Changes in weight and glucose can protect against progression in early diabetes independent of improvements in β-cell function

Y. R. Patel, M. S. Kirkman, Robert Considine, Tamara Hannon, Kieren Mather

Research output: Contribution to journalArticle

3 Scopus citations

Abstract

Context: Evidence-based strategies to prevent progression of dysglycemia in newly diagnosed type 2 diabetes are needed. Objective: To undertake a secondary analysis of the Early Diabetes Intervention Program (EDIP) in order to understand the features that were protective against worsening glycemia. Design: EDIP was a randomized, placebo-controlled trial. Setting: Two university diabetes centers. Patients: A total of 219 overweight individuals with fasting glucose < 7.8 mmol/L and 2-hour oral glucose tolerance test (OGTT) glucose > 11.1 mmol/L. Interventions: Acarbose versus placebo, on a background of dietary recommendations, with quarterly visits to assess glycemia and intervention adherence for up to 5 years. Main Outcome Measures: Progression of fasting glucose ≥ 7.8 mmol/L on two consecutive quarterly visits. Cox proportional hazards modeling and ANOVA were performed to evaluate determinants of progression. Results: Progression-freestatuswasassociatedwithreductionsinweight,fasting glucose,2-hourOGTT glucose, and increases in the high-density lipoprotein/triglyceride ratio. The reduction in fasting glucose was the only effect that remained significantly associated with progression-free status in multivariable Cox modeling. The reduction in fasting glucose was in turn primarily associated with reductions in weight and in 2-hour OGTT glucose. Acarbose treatment did not explain these changes. Conclusions: In early diabetes, reductions in glucose, driven by reductions in weight, can delay progressive metabolic worsening. These observations underscore the importance of lifestyle management including weight loss as a tool to mitigate worsening of glycemia in newly diagnosed diabetes. (J Clin Endocrinol Metab 101: 4076-4084, 2016).

Original languageEnglish (US)
Pages (from-to)4076-4084
Number of pages9
JournalJournal of Clinical Endocrinology and Metabolism
Volume101
Issue number11
DOIs
StatePublished - Nov 1 2016

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ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical

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