Department of Clinical Epidemiology, Steno Diabetes Center Copenhagen, Niels Steensens Vej 6, DK-2820, Gentofte, Denmark.
Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK.
Diabetologia. 2019 Aug;62(8):1385-1390. doi: 10.1007/s00125-019-4895-0. Epub 2019 May 23.
AIMS/HYPOTHESIS: Reversion from prediabetes to normoglycaemia is accompanied by an improvement in cardiovascular risk factors, but it is unclear whether this translates into a reduction in risk of cardiovascular disease (CVD) events or death. Hence, we studied the probability of reversion from prediabetes to normoglycaemia and the associated risk of future CVD and death using data from the Whitehall II observational cohort study.
Three glycaemic criteria for prediabetes (fasting plasma glucose [FPG] 5.6-6.9 mmol/l, 2 h plasma glucose [2hPG] 7.8-11.0 mmol/l, and HbA 39-47 mmol/mol [5.7-6.4%]) were assessed in 2002-2004 and 2007-2009 for 5193 participants free of known diabetes at enrolment. Among participants with prediabetes in the first examination, we calculated the probability of reversion to normoglycaemia by re-examination according to each glycaemic criterion. Poisson regression analysis was used to estimate and compare incidence rates of a composite endpoint of a CVD event or death in participants with prediabetes who did vs did not revert to normoglycaemia. Analyses were adjusted for age, sex, ethnicity and previous CVD.
Based on the FPG criterion, 820 participants had prediabetes and 365 (45%) of them had reverted to normoglycaemia in 5 years. The corresponding numbers were 324 and 120 (37%) for the 2hPG criterion and 1709 and 297 (17%) for the HbA criterion. During a median follow-up of 6.7 (interquartile range 6.3-7.2) years, 668 events of non-fatal CVD or death occurred among the 5193 participants. Reverting from 2hPG-defined prediabetes to normoglycaemia vs remaining prediabetic or progressing to diabetes was associated with a halving in event rate (12.7 vs 29.1 per 1000 person-years, p = 0.020). No association with event rate was observed for reverting from FPG-defined (18.6 vs 18.2 per 1000 person-years, p = 0.910) or HbA-defined prediabetes to normoglycaemia (24.5 vs 22.9 per 1000 person-years, p = 0.962).
CONCLUSIONS/INTERPRETATION: Most people with HbA-defined prediabetes remained prediabetic or progressed to diabetes during 5 years of follow-up. In contrast, reversion to normoglycaemia was frequent among people with FPG- or 2hPG-defined prediabetes. Only reversion from 2hPG-defined prediabetes to normoglycaemia was associated with a reduction in future risk of CVD and death.
目的/假设：从糖尿病前期恢复到正常血糖水平伴随着心血管风险因素的改善，但尚不清楚这是否转化为心血管疾病（CVD）事件或死亡风险的降低。因此，我们使用 Whitehall II 观察性队列研究的数据，研究了从糖尿病前期恢复到正常血糖水平的可能性，以及未来 CVD 和死亡的相关风险。
在 2002-2004 年和 2007-2009 年，对 5193 名在入组时无已知糖尿病的参与者进行了三种血糖水平的糖尿病前期评估（空腹血糖[FPG]5.6-6.9mmol/l、2 小时血糖[2hPG]7.8-11.0mmol/l 和 HbA 39-47mmol/mol[5.7-6.4%]）。在首次检查中患有糖尿病前期的参与者中，我们根据每个血糖标准，通过重新检查来计算恢复正常血糖水平的可能性。泊松回归分析用于估计和比较在糖尿病前期患者中，与未恢复正常血糖水平的患者相比，发生 CVD 事件或死亡的复合终点的发生率。分析调整了年龄、性别、种族和既往 CVD。
根据 FPG 标准，820 名参与者患有糖尿病前期，其中 365 名（45%）在 5 年内恢复到正常血糖水平。相应的数字是 324 名和 120 名（37%）对于 2hPG 标准，1709 名和 297 名（17%）对于 HbA 标准。在中位随访 6.7 年（四分位距 6.3-7.2 年）期间，5193 名参与者中有 668 例非致命性 CVD 或死亡事件发生。与继续处于糖尿病前期或进展为糖尿病相比，从 2hPG 定义的糖尿病前期恢复到正常血糖水平与事件发生率减半（每 1000 人年 12.7 例与 29.1 例，p=0.020）。从 FPG 定义（每 1000 人年 18.6 例与 18.2 例，p=0.910）或 HbA 定义的糖尿病前期恢复到正常血糖水平与事件发生率无相关性（每 1000 人年 24.5 例与 22.9 例，p=0.962）。
结论/解释：在 5 年的随访中，大多数 HbA 定义的糖尿病前期患者仍处于糖尿病前期或进展为糖尿病。相比之下，FPG 或 2hPG 定义的糖尿病前期患者恢复到正常血糖水平的情况较为常见。只有从 2hPG 定义的糖尿病前期恢复到正常血糖水平与未来 CVD 和死亡风险的降低有关。
