Herman William H, Pan Qing, Edelstein Sharon L, Mather Kieren J, Perreault Leigh, Barrett-Connor Elizabeth, Dabelea Dana M, Horton Edward, Kahn Steven E, Knowler William C, Lorenzo Carlos, Pi-Sunyer Xavier, Venditti Elizabeth, Ye Wen
University of Michigan, Ann Arbor, MI
George Washington University Biostatistics Center, Rockville, MD.
Diabetes Care. 2017 Dec;40(12):1668-1677. doi: 10.2337/dc17-1116. Epub 2017 Oct 11.
Both lifestyle and metformin interventions can delay or prevent progression to type 2 diabetes mellitus (DM) in people with impaired glucose regulation, but there is considerable interindividual variation in the likelihood of receiving benefit. Understanding an individual's 3-year risk of progressing to DM and regressing to normal glucose regulation (NGR) might facilitate benefit-based tailored treatment.
We used the values of 19 clinical variables measured at the Diabetes Prevention Program (DPP) baseline evaluation and Cox proportional hazards models to assess the 3-year risk of progression to DM and regression to NGR separately for DPP lifestyle, metformin, and placebo participants who were adherent to the interventions. Lifestyle participants who lost ≥5% of their initial body weight at 6 months and metformin and placebo participants who reported taking ≥80% of their prescribed medication at the 6-month follow-up were defined as adherent.
Eleven of 19 clinical variables measured at baseline predicted progression to DM, and 6 of 19 predicted regression to NGR. Compared with adherent placebo participants at lowest risk of developing diabetes, participants at lowest risk of developing diabetes who adhered to a lifestyle intervention had an 8% absolute risk reduction (ARR) of developing diabetes and a 35% greater absolute likelihood of reverting to NGR. Participants at lowest risk of developing diabetes who adhered to a metformin intervention had no reduction in their risk of developing diabetes and a 17% greater absolute likelihood of reverting to NGR. Participants at highest risk of developing DM who adhered to a lifestyle intervention had a 39% ARR of developing diabetes and a 24% greater absolute likelihood of reverting to NGR, whereas those who adhered to the metformin intervention had a 25% ARR of developing diabetes and an 11% greater absolute likelihood of reverting to NGR.
Unlike our previous analyses that sought to explain population risk, these analyses evaluate individual risk. The models can be used by overweight and obese adults with fasting hyperglycemia and impaired glucose tolerance to facilitate personalized decision-making by allowing them to explicitly weigh the benefits and feasibility of the lifestyle and metformin interventions.
生活方式干预和二甲双胍干预均可延缓或预防糖调节受损人群进展为2型糖尿病（DM），但个体受益的可能性存在很大差异。了解个体进展为DM以及恢复到正常血糖调节（NGR）的3年风险，可能有助于基于受益情况进行个性化治疗。
我们利用糖尿病预防计划（DPP）基线评估时测量的19个临床变量的值以及Cox比例风险模型，分别评估坚持干预的DPP生活方式干预组、二甲双胍组和安慰剂组进展为DM以及恢复到NGR的3年风险。在6个月时体重减轻≥初始体重5%的生活方式干预参与者以及在6个月随访时报告服用≥80%规定药物的二甲双胍和安慰剂参与者被定义为坚持干预者。
基线时测量的19个临床变量中有11个可预测进展为DM，19个中有6个可预测恢复到NGR。与患糖尿病风险最低的坚持安慰剂治疗的参与者相比，坚持生活方式干预且患糖尿病风险最低的参与者患糖尿病的绝对风险降低（ARR）8%，恢复到NGR的绝对可能性高35%。坚持二甲双胍干预且患糖尿病风险最低的参与者患糖尿病的风险没有降低，恢复到NGR的绝对可能性高17%。患DM风险最高且坚持生活方式干预的参与者患糖尿病的ARR为39%，恢复到NGR的绝对可能性高24%，而坚持二甲双胍干预的参与者患糖尿病的ARR为25%，恢复到NGR的绝对可能性高11%。
与我们之前试图解释人群风险的分析不同，这些分析评估个体风险。这些模型可供空腹血糖升高和糖耐量受损的超重及肥胖成年人使用，通过让他们明确权衡生活方式和二甲双胍干预的益处及可行性，促进个性化决策。
