Background: People with prediabetes have an increased risk of developing type 2 diabetes (T2D). Few studies have evaluated the influence of lifestyle factors on the risk of progression to diabetes and reversion to normoglycemia. The aim of this study was to determine the incidence of T2D in a large cohort of workers with prediabetes, and to evaluate the influence of sociodemographic, clinical, metabolic, and lifestyle factors that affect the persistence of prediabetes and the progression to T2D. Methods: A cohort study of 27,844 adult workers (aged 20 to 65 years) from Spain who had prediabetes based on an occupational medical examination from 2012 to 2013. Prediabetes was defined as fasting plasma glucose (FPG) between 100 and 125 mg/dL. At the baseline evaluation, sociodemographic, anthropometric, metabolic, and lifestyle data were collected. At the 5-year follow-up, incident T2D was defined as an FPG of at least 126 mg/dL or initiation of an antidiabetic medication. Results: Among 235,995 initially screened workers, the prevalence of T2D was 14.19% (95% confidence interval (CI) 14.05 to 14.33) and the prevalence of prediabetes was 11.85% (95% CI 11.71 to 11.99). Follow-up data were available for 23,293 individuals with prediabetes. Among them, 36.08% (95% CI 35.46 to 36.70) returned to normoglycemia, 40.92% (95% CI 40.29 to 41.55) had persistent prediabetes, and 23.00% (95% CI 22.46 to 23.54) progressed to T2D. The risk for persistence of prediabetes and for progression to T2D increased with age, body mass index (BMI), triglyceride level, and less than 150 min/week of physical activity. An HbA1c level of 6% or greater was the strongest individual predictor of progression to T2D. Conclusions: Physical activity, diet, smoking, and BMI are modifiable factors that are associated with the persistence of prediabetes and the progression to T2D. The workplace is a feasible setting for the early detection of prediabetes and the promotion of lifestyles that can prevent progression to T2D.

Background Fatty Liver Index (FLI) is strongly associated with changes in glycemic status and incident Type 2 Diabetes (T2D). The probability of reverting to normoglycemia from a state prediabetes could be determined by FLI, however such relationship remains poorly understood. Aim To determine the clinical interest of using FLI to estimate prediabetes reversion at 5 years in patients with impaired fasting plasma glucose at baseline, and identify those factors associated with changes in FLI, that could contribute to the reversion of prediabetes. Methods This 5-year cohort study included 16,648 Spanish working adults with prediabetes. Prediabetes was defined as fasting plasma glucose (FPG) between 100 and 125 mg/dl according to the ADA criteria, while prediabetes reversion was defined as a FPG <100 mg/dL. The population was classified as: FLI <30 (no hepatic steatosis), FLI 30–59 (intermediate status), and FLI ≥60 (hepatic steatosis). Results At 5 years follow-up, 33.7% of subjects reverted to normoglycemia (annual rate of 6.7%). The adjusted binomial logistic regression model showed that scoring FLI <30 (OR 1.544; 95% CI 1.355–1.759), performing at least 150 min/week of physical activity (OR 4.600; 95% CI 4.088–5.177) and consuming fruits and vegetables daily (OR 1.682; 95% CI 1.526–1.855) were associated with the probability of reverting form prediabetes to normoglycemia. The ROC curve for prediction of reversion showed that FLI (AUC 0.774;95% CI 0.767–0.781) was a better predictor than FPG (AUC 0.656; 95% CI 0.648–0.664). Conclusions Regular physical activity, healthy dietary habits and absence of hepatic steatosis are independently associated with the probability of reversion to normoglycemia in adult workers with prediabetes at baseline. Low FLI values (especially FLI< 30) may be useful to predict the probability of prediabetes reversion, especially in active subjects with healthy eating habits, and thus identify those who might benefit from early lifestyle intervention.

To evaluate the effectiveness of a nurse-led personalized telephone lifestyle intervention versus automated SMSs in the reduction of fasting plasma glucose in adults with prediabetes. Design:The PREDIPHONE is a randomized controlled, parallel, two arms, superiority trial with 15 months of follow-up. Participants will be randomized to either the intervention group (teleconsultations) or the active control group (SMSs).Methods: A total of 428 participants will be randomized in a 1:1 ratio to one of the two arms and followed up during 9 months. The teleconsultations group will receive nurse-led personalized advice, while the SMSs group will receive 4-5 brief SMSs a week. Participants in both groups will receive evidence-based recommendations for diet and physical activity (PA). Outcome measures will be collected at baseline, months 4 and 9 and at month 15, to evaluate post-intervention effects. Discussion: Prevention of diabetes through the implementation of lifestyle interventions remains an important priority. The current pandemic situation has magnified its urgency as it heavily affected the functionality of the healthcare system. Moreover, it created the need of remotely delivering preventative interventions. This study will provide insights on the effectiveness and feasibility of a telephone-based intervention led by nurses in the amelioration of risk factors associated with diabetes.| 3205 ABBATE ET Al.