Abstract
Healthy lifestyle interventions and drug therapies are proven to have a positive preventative influence on normal glucose regulation in prediabetes. However, little is known on the specific role that these factors play on reversion to normal glycemia according to type of prediabetes. We used data from the Observational prospective cohort study, The Cohort study in Primary Health Care on the Evolution of Patients with Prediabetes from 2012 to 2015. A total of 1184 individuals aged 30–74 years old were included and classified based on the ADA in three mutually exclusive groups using either fasting plasma glucose (FPG) levels (from 100 to 125 mg/dl, FPG group), HbA1c (5.7–6.4%, HbA1c group) or both impaired parameters. Information on lifestyle factors and biochemical parameters were collected at baseline. Reversion to normal glucose regulation was calculated at third year of follow-up. Relationship of lifestyle factor and type of prediabetes with reversion were estimated using odds ratios (ORs) with 95% confidence intervals (95% CIs) adjusting by different groups of confounders. Proportion of reversion rates were 31% for FPG group, 31% for HbA1c group and 7.9% for both altered parameters group, respectively. Optimal life style factors such as BMI < 25 kg/m2[OR (95% CI): 1.90 (1.20–3.01)], high adherence to Mediterranean diet 1.78 (1.21–2.63) and absence of abdominal obesity 1.70 (1.19–2.43) were the strongest predictors for reversion to normal glucose. However, those did not modify the ORs of reversion to normal glucose. Taking as reference those with both impaired parameters, subjects with FPG impairment (FPG group) had an OR of 4.87 (3.10–7.65) and 3.72 (2.39–5.78) for HbA1c group. These estimates remained almost the same after further adjustment for biochemical parameters and lifestyle factors (4.55(2.84–7.28) and 3.09 (1.92–4.97), respectively). Optimal lifestyle factors showed to be a positive predictor for reversion to normal glucose regulation however, the differences of reversion risk according type of prediabetes are not explained by lifestyle factors.
Highlights
Healthy lifestyle interventions and drug therapies are proven to have a positive preventative influence on normal glucose regulation in prediabetes
In order to develop a better understanding of the following matter, the current study aimed to study the heterogeneity in the reversal rate to normal glucose regulation among the three groups and to study the key role of lifestyle factors in predicting the reversal using a prospective cohort of individuals with prediabetes followed up by primary care physicians in Spain
There was an inverse proportion of men and women according to each prediabetes criteria; a total of 61% of group 1 population were men, corresponding percentages were 38.9% for group 2 and 50.3% for group 3, respectively (p < 0.001)
Summary
Healthy lifestyle interventions and drug therapies are proven to have a positive preventative influence on normal glucose regulation in prediabetes. Adherence to a healthy lifestyle [including healthy diet, smoking cessation, increase in physical activity, reduction in alcohol consumption, and reduction in body mass index (BMI)] at age 50–75, has been associated with six to ten years increase in life years and a significant improvement of quality of life These implementations resulted in a reduction in prevalence of major chronic diseases (including cancer, cardiovascular diseases and diabetes) compare to individuals with no vast improvement in lifestyle[7,8]. This stage is characterized by either an impaired fasting plasma glucose (IFG) or impaired glucose tolerance (IGT), or elevated glycated hemoglobin A1c (HbA1c) depending on the established diagnostic criteria[9] Prior research on this topic highlights how optimal lifestyle factors and drug therapies (majority oral antidiabetic medications) implementations are effective predictive positive factors to conversion to normal glucose regulation in subjects with prediabetes[5,10,11]. In order to develop a better understanding of the following matter, the current study aimed to study the heterogeneity in the reversal rate to normal glucose regulation among the three groups and to study the key role of lifestyle factors in predicting the reversal using a prospective cohort of individuals with prediabetes followed up by primary care physicians in Spain
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