Abstract
Aim It is known that different stages of type 2 diabetes represent distinct pathophysiological changes, but how the spectrum of risk factors varies at different stages is not yet clarified. Hence, the aim of this study was to compare the effect of different metabolic variables on the natural history of type 2 diabetes. Methods A total of 5,213 nondiabetic (normal glucose tolerance (NGT) and prediabetes) Chinese older than 40 years participated this prospective cohort study, and 4,577 completed the 3-year follow-up. Glycemic status was determined by standard oral glucose tolerance test both at enrollment and follow-up visit. Predictors for conversion in glycemic status were studied in a corresponding subcohort using the multiple logistic regression analysis. Results The incidence of prediabetes and diabetes of the cohort was 93.6 and 42.2 per 1,000 person-years, respectively. After a 3-year follow-up, 33.1% of prediabetes patients regressed to NGT. The predictive weight of body mass index (BMI), serum triglyceride, total cholesterol, and systolic blood pressure in different paths of conversions among diabetes, prediabetes, and NGT differed. Specifically, BMI was the strongest predictor for regression from prediabetes to NGT, while triglyceride was most prominent for onset of diabetes. One SD increase in serum triglyceride was associated with a 1.29- (95% CI 1.10–1.52; P = 0.002) or 1.12- (95% CI 1.01–1.27; P = 0.039) fold higher risk of diabetes for individuals with NGT or prediabetes, respectively. Conclusion Risk factors for different stages of diabetes differed, suggesting personalized preventive strategies for individuals with different basal glycemic statuses.
Highlights
In the face of the burden of diabetes worldwide [1, 2], great efforts have been made to explore the therapeutics for diabetes, and there have been improvements in the prognosis of diabetes [3]
Of the 2,833 individuals with normal glucose tolerance (NGT) at Baseline, 28.7% progressed to prediabetes and 6.6% developed to diabetes after a median follow-up of 3.1 years (Supplementary Material, Supplementary Table 2)
In this population-based, longitudinal cohort study, we documented the glycemic outcomes for 4,577 nondiabetic subjects from rural China after a 3-year follow-up, using oral glucose tolerance test (OGTT) to determine the glycemic status
Summary
In the face of the burden of diabetes worldwide [1, 2], great efforts have been made to explore the therapeutics for diabetes, and there have been improvements in the prognosis of diabetes [3]. This advance is overshadowed by the unprecedented growth in the numbers of people with diabetes [4, 5]. A full evaluation on how the spectrum of risk factors varies at the different stages of pathophysiology of type 2 diabetes is indispensable for guidance of targeted preventive strategies
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