Metabolic risk factors among prediabetic individuals and the trajectory toward the diabetes incidence
糖尿病前期人群代谢危险因素及糖尿病发病轨迹
Prior presentation: Parts of this study were presented on the 7th Iranian Congress of Obesity Prevention and Treatment.
Abstract
enBackground
This study investigates the trajectory of the risk factors of prediabetes progression to overt diabetes.
Methods
The study retrospectively investigated 1610 prediabetic individuals. The trajectory of metabolic indicators was investigated using the generalized estimated equation method with autoregressive working correlation structure through a linear model with the identity link function.
Results
During 15 years of follow-up, the trajectories of metabolic risk factors changed from 3 years before diabetes occurrence for fasting plasma glucose (FPG) and 2-hour plasma glucose (2hPG), 6 years for waist circumference (WC), 9 years for high-density lipoprotein cholesterol (HDL-C), and earlier for body mass index, triglyceride (TG), and TG:HDL ratio. It was shown that the differences in the trajectory of WC and HDL were stable after adjustment for other metabolic risk factors. The trajectories of FPG and 2hPG remained stable after considering multiple insulin resistance markers.
Conclusions
Deterioration of metabolic risk factor status can be a predictor of diabetes many years before its occurrence, but the abrupt change in plasma glucose is evident 3 years before diabetes mellitus onset. It seems that the HDL-C and WC trajectories are two independent predictors for diabetes incidence. It was also found that when the rising trend in plasma glucose starts, preventive strategies to lessen insulin resistance might not be efficient.
摘要
zh背景
本研究探讨糖尿病前期的危险因素向显性糖尿病发展的轨迹。
方法
对1610例糖尿病前期患者进行回顾性调查。采用具有自回归工作相关结构的广义估计方程法, 通过具有同一性链接函数的线性模型, 对代谢指标的运动轨迹进行了研究。
结果
在15年的随访中, 代谢危险因素从糖尿病发生前3年就开始发生改变, 包括空腹血糖(FPG)和2小时血糖(2hPG), 发病前6年腰围(WC)出现改变, 发病前9年高密度脂蛋白胆固醇(HDL-C)出现变化, 以及更早就会变化的体重指数(BMI), 甘油三酯(TG)和甘油三酯(TG)/高密度脂蛋白胆固醇(TG/HDL)。结果表明, 在调整其他代谢危险因素后, WC和HDL的轨迹差异是稳定的。在考虑多个胰岛素抵抗标志物后, 空腹血糖和2hPG的轨迹保持稳定。
结论
代谢危险因素状态恶化可作为糖尿病发病前多年的预测指标, 但血糖的突然变好在糖尿病发病前3年明显。似乎HDL-C和WC轨迹是糖尿病发病率的两个独立预测因子。研究还发现, 当血糖开始上升时, 减轻胰岛素抵抗的预防性策略可能并不有效。
CONFLICT OF INTEREST
No potential conflicts of interest are reported by the authors.
