clinical values in the CVHM (Table). Multivariate Cox regression analysis showed that DM increased the risk of dialysis 5- to 6-fold and DM and CVHMs synergistically increased the risk of HD. Results indicated that factors similar to those used to predict cardiovascular disease would also be useful to predict HD. These approaches might be helpful in clinical practice and patient education. Disclosure T.Osawa: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. K.Fujihara: None. M.H.Yamada: None. Y.Yaguchi: None. T.Sato: None. M.Kitazawa: None. Y.Matsubayashi: None. T.Yamada: None. S.Kodama: None.

Impaired muscle strength, balance, and flexibility have been associated with the development of type 2 diabetes and atherosclerosis. A physical score (PS), which integrates these physical fitness indices, could be expected to better predict future metabolic diseases. We investigated the longitudinal relationship between the baseline PS and changes in PS and future DM and MetS. Analyzed were 5,718 persons (4,068 men) aged 30 to 69 y without DM who underwent physical fitness tests. Principal component analysis was performed on the correlation matrix of the physical fitness test results according to age and sex. The PS was defined as the first principal component score. Associations between PSs at the start of observation (year −2), change in the PS two years later (year 0) and the incidence of DM at the end of observation (until year 3) were examined by logistic regression analysis. The same analysis was performed for 5,304 persons (3,729 men) without MetS at baseline. Although no significant difference was found in the incidence of DM, a significant difference was found in the incidence of MetS; odds ratio was 1.39 (1.20, 1.61) for each decrease of 1 in the PS in year −2 and 1.51 (1.18, 1.92) for each decrease of 1 in the change in PS from year -2 to year 0. = Results showed that the PS was a simple and non-invasive predictor of MetS. Disclosure T.Sato: None. K.Kato: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. K.Fujihara: None. M.H.Yamada: None. Y.Yaguchi: None. M.Yamamoto: None. M.Kitazawa: None. H.Ishiguro: None. T.Osawa: None. T.Yamada: None. Funding Japan Society for the Promotion of Science; Japan Ministry of Health, Labour and Welfare (21K11569)

The use of multiple diagnostic criteria for metabolic syndrome (MetS) may miss high-risk populations for cardiovascular disease. Moreover, since women are more likely to have subcutaneous fat deposits than men, the predictive ability of cardiovascular disease may be improved by optimizing the cut-off value of each component of criteria according to sex and considering whether to include waist circumference (WC) as a required component. In a nationwide cohort of 565,079 men and women from 2008 to 2016 in Japan, we analyzed the association between MetS and each component and the development of CAD, CVD, or CAD/CVD using multivariate Cox regression. Of these 3,934 men (1.19%) and 893 women (0.38%) developed CAD/CVD, with a 1.3- to 2.9-fold increased risk of CAD/CVD when current MetS components were met. The optimal thresholds for predicting CAD/CVD by ROC analysis in men and women were WC 83 and 77 cm, triglycerides 130 and 90 mg/dl, HDL-C 50 and 65 mg/dl, BP 130/80 and 120/80 mmHg, and FPG of 100 and 90 mg/dl, respectively. Although no significant difference was detected between the current MetS criteria and our modified criteria in the ability to predict CAD/CVD, using the new criteria increased prevalence of MetS and significantly improved sensitivity (Table). Optimizing MetS criteria could significantly reduce the number of high-risk individuals overlooked by the current criteria. Disclosure Y.Mitsuma: None. Y.Matsubayashi: None. M.Iwanaga: None. T.Yamada: None. K.Kato: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. K.Fujihara: None. K.Murai: None. T.Sato: None. Y.Yaguchi: None. M.H.Yamada: None. M.Yamamoto: None. T.Osawa: None. M.Kitazawa: None.

We examined the effects of a lifestyle intervention program with a smartphone app augmented by intermittently scanned continuous glucose monitoring (isCGM) of persons at high risk of developing diabetes in a 12-week randomized open-label trial (UMIN00004640). The program monitored blood glucose fluctuations and lifestyle habits and displayed them in an easy-to-understand interface as well as provided personalized lifestyle intervention messages. The primary endpoint was the change in time in range (TIR) of 70-140 mg/dL between intervention (App) and control (C) groups. Among 168 patients (mean age 48.1 y, mean BMI 26.6 kg/m2, and male 80.4%), 82 and 86 were assigned to the App group and C group, respectively. After 12 weeks, TIR of 70-140 mg/dL significantly improved in the App group compared to the C group (-2.6 min/day vs. +31.5 min/day, p=0.03). Changes in time above range (>140 mg/dL; -20.9 min/day vs. -22.6 min/day, p=0.86) did not differ, whereas time below range (<70 mg/dL; +23.5 min/day vs. -8.9 min/day, p=0.02) improved in App compared to C. BMI (-0.26 vs. -0.59, p=0.017) and carbohydrate intake (-4.4 kcal/day vs. -22.7 kcal/day, p=0.049) also improved in App compared to C. Intervention with a smartphone app and isCGM increased glycemic control with a decrease in carbohydrate intake and weight loss. Disclosure M.Kitazawa: None. H.Sone: Research Support; Novo Nordisk, Astellas Pharma Inc., Kyowa Kirin Co., Ltd., Taisho Pharmaceutical Holdings Co., Ltd., Ono Pharmaceutical Co., Ltd., Eisai Co., Ltd., Takeda Pharmaceutical Co., Ltd. H.Suzuki: None. C.Horikawa: None. Y.Takeda: None. I.Ikeda: None. M.Hatta: None. M.Iwanaga: None. T.Yamada: None. K.Fujihara: None.