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Determinants of the progression to type 2 diabetes and regression to normoglycemia in people with pre-diabetes: A population‐based cohort study over ten years

  • Karim Kohansal
    Affiliations
    Department of Epidemiology and Biostatistics, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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  • Nooshin Ahmadi
    Affiliations
    Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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  • Farzad Hadaegh
    Affiliations
    Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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  • Zeinab Alizadeh
    Affiliations
    Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
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  • Fereidoun Azizi
    Affiliations
    Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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  • Ali Siamak Habibi-Moeini
    Correspondence
    Correspondence to: Associated Professor of Epidemiology, Yaman St, P.O. Box 19395-4763, Tehran, Iran.
    Affiliations
    Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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  • Davood Khalili
    Correspondence
    Correspondence to: Associated Professor of Epidemiology, Yaman St, P.O. Box 19395-4763, Tehran, Iran.
    Affiliations
    Department of Epidemiology and Biostatistics, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Published:October 27, 2022DOI:https://doi.org/10.1016/j.pcd.2022.10.002

      Highlights

      • The progression rate to diabetes and regression to normoglycemia in prediabetic subjects was around 40%.
      • The modifiable predictors for regression to normoglycemia and progression to diabetes were roughly the same.
      • The impact of BMI on glycemic changes is going to fade out in the elderly prediabetic subjects.

      Abstract

      Aims

      To determine the rates and predictors of the regression to normoglycemia and progression to diabetes among subjects with pre-diabetes.

      Methods

      A 10-year longitudinal population-based study was conducted among 1329 participants with pre-diabetes in the Tehran Lipid and Glucose Study. Pre-diabetes was divided into isolated IFG (iIFG), isolated IGT (iIGT), and combined IFG/IGT. Univariate and stepwise multivariable Cox regression was used to evaluate predictors of glycemic conversions.

      Results

      The cumulative incidences of normoglycemia and diabetes were 43.7% (95%CI 40.9–46.4) and 40.1% (37.3–42.7), respectively. Isolated IGT returned to normoglycemia more than iIFG (HR:1.26, 1.05–1.51), but there was no difference in how quickly they progressed to diabetes. Regression to normoglycemia was associated with younger age, female sex, lower BMI, no familial history of diabetes, higher HDL-C, and ex-smoking. Older age, higher BMI, diastolic blood pressure, total cholesterol, lower HDL-C, and familial history for diabetes were associated with progression to diabetes. The influence of BMI on glycemic status conversions diminished with age. At approximately above 60 years old, the hazards of BMI for any conversions faded out.

      Conclusions

      The modifiable predictors of regression to normoglycemia and progression to diabetes are roughly the same. The importance of BMI attenuates in elderly subjects.

      Abbreviations:

      IFG (Impaired fasting glucose), iIFG (Isolated IFG), IGT (Impaired glucose tolerance), iIGT (Isolated IGT), ROC (Receiver operating characteristic), TLGS (Tehran Lipid and Glucose Study)

      Keywords

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