Metabolic syndrome components and their response to lifestyle and metformin interventions are associated with differences in diabetes risk in persons with impaired glucose tolerance

H. Florez, M. G. Temprosa, T. J. Orchard, K. J. Mather, S. M. Marcovina, E. Barrett-Connor, E. Horton, C. Saudek, X. F. Pi-Sunyer, R. E. Ratner, R. B. Goldberg

Research output: Contribution to journalArticle

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Abstract

Aims: To 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. Methods: We 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. Results: In 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. Conclusions: MetS 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.

Original languageEnglish (US)
Pages (from-to)326-333
Number of pages8
JournalDiabetes, Obesity and Metabolism
Volume16
Issue number4
DOIs
StatePublished - Apr 2014

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Glucose Intolerance
Metformin
Life Style
Waist Circumference
Placebos
Incidence
Intention to Treat Analysis
Hypertriglyceridemia
Proportional Hazards Models
Hyperglycemia
HDL Cholesterol
Fasting
Triglycerides
Cholesterol
Demography
Confidence Intervals
Education
Glucose

Keywords

  • Cardiometabolic risk
  • Diabetes prevention
  • Lifestyle
  • Metformin

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Medicine(all)

Cite this

Metabolic syndrome components and their response to lifestyle and metformin interventions are associated with differences in diabetes risk in persons with impaired glucose tolerance. / Florez, H.; Temprosa, M. G.; Orchard, T. J.; Mather, K. J.; Marcovina, S. M.; Barrett-Connor, E.; Horton, E.; Saudek, C.; Pi-Sunyer, X. F.; Ratner, R. E.; Goldberg, R. B.

In: Diabetes, Obesity and Metabolism, Vol. 16, No. 4, 04.2014, p. 326-333.

Research output: Contribution to journalArticle

Florez, H, Temprosa, MG, Orchard, TJ, Mather, KJ, Marcovina, SM, Barrett-Connor, E, Horton, E, Saudek, C, Pi-Sunyer, XF, Ratner, RE & Goldberg, RB 2014, 'Metabolic syndrome components and their response to lifestyle and metformin interventions are associated with differences in diabetes risk in persons with impaired glucose tolerance', Diabetes, Obesity and Metabolism, vol. 16, no. 4, pp. 326-333. https://doi.org/10.1111/dom.12220
Florez, H. ; Temprosa, M. G. ; Orchard, T. J. ; Mather, K. J. ; Marcovina, S. M. ; Barrett-Connor, E. ; Horton, E. ; Saudek, C. ; Pi-Sunyer, X. F. ; Ratner, R. E. ; Goldberg, R. B. / Metabolic syndrome components and their response to lifestyle and metformin interventions are associated with differences in diabetes risk in persons with impaired glucose tolerance. In: Diabetes, Obesity and Metabolism. 2014 ; Vol. 16, No. 4. pp. 326-333.
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AU - Mather, K. J.

AU - Marcovina, S. M.

AU - Barrett-Connor, E.

AU - Horton, E.

AU - Saudek, C.

AU - Pi-Sunyer, X. F.

AU - Ratner, R. E.

AU - Goldberg, R. B.

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N2 - Aims: To 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. Methods: We 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. Results: In 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. Conclusions: MetS 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.

AB - Aims: To 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. Methods: We 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. Results: In 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. Conclusions: MetS 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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