Trajectories of metabolic risk factors during the development of type 2 diabetes in Chinese adults

Aims: China has the largest number of adults with diabetes. Although multiple metabolic risk factors (MRFs) are implicated in the development of diabetes, it remains unclear how they progress during the development of diabetes among Chinese. We examined trajectories of multiple MRFs among Chinese and identified the critical period when drastic changes occurred during the development of diabetes.Methods: This prospective cohort study included participants since 2006-2007 in the Kailuan study. People attended biennial examinations until 2017 with additions of new participants at each examination cycle. The time when a participant first completed the examination was served as the baseline. A total of 122,659 par-ticipants without prevalent diabetes at baseline and with complete follow-up data were included. MRFs were collected via biennial physical examinations and laboratory measures. Incident diabetes cases were identified via biennial fasting glucose tests and self-reported physician-diagnosis.Results: During up to 12 years of follow-up, 14,922 incident diabetes cases were identified. Compared with participants who did not develop diabetes, those who developed diabetes had more adverse levels of most MRFs at baseline and during follow-up. Abrupt increases in multiple MRFs (including fasting glucose, surro-gate insulin resistance indicators, lipids, systolic blood pressure, pulse pressure, heart rate, alanine amino-transferase, and C-reactive protein) were observed 3 years before the diagnosis of diabetes. Conclusions: We identified 3 years before diabetes diagnosis as a critical period when multiple MRFs experi-enced drastic changes. This would have implications for early monitoring and timely prevention for individu-als who experience sudden adverse progression of multiple MRFs.(c) 2022 Elsevier Masson SAS. All rights reserved.

Automated summary

The study identified the critical period of drastic changes in multiple metabolic risk factors among Chinese individuals as 3 years before the diagnosis of diabetes.