期刊
DIABETES CARE
卷 42, 期 9, 页码 1809-1815出版社
AMER DIABETES ASSOC
DOI: 10.2337/dc19-0244
关键词
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资金
- DPPOS
- National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health
- NIDDK, including its Intramural Research Program
- Indian Health Service
- General Clinical Research Center Program, National Center for Research Resources
- Department of Veterans Affairs
- National Institute of Child Health and Human Development
- National Institute on Aging
- National Eye Institute
- National Heart, Lung, and Blood Institute
- National Cancer Institute
- Office of Research on Women's Health
- National Institute on Minority Health and Health Disparities
- Centers for Disease Control and Prevention
- American Diabetes Association
- LifeScan, Inc.
- Merck-Medco Managed Care, Inc.
- Nike Sports Marketing
- Lipha (Merck-Sante)
- Intramural Research Program of the NIDDK
- Bristol-Myers Squibb
- McKesson BioServices Corp.
- Matthews Media Group, Inc.
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.
- Novo Nordisk
- Sanofi
- NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES [ZIADK075078] Funding Source: NIH RePORTER
OBJECTIVE Regression from prediabetes to normal glucose regulation (NGR) was associated with reduced incidence of diabetes by 56% over 10 years in participants in the Diabetes Prevention Program Outcomes Study (DPPOS). In an observational analysis, we examined whether regression to NGR also reduced risk for microvascular disease (MVD). RESEARCH DESIGN AND METHODS Generalized estimating equations were used to examine the prevalence of aggregate MVD at DPPOS year 11 in people who regressed to NGR at least once (vs. never) during the Diabetes Prevention Program (DPP). Logistic regression assessed the relationship of NGR with retinopathy, nephropathy, and neuropathy, individually. Generalized additive models fit smoothing splines to describe the relationship between average A1C during follow-up and MVD (and its subtypes) at the end of follow-up. RESULTS Regression to NGR was associated with lower prevalence of aggregate MVD in models adjusted for age, sex, race/ethnicity, baseline A1C, and treatment arm (odds ratio [OR] 0.78, 95% CI 0.65-0.78, P = 0.011). However, this association was lost in models that included average A1C during follow-up (OR 0.95, 95% CI 0.78-1.16, P = 0.63) or diabetes status at the end of follow-up (OR 0.92, 95% CI 0.75-1.12, P = 0.40). Similar results were observed in examination of the association between regression to NGR and prevalence of nephropathy and retinopathy, individually. Risk for aggregate MVD, nephropathy, and retinopathy increased across the A1C range. CONCLUSIONS Regression to NGR is associated with a lower prevalence of aggregate MVD, nephropathy, and retinopathy, primarily due to lower glycemic exposure over time. Differential risk for the MVD subtypes begins in the prediabetes A1C range.
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