Comparison of the American diabetes association risk test, BMI, and estimated cardiorespiratory fitness with incident prediabetes and type 2 diabetes: A cohort study

AIM(S): To compare associations of nonexercise estimated cardiorespiratory fitness (eCRF), the American Diabetes Association Risk Test (ADART), and body mass index (BMI) with incident prediabetes and type 2 diabetes in adults with normoglycemia. METHODS: Participants were 10,715 healthy men and women aged 20-81 years from the Aerobics Center Longitudinal Study. eCRF was calculated in metabolic equivalents using sex-specific equations including age, BMI, resting heart rate, blood pressure, and smoking status. Incident prediabetes and type 2 diabetes were identified by fasting glucose or diagnosis. Cox regression models estimated hazard ratios (HRs) and 95% confidence intervals (CIs), adjusting for risk factors. RESULTS: Over a median follow-up of 5.1 years for prediabetes and 6.7 years for type 2 diabetes, 3912 and 320 cases occurred, respectively. Compared with unfit participants, fit individuals had a lower risk of prediabetes (HR: 0.83; 95% CI: 0.77-0.90) and type 2 diabetes (HR: 0.72; 95% CI: 0.55-0.95). Associations were significant in men for both outcomes and in women for prediabetes only. ADART and BMI predicted prediabetes but not type 2 diabetes after adjustment. CONCLUSIONS: eCRF demonstrated reliability as a noninvasive risk assessment tool for determining prediabetes and type 2 diabetes risk, particularly in men, highlighting its potential value for early risk assessment in lower-risk populations. All tools effectively assessed prediabetes risk.