Regression from prediabetes to normal glucose levels is more frequent than progression towards diabetes: The CRONICAS Cohort Study.
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ABSTRACT: Aims
This study aimed to (1) estimate the prevalence of prediabetes according to different definitions, (2) evaluate regression to normal glucose levels and progression towards T2DM, and (3) determine factors associated with regression and progression across four diverse geographical settings in a Latin American country.Methods
The CRONICAS Cohort Study was conducted in four different areas in Peru. Enrollment started in September 2010 and follow-up was conducted in 2013. Prediabetes, T2DM and normal glucose levels were determined according to definitions from the World Health Organization (WHO), American Diabetes Association (ADA), and National Institute for Health and Care Excellence (NICE). The main outcomes were regression to normal glucose levels and incidence of T2DM. Prevalence estimates and 95% confidence intervals (95% CI) were calculated. Crude and adjusted models using Poisson regression were performed and relative risk ratios (RRR) and 95% CI were calculated.Results
At baseline, the prevalence of prediabetes varied markedly by definition used: 6.5%(95% CI 5.6-7.6%), 53.6% (95% CI 51.6-55.6%), and 24.6% (95% CI 22.8-26.4%) according to WHO, ADA and NICE criteria, respectively. After 2.2 years of follow-up, in those with prediabetes, the cumulative incidence of regression to euglycemia ranged between 31.4% and 68.9%, whereas the incidence of T2DM varied from 5.5% to 28.8%. Factors associated with regression to normal glucose levels and progression to diabetes were age, body mass index, and insulin resistance.Conclusions
Regression from pre-diabetes back to euglycemia was much more common than progression to diabetes.
SUBMITTER: Lazo-Porras M
PROVIDER: S-EPMC7239508 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveRegression from prediabetes to normal glucose regulation (NGR) was associated with reduced incidence of diabetes by 56% over 10 years in participants in the Diabetes Prevention Program Outcomes Study (DPPOS). In an observational analysis, we examined whether regression to NGR also reduced risk for microvascular disease (MVD).Research design and methodsGeneralized estimating equations were used to examine the prevalence of aggregate MVD at DPPOS year 11 in people who regressed to NGR at least once (vs. never) during the Diabetes Prevention Program (DPP). Logistic regression assessed the relationship of NGR with retinopathy, nephropathy, and neuropathy, individually. Generalized additive models fit smoothing splines to describe the relationship between average A1C during follow-up and MVD (and its subtypes) at the end of follow-up.ResultsRegression to NGR was associated with lower prevalence of aggregate MVD in models adjusted for age, sex, race/ethnicity, baseline A1C, and treatment arm (odds ratio [OR] 0.78, 95% CI 0.65-0.78, P = 0.011). However, this association was lost in models that included average A1C during follow-up (OR 0.95, 95% CI 0.78-1.16, P = 0.63) or diabetes status at the end of follow-up (OR 0.92, 95% CI 0.75-1.12, P = 0.40). Similar results were observed in examination of the association between regression to NGR and prevalence of nephropathy and retinopathy, individually. Risk for aggregate MVD, nephropathy, and retinopathy increased across the A1C range.ConclusionsRegression to NGR is associated with a lower prevalence of aggregate MVD, nephropathy, and retinopathy, primarily due to lower glycemic exposure over time. Differential risk for the MVD subtypes begins in the prediabetes A1C range.
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Project description:ObjectiveDiabetes is associated with low levels of physical activity (PA), but detailed objective information about how PA patterns vary by diabetes definition is lacking.MethodsPA was measured with Actigraph accelerometers in older (60+) adults from the 2003-2006 National Health and Nutrition Examination Survey (n= 1,043) and analyzed in 2014. Diabetes definition (normal glucose levels, prediabetes, diabetes) was assessed (fasting glucose, hemoglobin A1C, and self-report). Accelerometer data were used to characterize total activity counts (TAC) per day and hour-by-hour activity counts by diabetes definition. Multiple linear regression models explored the relationship between diabetes definition and TAC.ResultsDespite similar patterns of PA, diabetes participants had significantly lower TAC compared to participants with normal glucose levels and prediabetes. Diabetes participants' activity counts per hour declined more rapidly after 12 pm, with the biggest differences between the groups occurring at 4 pm. Participants with normal glucose levels and prediabetes had similar TAC and daily PA profiles.ConclusionOur novel methodology provides information about PA patterns by diabetes definition. Significantly lower TAC in the diabetes group, their significant drop in afternoon PA, and the similarity of PA between participants with normal glucose levels and prediabetes provide insight into potential targets for intervention.
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Project description:BackgroundLifestyle intervention decreases diabetes risk in prediabetic subjects, but the impact of passive notification of prediabetes status on glycemia or health behavior is unclear.MethodsThe Pathobiology of Prediabetes in a Biracial Cohort (POP-ABC) study followed normoglycemic African American (AA) and European American (EA) offspring of parents with type 2 diabetes mellitus for incident prediabetes. During 5.5 years of follow-up (mean, 2.62 years), 101 of 343 subjects developed prediabetes and were notified, without any interventions. Participants were recalled 18 months poststudy. Here, we compared data from participants with incident prediabetes or normoglycemia (control) during POP-ABC who underwent retesting 18-months poststudy.ResultsThere were 73 subjects (46 female, 27 male; 36 AA, 37 EA) in the prediabetes group and 73 subjects (48 female, 25 male; 35 AA, 38 EA) in the control group. The mean (± SEM) enrollment age was 48.7 ± 0.96 years versus 48.3 ± 1.06 years (P = .37) and body mass index (BMI) was 31.1 ± 0.70 kg/m2 versus 29.2 ± 0.69 kg/m2 (P = .04) for prediabetes versus control groups, respectively. The 18-month changes (prediabetes vs control) were the following: fasting plasma glucose (FPG), -8.01 ± 1.11 vs 2.02 ± 0.64 mg/dL; 2-hour plasma glucose (2hrPG), -8.21 ± 3.34 vs 8.53 ± 3.17 mg/dL; weight, -0.54 ± 0.72 vs 2.77 ± 1.25 kg; and waist circumference -1.07 ± 0.78 vs 1.78 ± 0.85 (P = .03-<0.0001). The interval changes in FPG were significantly correlated with changes in weight and waist circumference (r = 0.2, P = .01). The prediabetes group reported improved dietary and exercise habits compared with control.ConclusionCommunication of prediabetes status is associated with improvements in glucose tolerance, glycemia, and adiposity, probably via self-directed lifestyle modification.
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Project description:OBJECTIVE:Participants in the Diabetes Prevention Program (DPP) randomized to intensive lifestyle modification (ILS) or metformin had a significantly reduced incidence of diabetes compared with those randomized to placebo, yet most were still at risk because they had pre-diabetes. We explored the effect of baseline characteristics, weight change, ILS, and metformin on regression from pre-diabetes to the lowest-risk state of normal glucose regulation (NGR) defined by American Diabetes Association criteria. RESEARCH DESIGN AND METHODS:The DPP was a prospective randomized trial. Cox proportional hazards modeling was used to identify predictors of regression from pre-diabetes to NGR over 3 years of follow-up. RESULTS:Lower baseline fasting (hazard ratio 1.52, P < 0.01) and 2-h (1.24, P < 0.01) glucose predicted regression to NGR, as did younger age (1.07, P < 0.01) and greater insulin secretion (1.09, P = 0.04). ILS (2.05, P < 0.01) and weight loss (1.34, P < 0.01) had significant and independent effects on regression. A nonsignificant trend for regression was also observed for metformin (1.25, P = 0.06), male sex (1.17, P = 0.08), and insulin sensitivity (1.07, P = 0.09). In those entering the study with both impaired fasting glucose (IFG) and impaired glucose tolerance (IGT), male sex and insulin sensitivity predicted regression to isolated IFG, whereas ILS, metformin, female sex, and greater insulin secretion predicted regression to isolated IGT. CONCLUSIONS:Insulin secretion, and other biologic processes retained with younger age, are key in restoring NGR in people with pre-diabetes. However, NGR may also be attained through weight loss and additional aspects of ILS.
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Project description:BackgroundPrediabetes progression is associated with increased mortality while its regression decreases it. It is unclear whether muscle strength is related to prediabetes progression or regression. This study investigated the associations of muscle strength, assessed by grip strength and chair-rising time, with prediabetes progression and regression based on the China Health and Retirement Longitudinal Study (CHARLS) enrolling middle-aged and older adults.MethodsWe included 2623 participants with prediabetes from CHARLS, who were followed up 4 years later with blood samples collected for measuring fasting plasma glucose and haemoglobin A1c. Grip strength (normalized by body weight) and chair-rising time were assessed at baseline and categorized into tertiles (low, middle, and high groups). Prediabetes at baseline and follow-up was defined primarily using the American Diabetes Association (ADA) criteria and secondarily using the World Health Organization (WHO) and International Expert Committee (IEC) criteria. Multinomial logistic regression analysis was applied to obtain the odds ratios (ORs) and 95% confidence intervals (CIs).ResultsThe mean age of included participants was 59.0 ± 8.6 years, and 46.6% of them were males. During follow-up, 1646 participants remained as prediabetes, 379 progressed to diabetes, and 598 regressed to normoglycaemia based on ADA criteria. Participants who progressed to diabetes had lower normalized grip strength than those who remained as prediabetes (0.49 ± 0.15 vs. 0.53 ± 0.15, P < 0.001), but participants who regressed to normoglycaemia showed the opposite (0.55 ± 0.16 vs. 0.53 ± 0.15, P = 0.003). However, chair-rising time was comparable across different groups (Poverall = 0.17). Compared with participants in low normalized grip strength or high chair-rising time group, those in high normalized grip strength or low chair-rising time group had decreased odds of progression to diabetes (OR 0.62, 95% CI 0.44 to 0.87; and OR 0.69, 95% CI 0.51 to 0.93, respectively) after multivariable adjustment. However, both were unrelated to the odds of regression to normoglycaemia (OR 0.94, 95% CI 0.71 to 1.25; and OR 0.84, 95% CI 0.65 to 1.07, respectively). These outcomes remained generally comparable when prediabetes was defined by WHO or IEC criteria. Higher normalized grip strength but not lower chair-rising time was prospectively associated with lower blood pressure, better glycaemic condition, and lower inflammation (all P ≤ 0.04).ConclusionsHigh muscle strength is associated with reduced odds of progression to diabetes but does not predict regression to normoglycaemia in prediabetes. Future studies are warranted to assess whether increases in muscle strength promote prediabetes regression.
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Project description:OBJECTIVE:The association between tuberculosis (TB), diabetes mellitus (DM) and vitamin D status is poorly characterised. We therefore: (1) determined vitamin D status in patients with TB in relation to whether they had normal fasting blood glucose (FBG), pre-DM or DM and (2) assessed whether baseline characteristics in patients with TB, including their DM status, were associated with vitamin D deficiency. METHODS:In patients with TB consecutively attending six clinics or hospitals in China, we measured 25-hydroxycholecalciferol (25-(OH)D3) at the time of registration using electrochemiluminescence in a COBASE 601 Roche analyser by chemiluminescence immunoassay. Data analysis was performed using the χ2 test, ORs and multivariate logistic regression. RESULTS:There were 306 eligible patients with TB, including 96 with smear positive pulmonary TB, 187 with smear negative pulmonary TB and 23 with extrapulmonary TB. Of these, 95 (31%) had normal blood glucose, 83 (27%) had pre-DM and 128 (42%) had DM. Median serum vitamin D levels were 16.1 ng/mL in patients with TB with normal FBG, 12.6 ng/mL in patients with TB with pre-DM and 12.1 ng/mL in patients with TB with DM (p<0.001). The study highlighted certain baseline characteristics associated with vitamin D deficiency (25-(OH)D3<20 ng/mL). After adjusting for confounders, serum vitamin D deficiency was significantly more common in patients being registered in the cold season (November to April) (p=0.006) and in those with DM (p=0.003). CONCLUSION:Vitamin D levels are lower in patients with TB with pre-DM and DM and are also affected by certain baseline characteristics that include being registered in the cold season and having DM. TB programmes need to pay more attention to vitamin D status in their patients, especially if there is coexisting pre-DM or DM.
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