Journal
DIABETES OBESITY & METABOLISM
Volume 16, Issue 4, Pages 326-333Publisher
WILEY
DOI: 10.1111/dom.12220
Keywords
cardiometabolic risk; diabetes prevention; lifestyle; metformin
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Funding
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health
- NIDDK
- University of Miami [CTSA/1R18AE000049-01/VA-GRECC]
- Indian Health Service
- Office of Research on Minority Health
- National Institute of Child Health and Human Development
- National Institute on Aging
- Centers for Disease Control and Prevention
- Office of Research on Women's Health
- American Diabetes Association
- McKesson BioServices Corp.
- Matthews Media Group, Inc.
- Henry M. Jackson Foundation
- Coordinating Centre
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AimsTo determine the association of metabolic syndrome (MetS) and its components with diabetes risk in participants with impaired glucose tolerance (IGT), and whether intervention-related changes in MetS lead to differences in diabetes incidence. MethodsWe used the National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III) revised MetS definition at baseline and intervention-related changes of its components to predict incident diabetes using Cox models in 3234 Diabetes Prevention Program (DPP) participants with IGT over an average follow-up of 3.2years. ResultsIn an intention-to-treat analysis, the demographic-adjusted hazard ratios (95% confidence interval) for diabetes in those with MetS (vs. no MetS) at baseline were 1.7 (1.3-2.3), 1.7 (1.2-2.3) and 2.0 (1.3-3.0) for placebo, metformin and lifestyle groups, respectively. Higher levels of fasting plasma glucose and triglycerides at baseline were independently associated with increased risk of diabetes. Greater waist circumference (WC) was associated with higher risk in placebo and lifestyle groups, but not in the metformin group. In a multivariate model, favourable changes in WC (placebo and lifestyle) and high-density lipoprotein cholesterol (placebo and metformin) contributed to reduced diabetes risk. ConclusionsMetS and some of its components are associated with increased diabetes incidence in persons with IGT in a manner that differed according to DPP intervention. After hyperglycaemia, the most predictive factors for diabetes were baseline hypertriglyceridaemia and both baseline and lifestyle-associated changes in WC. Targeting these cardiometabolic risk factors may help to assess the benefits of interventions that reduce diabetes incidence.
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