Regression from prediabetes to normal glucose regulation and prevalence of microvascular disease in the diabetes prevention program outcomes study (DPPOS)

Leigh Perreault, Qing Pan, Emily B. Schroeder, Rita R. Kalyani, George A. Bray, Samuel Dagogo-Jack, Neil H. White, Ronald B Goldberg, Steven E. Kahn, William C. Knowler, Nestoras Mathioudakis, Dana Dabelea

Research output: Contribution to journalArticle

Abstract

OBJECTIVE Regression from prediabetes to normal glucose regulation (NGR) was associated with reduced incidence of diabetes by 56% over 10 years in participants in the Diabetes Prevention Program Outcomes Study (DPPOS). In an observational analysis, we examined whether regression to NGR also reduced risk for microvascular disease (MVD). RESEARCH DESIGN AND METHODS Generalized estimating equations were used to examine the prevalence of aggregate MVD at DPPOS year 11 in people who regressed to NGR at least once (vs. never) during the Diabetes Prevention Program (DPP). Logistic regression assessed the relationship of NGR with retinopathy, nephropathy, and neuropathy, individually. Generalized additive models fit smoothing splines to describe the relationship between average A1C during follow-up and MVD (and its subtypes) at the end of follow-up. RESULTS Regression to NGR was associated with lower prevalence of aggregate MVD in models adjusted for age, sex, race/ethnicity, baseline A1C, and treatment arm (odds ratio [OR] 0.78, 95% CI 0.65-0.78, P = 0.011). However, this association was lost in models that included average A1C during follow-up (OR 0.95, 95% CI 0.78-1.16, P = 0.63) or diabetes status at the end of follow-up (OR 0.92, 95% CI 0.75-1.12, P = 0.40). Similar results were observed in examination of the association between regression to NGR and prevalence of nephropathy and retinopathy, individually. Risk for aggregate MVD, nephropathy, and retinopathy increased across the A1C range. CONCLUSIONS Regression to NGR is associated with a lower prevalence of aggregate MVD, nephropathy, and retinopathy, primarily due to lower glycemic exposure over time. Differential risk for the MVD subtypes begins in the prediabetes A1C range.

Original languageEnglish (US)
Pages (from-to)1809-1815
Number of pages7
JournalDiabetes care
Volume42
Issue number9
DOIs
StatePublished - Sep 1 2019

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Prediabetic State
Outcome Assessment (Health Care)
Glucose
Odds Ratio
Research Design
Logistic Models
Incidence

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Perreault, L., Pan, Q., Schroeder, E. B., Kalyani, R. R., Bray, G. A., Dagogo-Jack, S., ... Dabelea, D. (2019). Regression from prediabetes to normal glucose regulation and prevalence of microvascular disease in the diabetes prevention program outcomes study (DPPOS). Diabetes care, 42(9), 1809-1815. https://doi.org/10.2337/dc19-0244

Regression from prediabetes to normal glucose regulation and prevalence of microvascular disease in the diabetes prevention program outcomes study (DPPOS). / Perreault, Leigh; Pan, Qing; Schroeder, Emily B.; Kalyani, Rita R.; Bray, George A.; Dagogo-Jack, Samuel; White, Neil H.; Goldberg, Ronald B; Kahn, Steven E.; Knowler, William C.; Mathioudakis, Nestoras; Dabelea, Dana.

In: Diabetes care, Vol. 42, No. 9, 01.09.2019, p. 1809-1815.

Research output: Contribution to journalArticle

Perreault, L, Pan, Q, Schroeder, EB, Kalyani, RR, Bray, GA, Dagogo-Jack, S, White, NH, Goldberg, RB, Kahn, SE, Knowler, WC, Mathioudakis, N & Dabelea, D 2019, 'Regression from prediabetes to normal glucose regulation and prevalence of microvascular disease in the diabetes prevention program outcomes study (DPPOS)', Diabetes care, vol. 42, no. 9, pp. 1809-1815. https://doi.org/10.2337/dc19-0244
Perreault, Leigh ; Pan, Qing ; Schroeder, Emily B. ; Kalyani, Rita R. ; Bray, George A. ; Dagogo-Jack, Samuel ; White, Neil H. ; Goldberg, Ronald B ; Kahn, Steven E. ; Knowler, William C. ; Mathioudakis, Nestoras ; Dabelea, Dana. / Regression from prediabetes to normal glucose regulation and prevalence of microvascular disease in the diabetes prevention program outcomes study (DPPOS). In: Diabetes care. 2019 ; Vol. 42, No. 9. pp. 1809-1815.
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abstract = "OBJECTIVE Regression from prediabetes to normal glucose regulation (NGR) was associated with reduced incidence of diabetes by 56{\%} over 10 years in participants in the Diabetes Prevention Program Outcomes Study (DPPOS). In an observational analysis, we examined whether regression to NGR also reduced risk for microvascular disease (MVD). RESEARCH DESIGN AND METHODS Generalized estimating equations were used to examine the prevalence of aggregate MVD at DPPOS year 11 in people who regressed to NGR at least once (vs. never) during the Diabetes Prevention Program (DPP). Logistic regression assessed the relationship of NGR with retinopathy, nephropathy, and neuropathy, individually. Generalized additive models fit smoothing splines to describe the relationship between average A1C during follow-up and MVD (and its subtypes) at the end of follow-up. RESULTS Regression to NGR was associated with lower prevalence of aggregate MVD in models adjusted for age, sex, race/ethnicity, baseline A1C, and treatment arm (odds ratio [OR] 0.78, 95{\%} CI 0.65-0.78, P = 0.011). However, this association was lost in models that included average A1C during follow-up (OR 0.95, 95{\%} CI 0.78-1.16, P = 0.63) or diabetes status at the end of follow-up (OR 0.92, 95{\%} CI 0.75-1.12, P = 0.40). Similar results were observed in examination of the association between regression to NGR and prevalence of nephropathy and retinopathy, individually. Risk for aggregate MVD, nephropathy, and retinopathy increased across the A1C range. CONCLUSIONS Regression to NGR is associated with a lower prevalence of aggregate MVD, nephropathy, and retinopathy, primarily due to lower glycemic exposure over time. Differential risk for the MVD subtypes begins in the prediabetes A1C range.",
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AU - Kalyani, Rita R.

AU - Bray, George A.

AU - Dagogo-Jack, Samuel

AU - White, Neil H.

AU - Goldberg, Ronald B

AU - Kahn, Steven E.

AU - Knowler, William C.

AU - Mathioudakis, Nestoras

AU - Dabelea, Dana

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N2 - OBJECTIVE Regression from prediabetes to normal glucose regulation (NGR) was associated with reduced incidence of diabetes by 56% over 10 years in participants in the Diabetes Prevention Program Outcomes Study (DPPOS). In an observational analysis, we examined whether regression to NGR also reduced risk for microvascular disease (MVD). RESEARCH DESIGN AND METHODS Generalized estimating equations were used to examine the prevalence of aggregate MVD at DPPOS year 11 in people who regressed to NGR at least once (vs. never) during the Diabetes Prevention Program (DPP). Logistic regression assessed the relationship of NGR with retinopathy, nephropathy, and neuropathy, individually. Generalized additive models fit smoothing splines to describe the relationship between average A1C during follow-up and MVD (and its subtypes) at the end of follow-up. RESULTS Regression to NGR was associated with lower prevalence of aggregate MVD in models adjusted for age, sex, race/ethnicity, baseline A1C, and treatment arm (odds ratio [OR] 0.78, 95% CI 0.65-0.78, P = 0.011). However, this association was lost in models that included average A1C during follow-up (OR 0.95, 95% CI 0.78-1.16, P = 0.63) or diabetes status at the end of follow-up (OR 0.92, 95% CI 0.75-1.12, P = 0.40). Similar results were observed in examination of the association between regression to NGR and prevalence of nephropathy and retinopathy, individually. Risk for aggregate MVD, nephropathy, and retinopathy increased across the A1C range. CONCLUSIONS Regression to NGR is associated with a lower prevalence of aggregate MVD, nephropathy, and retinopathy, primarily due to lower glycemic exposure over time. Differential risk for the MVD subtypes begins in the prediabetes A1C range.

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