Size and shape of the associations of glucose, HbA1c, insulin and HOMA-IR with incident type 2 diabetes: the Hoorn Study

Abstract

Aims/hypothesis Glycaemic markers and fasting insulin are frequently measured outcomes of intervention studies. To extrapolate accurately the impact of interventions on the risk of diabetes incidence, we investigated the size and shape of the associations of fasting plasma glucose (FPG), 2 h post-load glucose (2hPG), HbA 1c , fasting insulin and HOMA-IR with incident type 2 diabetes mellitus. Methods The study population included 1349 participants aged 50-75 years without diabetes at baseline (1989) from a population-based cohort in Hoorn, the Netherlands. Incident type 2 diabetes was defined by the WHO 2011 criteria or known diabetes at follow-up. Logistic regression models were used to determine the associations of the glycaemic markers, fasting insulin and HOMA-IR with incident type 2 diabetes. Restricted cubic spline logistic regressions were conducted to investigate the shape of the associations.Results After a mean follow-up duration of 6.4 (SD 0.5) years, 152 participants developed diabetes (11.3%); the majority were screen detected by high FPG. In multivariate adjusted models, ORs (95% CI) for incident type 2 diabetes for the highest quintile in comparison with the lowest quintile were 9.0 (4.4, 18.5) for FPG, 6.1 (2.9, 12.7) for 2hPG, 3.8 (2.0, 7.2) for HbA 1c , 1.9 (0.9, 3.6) for fasting insulin and 2.8 (1.4, 5.6) for HOMA-IR. The associations of FPG and HbA 1c with incident diabetes were non-linear, rising more steeply at higher values. Conclusions/interpretation FPG was most strongly associated with incident diabetes, followed by 2hPG, HbA 1c , HOMA-IR and fasting insulin. The strong association with FPG is probably because FPG is the most frequent marker for diabetes diagnosis. Non-linearity of associations between glycaemic markers and incident type 2 diabetes should be taken into account when estimating future risk of type 2 diabetes based on glycaemic markers.

Size and Shape of Associations of OGTT as Well as Mediating Effects on Adverse Pregnancy Outcomes Among Women With Gestational Diabetes Mellitus: Population-Based Study From Southern Han Chinese

“…Our current finding was linear relationships between fasting and postload glucose and macrosomia among GDM patients in both two age groups (age<35 and ≥35 years), which was consistent with the meta-analysis in some way. It was suggested that FPG and HbA1c had curvilinear associations with T2DM, and rose more steeply at higher values (8,9). In our results, three continuous OGTT values had different strengths in associations with HDP, preterm, neonatal hyperbilirubinemia, and macrosomia among GDM patients, but as a whole, the probability of obtaining these outcomes was at a similar range from 0.2 to 0.5.…”

“…Other studies reported linear continuous association of glycemic markers with diabetic risk (6,7). Only a limited number of articles showed a non-linear relation between blood glucose and diabetes (8,9). However, the precise correlations between three values' characteristics of OGTT at different points of time and adverse outcomes among women with GDM still remain ambiguous.…”

Incidence of diabetes mellitus in Spain as results of the nation-wide cohort di@bet.es study

“…The studies conducted in Europe (mostly local) in the last years, based on glucose determinations and rarely using OGTT, reveal the heterogeneity of diabetes incidence among the different studies [14][15][16][17][18][19][20][21][22] ranging from 5 per 1000 cases of the ICARIA study 14 in working population, to more than 17 per 1000 of the Hoorn study 18 with OGTT in a population with mean age around 60 years old. These differences may be due to (besides the methodology) the important differences between countries in the prevalence of obesity, physical activity, or eating patterns, which might partially explain the variation in diabetes prevalence 23 .…”

Long non-coding RNA H19 is associated with polycystic ovary syndrome in Chinese women: a preliminary study

“…FPG is known to be the most frequent and sensitive indicator for detecting the early stages of several metabolic diseases and is also known to represent a stronger predictor for type 2 diabetes than TG/HDL-C, TyG and HOMA-IR indices [31]. Previous research showed that FPG was most strongly associated with incident diabetes, followed by 2hPG, HbA1c, HOMA-IR and fasting insulin [32]. Indeed, pre-stimulatory glucose levels have been shown to influence both the function of β-cells and insulin sensitivity in very different ways when compared between non-diabetics and those with type 2 diabetes [33].…”