TOPLINE:

In a real-world cohort of patients with a recent myocardial infarction and overweight or obesity, prediabetes with A1c levels of 6.0%-6.4% was associated with a markedly higher risk for progression to type 2 diabetes (T2D) within 5 years than normal glucose levels.

METHODOLOGY:

• Researchers in Denmark analysed real-world data to investigate the 5-year risk for progression to T2D in 7398 patients without diabetes who had a first-time myocardial infarction and BMI ≥ 27; they also assessed the estimated preventive potential of semaglutide in this cohort.
• Participants were categorised on the basis of baseline A1c levels: those with prediabetes A1c levels of 6.0%-6.4% (n = 1385), those with prediabetes A1c levels of 5.7%-6.4% (n = 3751), and those with normoglycaemia (A1c levels < 5.7%; n = 3647). The median age across groups was 62-66 years, and 73%-79% of participants were men.
• Outcomes were progression to T2D and all-cause mortality; T2D was defined through hospital records, A1c levels of ≥ 6.5%, or previous redemption of any diabetes medication.
• The 5-year number needed to treat with semaglutide to prevent one case of T2D was estimated by applying effect sizes from the SELECT trial.
• The median follow-up duration was 4.7 years beginning 60 days after coronary angiography.

TAKEAWAY:

• Overall, 15% of patients progressed to T2D; the 5-year risk for progression to T2D was 54% for those with prediabetes A1c levels of 6.0%-6.4%, 30% for those with prediabetes A1c levels of 5.7%-6.4%, and 5% for those with normoglycaemia.
• Compared to patients with normoglycaemia, those with prediabetes A1c levels of 6.0%-6.4% had an 18-fold higher rate of progression to T2D (adjusted hazard ratio [aHR], 18.3; 95% CI, 15.2-22.1), and those with prediabetes A1c levels of 5.7%-6.4% had a nearly eightfold higher rate (aHR, 7.94; 95% CI, 6.63-9.51).
• Prediabetes with A1c levels of 6.0%-6.4% was associated with a 29% increased rate of all-cause mortality (aHR, 1.29; 95% CI, 1.05-1.58).
• The estimated 5-year number needed to treat with semaglutide to prevent one case of T2D was 2.7 for patients with prediabetes A1c levels of 6.0%-6.4%.

IN PRACTICE:

"Taken together, [the study] results indicate that treatment with semaglutide may be particularly advantageous for patients with prediabetes, preexisting cardiovascular disease, and overweight or obesity — combining its proven benefits on cardiovascular outcomes and all-cause mortality with a potential major reduction in the progression to type diabetes with all the associated patient, health care and surveillance benefits of fewer patients with type 2 diabetes," the authors wrote.

SOURCE:

This study was led by Pernille Tilma Tonnesen, MD, Aarhus University Hospital, Aarhus, Denmark. It was published online on January 24, 2026, in Cardiovascular Diabetology.

LIMITATIONS:

High A1c levels at admission may have prompted additional testing and introduced surveillance bias. The exclusion of SGLT2 inhibitor monotherapy from the diabetes definition may have slightly underestimated the incidence of diabetes. In addition, residual confounding was possible given the cohort design.

DISCLOSURES:

This study was funded by a grant from the Novo Nordisk Foundation. Some authors reported having equity in Novo Nordisk; receiving support from the Danish Cardiovascular Academy, which is funded by the Novo Nordisk Foundation; receiving consulting fees, speaker honoraria, research grants, and travel support; and having other relationships with several pharmaceutical companies, including Novo Nordisk.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.