Li Yan-Yan, Tong Lin-Ping, Wu Xian-Dan, Lin Dan, Lin Yue, Lin Xiao-Yang
Department of General Practice, The First People's Hospital of Wenling City, Wenling 317500, Zhejiang Province, China.
Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China.
World J Diabetes. 2023 Oct 15;14(10):1551-1561. doi: 10.4239/wjd.v14.i10.1551.
The trend of prediabetes progressing to type 2 diabetes mellitus (T2DM) is prominent, and effective intervention can lead to a return to prediabetes. Exploring the factors influencing the outcome of prediabetes is helpful to guide clinical intervention. The weight change in patients with prediabetes has not attracted much attention.
To explore the interaction between body weight and the factors affecting the progression of prediabetes to T2DM.
We performed a retrospective analysis of 236 patients with prediabetes and 50 with normal glucose tolerance (NGT), and collected clinical data and follow-up results of all patients. Based on natural blood glucose outcomes, we classified 66 patients with progression to T2DM into the disease progression (DP) group, and 170 patients without progression to T2DM into the disease outcome (DO) group. We analyzed the factors that influenced prediabetes outcome and the influence of body weight on prediabetes blood glucose outcome by unconditional logistic regression. A general linear model (univariate) was used to analyze the inter-action between body weight and independent influencing factors.
There were 98 cases of impaired fasting glucose (IFG), 90 cases of impaired glucose tolerance (IGT), and 48 cases of coexistent IFG and IGT. The body weight, waist circumference, body mass index, fasting blood glucose, and 2 h plasma glucose of patients with IFG, IGT, and coexistent IFG and IGT were higher than those in patients with NGT ( < 0.05). Logistic regression analysis showed that body weight, glycosylated hemoglobin, uric acid, fasting insulin, and homeostatic model assessment for insulin resistance were independent factors affecting progression of prediabetes to T2DM ( < 0.05). Receiver operating characteristic curve analysis showed that the area under the curve predicted by the above indicators combined was 0.905 [95% confidence interval (CI): 0.863-0.948], which was greater than that predicted by each indicator alone. Logistic regression analysis with baseline body weight as an independent variable showed that compared with body weight 1, the odds ratio (95%CI) of body weight 3 was 1.399 (1.142-2.126) ( = 0.033). There was a multiplicative interaction between body weight and uric acid (β = 1.953, 0.005).
High body weight in patients with prediabetes is an independent risk factor for progression to T2DM, and the risk of progression is increased when coexisting with high uric acid level.
糖尿病前期进展为2型糖尿病（T2DM）的趋势显著，有效的干预可使其恢复至糖尿病前期。探索影响糖尿病前期转归的因素有助于指导临床干预。糖尿病前期患者的体重变化尚未引起足够重视。
探讨体重与影响糖尿病前期进展为T2DM的因素之间的相互作用。
对236例糖尿病前期患者和50例糖耐量正常（NGT）者进行回顾性分析，收集所有患者的临床资料及随访结果。根据血糖自然转归情况，将进展为T2DM的66例患者分为疾病进展（DP）组，未进展为T2DM的170例患者分为疾病转归（DO）组。采用非条件logistic回归分析影响糖尿病前期转归的因素及体重对糖尿病前期血糖转归的影响。采用一般线性模型（单因素）分析体重与独立影响因素之间的交互作用。
空腹血糖受损（IFG）98例，糖耐量受损（IGT）90例，IFG合并IGT 48例。IFG、IGT及IFG合并IGT患者的体重、腰围、体质指数、空腹血糖及餐后2 h血糖均高于NGT者（<0.05）。logistic回归分析显示，体重、糖化血红蛋白、尿酸、空腹胰岛素及胰岛素抵抗稳态模型评估是影响糖尿病前期进展为T2DM的独立因素（<0.05）。受试者工作特征曲线分析显示，上述指标联合预测的曲线下面积为0.905[95%置信区间（CI）：0.863 - 0.948]，大于各指标单独预测的曲线下面积。以基线体重为自变量的logistic回归分析显示，与体重1相比，体重3的比值比（95%CI）为1.399（1.142 - 2.126）（ = 0.033）。体重与尿酸之间存在相乘交互作用（β = 1.953， 0.005）。
糖尿病前期患者体重过高是进展为T2DM的独立危险因素，与高尿酸水平并存时进展风险增加。
