Longitudinal Changes in Insulin Resistance, Beta-Cell Function and Glucose Regulation Status in Prediabetes

초록

Background: The changes in insulin resistance and insulin secretion and their association with changes in glucose regulation status in Asians with prediabetes remain uncertain. Materials and Methods: We included Korean adults (aged 20-79 years) with prediabetes who underwent routine medical check-ups at a mean interval of 5 years. Prediabetes was defined as fasting plasma glucose (FPG) 5.6-6.9 mmol/1 or HbA1c 5.7-6.4% (39-46 mmol/mol). Insulin resistance (HOMA-IR) and beta-cell function (HOMA-%B) indices were assessed by homeostasis model assessment. Incident diabetes was defined as FPG >= 7.0 mmol/1, HbA1c >= 6.5% (48 mmol/mol), or initiation of antidiabetic medications. Results: Among the 7,208 participants with prediabetes, 4,410 (61.2%) remained as prediabetes (control group), 2,123 (29.5%) reverted to normal glucose regulation (regressors), and 675 (9.4%) progressed to type 2 diabetes (progressors) after 5 years. Compared with the control group, the progressors had higher baseline HOMA-IR (2.48 +/- 1.45 versus 2.06 +/- 1.20, P < 0.001), but similar baseline HOMA-%B (74.6 +/- 47.6 versus 73.1 +/- 41.4, P=0.68). By contrast, the regressors had lower baseline HOMA-IR (1.98 +/- 1.14 versus 2.06 +/- 1.20, P = 0.035) but higher baseline HOMA-%B (77.4 +/- 43.1 versus 73.1 41.4, P = 0.001). After 5 years, the progressors showed a 31% increase in HOMA-IR (2.48 1.45 versus 3.24 +/- 2.10, P < 0.001) and 15% decrease in HOMA-%B (74.6 +/- 47.6 versus 63.8 +/- 40.4, P < 0.001), whereas the regressors showed 29% decrease in HOMA-IR (1.98 +/- 1.14 versus 1.41 +/- 0.78, P < 0.001) and 4% increase in HOMA-%B (77.4 +/- 43.1 versus 80.2 +/- 47.9, P = 0.010). Conclusions: Although increase in insulin resistance and decrease in beta-cell function both contributed to the progression to type 2 diabetes from prediabetes, longitudinal change in insulin resistance was the predominant factor in Koreans.

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