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 Citations (Scopus)

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

Fingerprint

Medical problems
Weights and Measures
Glucose
Fasting
Acarbose
Weight Loss
Placebos
HDL Lipoproteins
Glucose Tolerance Test
Analysis of variance (ANOVA)
Type 2 Diabetes Mellitus
Life Style
Hazards
Analysis of Variance
Randomized Controlled Trials
Outcome Assessment (Health Care)

ASJC Scopus subject areas

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

Cite this

@article{10865d4e0ee34cf28a2e3fe24ce2fd14,
title = "Changes in weight and glucose can protect against progression in early diabetes independent of improvements in β-cell function",
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).",
author = "Patel, {Y. R.} and Kirkman, {M. S.} and Robert Considine and Tamara Hannon and Kieren Mather",
year = "2016",
month = "11",
day = "1",
doi = "10.1210/jc.2016-2056",
language = "English (US)",
volume = "101",
pages = "4076--4084",
journal = "Journal of Clinical Endocrinology and Metabolism",
issn = "0021-972X",
publisher = "The Endocrine Society",
number = "11",

}

TY - JOUR

T1 - Changes in weight and glucose can protect against progression in early diabetes independent of improvements in β-cell function

AU - Patel, Y. R.

AU - Kirkman, M. S.

AU - Considine, Robert

AU - Hannon, Tamara

AU - Mather, Kieren

PY - 2016/11/1

Y1 - 2016/11/1

N2 - 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).

AB - 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).

UR - http://www.scopus.com/inward/record.url?scp=84994876282&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84994876282&partnerID=8YFLogxK

U2 - 10.1210/jc.2016-2056

DO - 10.1210/jc.2016-2056

M3 - Article

C2 - 27533307

AN - SCOPUS:84994876282

VL - 101

SP - 4076

EP - 4084

JO - Journal of Clinical Endocrinology and Metabolism

JF - Journal of Clinical Endocrinology and Metabolism

SN - 0021-972X

IS - 11

ER -