MI Accelerates Transition of Obese Prediabetes Patients to Diabetes, Semaglutide Prevents: Study
Denmark: A study published in Cardiovascular Diabetology has found that patients with overweight or obesity who have prediabetes after a myocardial infarction face a substantially higher risk of progressing to type 2 diabetes. Those with an A1C of 6.0%–6.4% had a 54% risk of developing diabetes within five years, compared with only 5% among patients with normal glucose levels.
Preventive analysis showed that treating just 2.7 such high-risk patients with semaglutide could prevent one case of diabetes, suggesting semaglutide may be particularly beneficial for individuals with prediabetes, established cardiovascular disease, and excess weight.
The real-world cohort study was led by Pernille Tilma Tønnesen from the Department of Cardiology at Aarhus University Hospital, Denmark, and colleagues. The researchers aimed to identify which post–myocardial infarction patients are most likely to benefit from semaglutide, given the drug’s high cost and limited availability in routine clinical practice. While semaglutide has previously demonstrated efficacy in reducing diabetes progression in clinical trials, translating these benefits into everyday care requires careful patient selection.
Using data from the Western Denmark Heart Registry, the investigators included patients with a first-time myocardial infarction, a body mass index of at least 27 kg/m², and no prior diagnosis of diabetes. All participants met the eligibility criteria of the SELECT trial. Patients were categorized according to baseline glycemic status into three groups: HbA1c 6.0%–6.4%, HbA1c 5.7%–6.4%, and normoglycemia with HbA1c below 5.7%.
The study led to the following notable findings:
- The cohort included 7,398 patients with a median follow-up of nearly five years, with similar median BMI values of around 30 kg/m² across all groups, suggesting diabetes risk was primarily driven by glycemic status rather than degree of overweight.
- Progression to type 2 diabetes differed markedly by baseline HbA1c levels, occurring in over 50% of patients with HbA1c 6.0%–6.4%, 30% of those with HbA1c 5.7%–6.4%, and only 5% of patients with normal glucose levels within five years.
- After adjustment for age, sex, hypertension, and smoking, patients with HbA1c 6.0%–6.4% had an 18-fold higher risk of developing type 2 diabetes compared with normoglycemic individuals.
- The risk of diabetes progression in this high-risk group was substantially greater than that reported in earlier randomized trials, underscoring the vulnerability of real-world post–myocardial infarction patients.
- Preventive analysis indicated that treating 2.7 patients with HbA1c 6.0%–6.4% with semaglutide could prevent one case of type 2 diabetes over five years, highlighting a strong potential benefit in this subgroup.
The authors concluded that prediabetes is a powerful predictor of diabetes progression in patients with recent myocardial infarction and overweight or obesity. Their findings support prioritizing semaglutide therapy for those at the highest risk, particularly individuals with established cardiovascular disease and elevated HbA1c levels, to maximize preventive benefit in clinical practice.
Reference:
Tonnesen, P.T., Olesen, K.K.W., Gyldenkerne, C. et al. Progression to type 2 diabetes among post–myocardial infarction patients with overweight or obesity: a real-world cohort study. Cardiovasc Diabetol (2026). https://doi.org/10.1186/s12933-026-03085-4
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