Natural Outcome And Associated Predictors Of Glucose Metabolism Among Non-diabetic Population

0bjectiveTo analyze characters and associated risk factors of natural outcome of glucosemetabolism among non-diabetic population of Shijingshan community in Beijing. Toexplore the relationship between changes of metabolism abnormalities and the conversion ofglucose tolerance.MethodsA total number of1092non-diabetics (mean age49.0±14.6years,40%males) wereselected through glucose tolerance test in Shijingshan community of Beijing in2007.Follow-up study was carried out at two consecutive phases in2010and2012.The glucosetolerance status were defined according to the ADA2003criteria. Clinical characters andconversion outcomes were compared for different glucose metabolism status at baseline.Coxregression was used to determine the independent variables associated with incident IGR ordiabetes and their odds ratios (OR). Changes of risk factors such as BMI、WHR、SBP、DBPand dyslipidemia were described in different conversion groups.Results1. According to the baseline census data, among IGR group, the prevalence were8.47%for IGT group,5.23%for IFG group,3.85%for IFG/IGT group. Multilvariate analysisof variance models adjusted for age and sex confirmed that waist circumference,WHR, SBP,DBP, UA, TC, LDL-C (P<0.05) were higher in IGR group than those in NGT group; BMI,waist circumference, WHR, blood pressure, UA, TC, TG, LDL-C, HDL-C had nodifferences between IFG/IGT group and newly diagnosed T2DM group. Compared withNGT group, IGR group displayed higher prevalence of obesity, hypertension andcardiovascular diseases. IGR group was characterized with more serious insulin resistanceand deteriorated insulin secretion than NGT group; there were differences between IFG andIGT group in insulin secretion and sensitivity, HOMA-IR was higher in IFG group,HBCI/IR was lower in IFG group,△I120/△G120/IR was higher in IFG group(P<0.05). 2. The annual incidence rates of diabetes were10.37%in IFG/IGT group,4.94%inIGT group,4.68%in IFG group and1.27%in NGT group respectively. Cox regressionanalysis showed elevated FPG(OR=2.105，95%CI1.326～3.343，P=O.OO2)、2hPG(OR=1.342，95%CI1.150～1.565，P=0.000)and BMI(OR=1.289，95%Cl1.040～1.597，P=0.020) were significantly associated with conversion from NGT to diabetes or IGR;ALT(OR=2.535，95%CI1.152～5.579，P=0.021)、HBCI/IR（OR=2.941，95%CI1.285～6.711，P=0.011）and△I120/△G120/IR（OR=1.462，95%CI1.075～1.988，P=0.015）weresignificantly associated with conversion from IGR to diabetes. For baseline NGT group,IGR or diabetes OR was1.289for obesity people compared with overweight ones, whichwas same for overweight people compared to normal weight ones. For baseline IGR group,compared with people with normal range of ALT value, diabetes OR for those with ALTabove40U/L was2.535.3. For baseline NGT group, controlling the risk factors such as waist circumferencebelow82cm, BMI below25kg/m2, SBP below130mmHg is key to maintain normalglucose state for a long time; once stepping into IGR stage during the follow-up, more strictcontrolling to keep blood pressure around120/70mmHg, HDL-C above1.5mmol/L, withobviously decreased TC level often predicted better conversion. For baseline IGR group,controlling the risk factors such as waist circumference below80cm, BMI below25kg/m2,WHR below0.9, blood pressure below130/70mmHg, HDL-C above1.4mmol/L，TC below5mmol/L，LDL-C below3mmol/L and TG below1.8mmol/L made great chance forconversion to NGT; Conversely, clustering of metabolism abnormalities such as mean waistcircumference above90cm，blood pressure above140/80mmHg，TC above5mmol/L，LDL-C above3mmol/L, TG above2mmol/L and HDL-C below1.2mmol/L resulted DMonset inevitably.ConclusionMetabolism disorders are common in the IGR group. Prediabetes state are associatedwith increased obesity, hypertension, dyslipidemia and macrovascular diseases. Insulinresistance and β-cell dysfunction play a key role during deterioration in glucose levels.Better controlling of modifiable metabolism abnormalities such as obesity, hypertension,dyslipidemia make effect for NGT maintaining or increasing the conversion ratio to NGT.