Researchers shed light on the risk factor and the interaction of diabetes development

Researchers shed light on the risk factor and the interaction of diabetes development

The study finds a 10-year diabetes risk of 12.8% in a cohort of 44,992 people, highlighting the role of fasting plasma glucose, body mass index, age and gender in predicting risks - even in people with normal FPG levels

In a recently published study in theJama Network OpenA group of researchers assessed how fasting plasma glucose (FPG), age, gender and body mass index (BMI) influence progression to diabetes and enable targeted prevention strategies.

background

The progression of normal fasting glucose and glucose tolerance to type 2 diabetes often includes an intermediate stage with impaired fasting glucose or impaired glucose tolerance, referred to as prediabetes. Lifestyle and pharmacological interventions can significantly reduce the risk of diabetes for high-risk individuals.

The American Diabetes Association recommends clinical risk assessments to guide diagnostic testing for prediabetes or diabetes using FPG, 2-hour plasma glucose during a 75-G oral glucose tolerance test, or hemoglobin A1C (HbA1c). Further research is important to examine interactions between FPG, age, gender, BMI, and other variables to refine risk prediction.

About the study

The Rochester Epidemiology Project (REP) is a medical records system that identifies unique individuals across multiple healthcare organizations in Olmsted County, Minnesota. In this retrospective cohort study, representative data were used to exclude individuals aged 18 to 65 years with at least two FPGs and samples collected during inpatient hospital stays were excluded.

Individuals with pre-existing diabetes, those on glucose-lowering medications, or those with an initial FPG level of 126 mg/dL or greater were also excluded. The accuracy of electronically retrieved data was verified by manually reviewing a subset of records.

Study results

A total of 44,992 individuals were included in the cohort, with a mean (SD) age of 43.7 (11.8) years and an age range of 18 to 65 years. The cohort included 26,025 women (57.8%) and 18,967 men (42.2%), including 1,844 Asian participants (4.1%), 1,934 Black participants (4.3%), 39,178 White participants (87.1%), and 2,036 people of other races or ethnicities or Ethnicities or ethnicities or ethnicities or ethnicities or ethnicities or ethnicities or ethnicities or ethnicities or ethnicities that races or ethnicities or ethnicities to ethnic races or ethnicities to (4.5%). The mean (SD) BMI was 28.9 (6.6).

During a median follow-up of 6.8 years (IQR, 3.6 to 9.7 years), 3,879 people (8.6%) developed diabetes, affecting 7.1% of women (1,847 of 26,025) and 10.7% of men (2,032 of 18,967). The Kaplan-Meier 10-year cumulative diabetes risk was 12.8% (95% CI, 12.4%-13.2%).

Cox proportional hazards regression analysis identified significant risk factors including FPG levels, gender, age and BMI. Individuals with FPG levels outside the reference range (80-94 mg/dL) were at increased risk with an HR of 3.49 (95% CI, 2.19-5.57) for FPG <70 mg/dL and HR of 12.47 (95% CI, CI, CI, CI, 95% CI, faced). 10.84-14.34) for FPG 120-125 mg/dl. Male gender increased diabetes risk compared to women (HR, 1.31 [95% CI, 1.22-1.40]). Abnormal BMI categories also increased risk, with HRs ranging from 2.42 (95% CI, 1.77-3.29) for underweight (BMI <18.5) to 4.03 (95% CI, 3.56-4.56) for class III (BMI ≥40). Age ≥ 60 years was associated with nearly double the risk of duplication (HR 1.97 [95% CI, 1.71-2.28]).

The additive model provided interpretable risk estimates and highlighted the combined effects of FPG, BMI, age and gender. For example, a 55- to 59-year-old woman with a BMI of 18.5 to 24.9 and an FPG level of 95 to 99 mg/dL had a 10-year diabetes risk of 7.0%. This risk increased with a BMI of 30-34.9 and 28.0% to 13.0%, with both a higher BMI and FPG level of 105 to 109 mg/dL.

Across all age groups, individuals with BMI <18.5 or FPG <80 mg/dL were at increased risks compared to those in the lowest risk categories. The risk of diabetes increased steadily with increasing FPG levels above 80 mg/dL, but no sharp inflection was observed at the prediabetes cutoff of 100 mg/dL.

The nomogram, based on cumulative points assigned to the categories FPG, age, gender and BMI risk), moderate (7-9 points, 26% risk) and high (≥ 10 points, 56% risk).

Conclusions

In summary, in this cohort study of individuals without diabetes at baseline, 8.6% developed diabetes over a median follow-up of 6.8 years, with a 10-year cumulative risk of 12.8%. The risk increased with higher baseline FPG levels, even within the normal range, as well as additive contributions from male gender, increasing age and BMI.

Notably, both underweight BMI and FPG levels below 80 mg/dL were associated with a higher risk of diabetes, likely reflecting poor nutritional status or sarcopenia. While FPG testing is widely used, its limitations highlight the growing role of Hba1c testing for improved diagnostic accuracy and intervention targets.

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