Progression From Newly Acquired Impaired Fasting Glusose to Type 2 Diabetes

Abstract

OBJECTIVE -We sought to estimate the rate of progression from newly acquired (incident) impaired fasting glucose (IFG) to diabetes under the old and new IFG criteria and to identify predictors of progression to diabetes.RESEARCH DESIGN AND METHODS -We identified 5,452 members of an HMO with no prior history of diabetes, with at least two elevated fasting glucose tests (100 -125 mg/dl) measured between 1 January 1994 and 31 December 2003, and with a normal fasting glucose test before the two elevated tests. All data were obtained from electronic records of routine clinical care. Subjects were followed until they developed diabetes, died, left the health plan, or until 31 December 2005.RESULTS -Overall, 8.1% of subjects whose initial abnormal fasting glucose was 100 -109 mg/dl (added IFG subjects) and 24.3% of subjects whose initial abnormal fasting glucose was 110 -125 mg/dl (original IFG subjects) developed diabetes (P Ͻ 0.0001). Added IFG subjects who progressed to diabetes did so within a mean of 41.4 months, a rate of 1.34% per year. Original IFG subjects converted at a rate of 5.56% per year after an average of 29.0 months. A steeper rate of increasing fasting glucose; higher BMI, blood pressure, and triglycerides; and lower HDL cholesterol predicted diabetes development.CONCLUSIONS -To our knowledge, these are the first estimates of diabetes incidence from a clinical care setting when the date of IFG onset is approximately known under the new criterion for IFG. The older criterion was more predictive of diabetes development. Many newly identified IFG patients progress to diabetes in Ͻ3 years, which is the currently recommended screening interval. Diabetes Care 30:228 -233, 2007T he American Diabetes Association (ADA) defines impaired fasting glucose (IFG) as an intermediate state of hyperglycemia in which glucose levels do not meet criteria for diabetes but are too high to be considered normal (1). Although the ADA calls IFG "pre-diabetes" (1), reported estimates of diabetes development in IFG patients vary widely (2). The Hoorn Study (3) found that 33% of patients with IFG but not impaired glucose tolerance (IGT) and 64.5% of patients with IFG and IGT developed diabetes over a follow-up of 5.8 -6.5 years. The Paris Prospective Study (4) reported much lower proportions: 2.7% among patients with normal glucose tolerance or isolated IFG and 14.9% among patients with IFG and IGT over 30 months of follow-up. An Italian study (5) spanning 11.5 years found that 9.1% of patients with isolated IFG and 44.4% of subjects with IFG and IGT developed diabetes. Studies of nonwhite populations have reported diabetes development proportions ranging from 21.6% over 5 years among Mauritians with isolated IFG (6) to 41.2% over 5 years among Pima Indians with IFG and IGT (7). The highest proportion of diabetes development, 72.7% over 7 years among subjects with IGT and IFG, was found in a Brazilian-Japanese population (8).Most of this wide variation in reported rates of diabetes development among IFG patients probably arises f...

Determinants of progression from impaired fasting glucose and impaired glucose tolerance to diabetes in a high-risk screened population: 3 year follow-up in the ADDITION study, Denmark

“…Higher levels of glucose measures, BMI and triacylglycerol were associated with progression in the final model. These determinants were also among those found in a study of progression from incident IFG, though not excluding IGT [16].…”

“…As far as we are aware, interval censoring or how person-years were calculated is described in only few publications on progression rates to diabetes [16,29]. This may indicate that the remaining studies [16,26,28,30,31] underestimate the true progression rates because of conservatively calculated risk times. We evaluated incident diabetes epidemiologically by one FBG or 2hBG.…”

“…By knowing which risk factors or changes in risk factor levels determine progression to diabetes, we may be able to develop individualised focused interventions. Current publications on determinants of progression from IGT have studied population-based cohorts including moderate and low-risk individuals; few studies have reported on IFG [10][11][12][13][14][15][16].…”

A community screening plan for the prevalence of some chronic diseases in specified adult populations in Saudi Arabia-II: pre-hypertension and hypertension

“…Pre-diabetes is a term given to those with newly RBG≥200mg%, and diabetes = self-identified as having type-I or type-II diabetes while reported being seen by a medical professional about diabetes treatment. 37 A "smoker" was a term given to those who were "currently smoking -or quit ≤5 years" prior to the survey. 1 Data were entered to a Microsoft program with adequate back up; openended questions coded, and observations were made ready for statistical analysis.…”

Frequency of Diabetes and Prediabetes in Heart Failure Patients and Their Association with In-Hospital Outcome

“…There is a 50% risk of progressing to overt diabetes over 10 years. A recent study cited the average time for progression as less than three years 4 . IFG is also a risk factor for mortality 5 .…”