Lifestyle and Progression to Type 2 Diabetes in a Cohort of Workers with Prediabetes

Abstract

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.

Fatty liver index and progression to type 2 diabetes: a 5-year longitudinal study in Spanish workers with pre-diabetes

“…The study methods have been described in detail previously. 32 Briefly, participants were carefully chosen from 234 995 potentially eligible individuals who underwent periodic occupational health assessments between 2012 and 2013. Participants were included if they were aged 20–65 years and had an fasting plasma glucose (FPG) of 100–125 mg/dL.…”

Utility of Fatty Liver Index to predict reversion to normoglycemia in people with prediabetes

“…The present cohort study included 16,648 male and female Spanish adults, aged between 20 and 65 years, presenting prediabetes at baseline, and who worked in the service sector. The study methods have been described in detail previously [ 24 ]. Briefly, participants were carefully selected from a population of 234,995 potentially suitable individuals who underwent periodic occupational health assessments between 2012 and 2013.…”

Nurse‐led telephone intervention for lifestyle changes on glycaemic control in people with prediabetes: Study protocol for a randomized controlled trial

“…In the natural history of the disease, T2D is preceded by a phase of prediabetes (Khetan & Rajagopalan, 2018), which, according to the American Diabetes Association (ADA), is defined as impaired FPG of 100-125 mg/dL, and/or impaired glucose tolerance of 140-199 mg/dL 2 h after a 75-g oral glucose tolerance test, and/or glycosylated haemoglobin (HbA1c) levels of 5.7-6.4% (ADA, 2021). The International Diabetes Federation (IDF) estimated that 7.5% of the worldwide population aged 20-79 years have prediabetes (Saeedi et al, 2019); although prediabetes does not necessarily develop into incident T2D, an ADA expert panel estimated that 70% of the prediabetic population will eventually develop T2D (Nathan et al, 2007), with a mean annual incidence rate of 5-10% (Bennasar-Veny et al, 2020;Forouhi et al, 2007).…”