Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany.
Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany; German Center for Diabetes Research (DZD), München, Neuherberg, Germany.
Nutr Metab Cardiovasc Dis. 2021 Feb 8;31(2):429-438. doi: 10.1016/j.numecd.2020.09.008. Epub 2020 Sep 12.
In a non-interventional study of older persons, we assessed the impact of changes in BMI and waist circumference (WC) on reversion from glucose- and HbA1c-defined prediabetes to normoglycaemia (in short: reversion) and on persistence of normoglycaemia. Moreover, we studied whether reversion reduced cardiovascular risk.
From the population-based KORA S4/F4/FF4 cohort study conducted in Southern Germany, we utilized data from the second and third visit to the study center (median follow-up 6.5 years). We used two overlapping data sets, one with 563 persons with HbA1c<6.5% (mean age 69 years, 51.5% men), one with 510 persons with glucose-based prediabetes or normal glucose tolerance. We calculated proportions of reversion, and estimated adjusted relative risks for the association between initial BMI/WC and change of BMI/WC, respectively, and reversion (and persistence of normoglycaemia, respectively). We estimated 10-year cardiovascular risks using the Framingham 2008 score. Overall, 27.3% of persons with HbA1c-defined prediabetes and 9.2% of persons with glucose-based prediabetes returned to normoglycaemia during follow-up. Lower initial BMI/WC and reduction of BMI/WC were associated with larger probabilities of returning to normoglycaemia (e.g., for HbA1c 5.7-6.4%, RR = 1.24 (95% CI: 1.09-1.41) per 1 kg/m decline of BMI). Moreover, reduction of BMI/WC increased probabilities of maintaining normoglycaemia (e.g., for glucose-based prediabetes, RR = 1.09 (1.02-1.16) per 1 kg/m decline of BMI). 10-year cardiovascular risk was 5.6 (1.7-9.6) percentage points lower after reversion from glucose-based prediabetes to normoglycaemia.
In older adults, even moderate weight reduction contributes to reversion from prediabetes to normoglycaemia and to maintaining normoglycaemia.
在一项针对老年人的非干预性研究中，我们评估了 BMI 和腰围（WC）变化对血糖和 HbA1c 定义的糖尿病前期恢复为正常血糖（简称：逆转）以及对维持正常血糖的影响。此外，我们研究了逆转是否降低了心血管风险。
我们利用了德国南部进行的基于人群的 KORA S4/F4/FF4 队列研究中的数据，这些数据来自研究中心的第二次和第三次访问（中位随访时间为 6.5 年）。我们使用了两个重叠的数据集，一个包含 563 名 HbA1c<6.5%（平均年龄 69 岁，51.5%为男性）的人，一个包含 510 名有血糖性糖尿病前期或正常糖耐量的人。我们计算了逆转的比例，并分别估计了初始 BMI/WC 和 BMI/WC 变化与逆转（以及分别与正常血糖的维持）之间的关联的调整相对风险。我们使用 Framingham 2008 评分估计了 10 年心血管风险。总的来说，在随访期间，27.3%的 HbA1c 定义的糖尿病前期患者和 9.2%的血糖性糖尿病前期患者恢复为正常血糖。较低的初始 BMI/WC 和 BMI/WC 的减少与恢复为正常血糖的可能性更大相关（例如，对于 HbA1c 为 5.7-6.4%，每降低 1kg/m2 BMI，RR=1.24（95%CI：1.09-1.41））。此外，BMI/WC 的减少增加了维持正常血糖的可能性（例如，对于血糖性糖尿病前期，RR=1.09（1.02-1.16），每降低 1kg/m2 BMI））。从血糖性糖尿病前期恢复为正常血糖后，10 年心血管风险降低了 5.6（1.7-9.6）个百分点。
在老年人中，即使是适度的体重减轻也有助于从糖尿病前期恢复为正常血糖，并维持正常血糖。
