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Incidence rates and predictors of diabetes in those with prediabetes: the Strong Heart Study
Author(s) -
Wang Hong,
Shara Nawar M.,
Calhoun Darren,
Umans Jason G.,
Lee Elisa T.,
Howard Barbara V.
Publication year - 2010
Publication title -
diabetes/metabolism research and reviews
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.307
H-Index - 110
eISSN - 1520-7560
pISSN - 1520-7552
DOI - 10.1002/dmrr.1089
Subject(s) - prediabetes , medicine , impaired fasting glucose , diabetes mellitus , impaired glucose tolerance , endocrinology , hazard ratio , type 2 diabetes , insulin resistance , incidence (geometry) , obesity , body mass index , albuminuria , metabolic syndrome , confidence interval , physics , optics
Background The association between prediabetes as currently defined and incident diabetes in populations with widespread obesity, insulin resistance syndrome, and diabetes is not well defined. In this article, diabetes risk factors and incidence rates in American Indians (AI) with prediabetes are examined. Methods A total of 1677 AI who were nondiabetic at baseline was examined during a median 7.8‐year follow‐up as part of the Strong Heart Study (SHS). Risk factors for incident diabetes were measured. Prediabetes was defined according to American Diabetes Association 2003 criteria as having impaired glucose tolerance (IGT) (2‐h plasma glucose [2‐h PG] ≥ 140 mg/dL but < 200 mg/dL) and/or impaired fasting glucose (IFG) (fasting plasma glucose [FPG] ≥ 100 mg/dL but < 126 mg/dL). Results Prediabetes was identified by FPG alone in 87.5%. Diabetes incidence in those with baseline prediabetes was 66.1/1000 person‐years, with a hazard ratio (HR) of 2.35 (95% conference interval: 1.84–3.01), compared with participants with normal glucose tolerance (NGT) at baseline. Elevated A 1c , 2‐h PG, and fasting insulin (FI); albuminuria; and obesity were significantly associated with conversion from prediabetes to diabetes. Younger age, elevated FI (or body mass index [BMI] in models without FI), and less physical activity were significantly associated with conversion from NGT. Conclusions Prediabetes is an independent predictor of conversion to type 2 diabetes in AI, and most can be identified through a fasting glucose measure. Measures of obesity, A 1c , FPG, 2‐h PG, FI, albuminuria, and insulin resistance (IR) help predict this conversion. Obesity is a modifiable risk factor. Strategies to reduce obesity should be emphasized in individuals with prediabetes. Copyright © 2010 John Wiley & Sons, Ltd.