Diversity in the risk of type 2 diabetes associated with age, sex, and 1-h post-load plasma glucose levels in the Japanese population with prediabetes

doi:10.1016/j.diabres.2021.108780

Diabetes Research and Clinical Practice

Volume 175, May 2021, 108780

https://doi.org/10.1016/j.diabres.2021.108780 Get rights and content

Highlights

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The risk of T2D was higher in isolated IFG than isolated IGT in elderly individuals.
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There was a higher risk of T2D in isolated IFG as compared to isolated IGT in women.
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1-h post-load PG level was closely related to the risk of T2D in both IFG and IGT.
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Marked diversity in the risk of T2D was found among subdivided prediabetes groups.

Abstract

Aims

We investigated the risk of type 2 diabetes in the Japanese population with prediabetes, focusing on prediabetes categories, age- and sex-related differences, and plasma glucose levels during a 75-g oral glucose tolerance test.

Methods

This retrospective cohort study included 11,414 participants (5330, 2560, 1501, and 2023 with normal fasting glucose/normal glucose tolerance, isolated impaired fasting glucose [IFG], isolated impaired glucose tolerance [IGT], and IFG plus IGT, respectively). The risk of type 2 diabetes was stratified by age and sex. Moreover, prediabetes was subdivided according to fasting plasma glucose (FPG) and 1-h post-load glucose levels.

Results

Over a mean 6.3-year follow-up period, 1002 participants developed type 2 diabetes. The risk of type 2 diabetes was higher in isolated IFG than isolated IGT in elderly participants, but not in middle-aged participants. A higher risk was evident in isolated IFG in women, but not men. Moreover, about a 27- and 29-fold difference exists in men and women, respectively, in the risk of type 2 diabetes among the subdivided prediabetes categories.

Conclusion

The assessment of age and sex-differences and subdivided prediabetes categories based on FPG and 1-h post-load glucose levels may effectively evaluate the risk of type 2 diabetes, which displays marked diversity.

Introduction

Identifying individuals at high risk of type 2 diabetes is critical for effective intervention strategies and disease prevention [1], [2]. Prediabetes described individuals at a high risk of type 2 diabetes [3], [4], [5] and comprises two different types: impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) [6]. Several studies have reported fasting plasma glucose (FPG) level-related differences in the risk of type 2 diabetes in individuals with IFG [7], [8]. Consequently, a recent meta-analysis showed 1-h post-load plasma glucose (1-h PG) level-related differences in the risk of conversion to type 2 diabetes in individuals with IGT [9]. Furthermore, factors including age [10], sex [11], obesity [12], smoking [13], dyslipidemia [14], and hyperuricemia [15] have been reported to influence the risk of type 2 diabetes. The difference in the pathophysiology between IFG and IGT, plasma glucose (PG) levels, and various confounding factors may contribute to the heterogeneity in the risk of conversion to type 2 diabetes among individuals with prediabetes. Some studies have reported an elevated risk in patients with IFG plus IGT compared with those with isolated IFG or IGT [5], [16]. However, limited data exists on the diversity of risks of conversion to type 2 diabetes in patients in each prediabetes category, segmented by the confounding factors. Moreover, ethnic differences in pathophysiology in the development of type 2 diabetes are well-known [17], [18], suggesting that differences exist in the risk of conversion to type 2 diabetes among ethnic groups of patients with prediabetes. However, little is known about the differences in the impacts of age, sex, and PG levels on the risk of type 2 diabetes among the Japanese population with each prediabetes category.

The present study aimed to investigate the association of the potential confounding factors, including age and sex, with differences in the risk of type 2 diabetes between subtypes of prediabetes (i.e., isolated IGT, isolated IFG, and IFG plus IGT) and clarify the diversity based on the PG level during the oral glucose tolerance test (OGTT) in the risk of type 2 diabetes within each subgroup of prediabetes, using a large-scale database of Japanese patients with prediabetes.

Section snippets

Study population

The present study used data collected from the Hiroshima Study on Glucose Metabolism and Cardiovascular Diseases (Hiroshima GMCVD), which was a cross-sectional, longitudinal study that examined the interrelationships among impaired glucose metabolism, hypertension, and cardiovascular disease (CVD) [19], [20]. Details of the participants in Hiroshima GMCVD were described previously [19]. Among the 18,713 participants who underwent a 75-g OGTT at the Health Management and Promotion Center of

Clinical characteristics of study population

A total of 11,414 participants (5330 with NFG/NGT, 2560 with IFG, 1501 with IGT, and 2023 with IFG plus IGT) were enrolled in the present analysis. Among these patients, 5003 (44%) had hypertension, 6897 (60%) had dyslipidemia, 1376 (12%) had hyperuricemia, 2215 (19%) had renal dysfunction, 1173 (10%) had a history of CVD, and 2659 (23%) had a family history of diabetes. Furthermore, 1842 (16%) were current smokers, 1934 (17%) were former smokers, and 7638 (67%) were never smokers, and 2430

Discussion

In the present study, we confirmed an increased risk of type 2 diabetes in Japanese population with different stages of prediabetes and demonstrated following novel findings. First, age and sex were associated with differences in the risk of type 2 diabetes between the IFG and IGT groups. Second, FPG and 1-h post-load glucose level were significant predictors of the conversion to type 2 diabetes across all types of prediabetes. Third, assessment of the subdivided prediabetes categories based on

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

CRediT authorship contribution statement

NS, RO, and YH designed the studies. NS, and RM contributed to data collection and analysis. NS, RM, RO, YN, and YH contributed to interpretation of data. NS wrote the manuscript. RM, RO, YN, and YH reviewed/edited the manuscript. All authors read and approved the final manuscript.

Declaration of Competing Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Acknowledgments

The authors thank Naomi Yuzono for her technical and secretarial assistance.

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Cited by (3)

International Diabetes Federation Position Statement on the 1-hour post-load plasma glucose for the diagnosis of intermediate hyperglycaemia and type 2 diabetes
2024, Diabetes Research and Clinical Practice
Many individuals with intermediate hyperglycaemia (IH), including impaired fasting glycaemia (IFG) and impaired glucose tolerance (IGT), as presently defined, will progress to type 2 diabetes (T2D). There is confirmatory evidence that T2D can be prevented by lifestyle modification and/or medications, in people with IGT diagnosed by 2-h plasma glucose (PG) during a 75-gram oral glucose tolerance test (OGTT). Over the last 40 years, a wealth of epidemiological data has confirmed the superior value of 1-h plasma glucose (PG) over fasting PG (FPG), glycated haemoglobin (HbA_1c) and 2-h PG in populations of different ethnicity, sex and age in predicting diabetes and associated complications including death. Given the relentlessly rising prevalence of diabetes, a more sensitive, practical method is needed to detect people with IH and T2D for early prevention or treatment in the often lengthy trajectory to T2D and its complications. The International Diabetes Federation (IDF) Position Statement reviews findings that the 1-h post-load PG ≥ 155 mg/dL (8.6 mmol/L) in people with normal glucose tolerance (NGT) during an OGTT is highly predictive for detecting progression to T2D, micro- and macrovascular complications, obstructive sleep apnoea, cystic fibrosis-related diabetes mellitus, metabolic dysfunction-associated steatotic liver disease, and mortality in individuals with risk factors. The 1-h PG of 209 mg/dL (11.6 mmol/L) is also diagnostic of T2D. Importantly, the 1-h PG cut points for diagnosing IH and T2D can be detected earlier than the recommended 2-h PG thresholds. Taken together, the 1-h PG provides an opportunity to avoid misclassification of glycaemic status if FPG or HbA_1c alone are used. The 1-h PG also allows early detection of high-risk people for intervention to prevent progression to T2D which will benefit the sizeable and growing population of individuals at increased risk of T2D. Using a 1-h OGTT, subsequent to screening with a non-laboratory diabetes risk tool, and intervening early will favourably impact the global diabetes epidemic. Health services should consider developing a policy for screening for IH based on local human and technical resources. People with a 1-h PG ≥ 155 mg/dL (8.6 mmol/L) are considered to have IH and should be prescribed lifestyle intervention and referred to a diabetes prevention program. People with a 1-h PG ≥ 209 mg/dL (11.6 mmol/L) are considered to have T2D and should have a repeat test to confirm the diagnosis of T2D and then referred for further evaluation and treatment. The substantive data presented in the Position Statement provides strong evidence for redefining current diagnostic criteria for IH and T2D by adding the 1-h PG.
Early-Phase Changes in Serum Free Fatty Acid Levels After Glucose Intake Are Associated With Type 2 Diabetes Incidence: The Hiroshima Study on Glucose Metabolism and Cardiovascular Diseases
2022, Diabetes Care
Association of obesity with serum free fatty acid levels in individuals at different stages of prediabetes
2022, Clinical Obesity

View full text

Diversity in the risk of type 2 diabetes associated with age, sex, and 1-h post-load plasma glucose levels in the Japanese population with prediabetes

Highlights

Abstract

Aims

Methods

Results

Conclusion

Introduction

Section snippets

Study population

Clinical characteristics of study population

Discussion

Funding

CRediT authorship contribution statement

Declaration of Competing Interest

Acknowledgments

Lancet

Lancet Diabetes Endocrinol

J Am Coll Cardiol

Metabolism

Diabetes Res Clin Pract

Diabetes Res Clin Pract

Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance

N Engl J Med

Risk factors for NIDDM in white population. Paris prospective study

Diabetes

Incidence rates of type 2 diabetes in people with impaired fasting glucose (ADA vs. WHO Criteria) and impaired glucose tolerance: results from an older population (KORA S4/F4/FF4 Study)

Diabetes Care

Impaired fasting glucose and impaired glucose tolerance: implications for care

Diabetes Care

One-hour postload hyperglycemia: implications for prediction and prevention of type 2 diabetes

J Clin Endocrinol Metab

Anglo-Scandinavian Cardiac Outcomes Trial Investigators. Determinants of new-onset diabetes among 19,257 hypertensive patients randomized in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm and the relative influence of antihypertensive medication

Diabetes Care

Sex differences in metabolic regulation and diabetes susceptibility

Diabetologia

Predictors of and longitudinal changes in insulin sensitivity and secretion preceding onset of type 2 diabetes

Diabetes

Active smoking and the risk of type 2 diabetes: a systematic review and meta-analysis

JAMA

The Singapore impaired glucose tolerance follow-up study: does the ticking clock go backward as well as forward?

Diabetes Care

Uric acid and risk of new-onset metabolic syndrome, impaired fasting glucose and diabetes mellitus in a general Italian population: data from the Pressioni Arteriose Monitorate E Loro Associazioni study

J Hypertens