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Objective— We examined whether B-mode ultrasound–detected carotid artery intima-media thickness (IMT) was elevated before the onset of clinical diabetes.Methods and Results— The study population for these analyses included 1127 nondiabetic participants, 66 prediabetic participants, and 303 diabetic participants with a mean age of 49.8 years who participated in the Mexico City Diabetes Study, a prospective cohort study. Common carotid artery (CCA) and internal carotid artery (ICA) IMTs were measured bilaterally by B-mode ultrasound. Age- and sex-adjusted mean ICA and CCA IMTs were both significantly higher among prediabetic individuals {0.81 mm [95% confidence interval (CI), 0.75–0.88] and 0.72 mm [95% CI, 0.69–0.75], respectively} than in individuals who remained free of diabetes [0.71 mm (95% CI, 0.69–0.72) and 0.69 mm (95% CI, 0.68–0.69), respectively]. However, after adjustment for established cardiovascular risk factors, ICA IMT, but not CCA IMT, remained significantly higher among prediabetic individuals [0.81 mm (95% CI, 0.75–0.88) and 0.71 mm (95% CI, 0.68–0.74)] than in individuals who remained free of diabetes [0.71 mm (95% CI, 0.69–0.72) and 0.69 mm (95% CI, 0.68–0.70)].Conclusions— The present study provides direct evidence at the vascular level that atherosclerosis levels are elevated before the clinical onset of diabetes.

Elevated Carotid Artery Intima-Media Thickness Levels in Individuals Who Subsequently Develop Type 2 Diabetes