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Regression from prediabetes to normal glucose regulation could cut risk for disease progression

Issue: July 2012

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PHILADELPHIA — Patients with prediabetes who return to normal glucose regulation experienced a lower risk for developing diabetes, according to on data presented here at the American Diabetes Association’s 72nd Annual Scientific Sessions.

“I don’t think that it’s news to anyone that we are living in a time when type 2 diabetes is an epidemic around the world,” Leigh Perreault, MD, of the University of Colorado Anschutz Medical Campus, said during a presentation. “But despite our collective efforts at education, research and caring for our patients, this epidemic shows no sign of abating because it is being driven by an even larger epidemic, an epidemic of prediabetes.”

Perreault and colleagues from the Diabetes Prevention Program Research Group conducted an ongoing observational study of patients (n=1,990) from the randomized Diabetes Prevention Program Outcomes Study (DPPOS), previously assigned to treatment groups.

The risk for diabetes during the DPPOS was 56% lower 10 years later for patients who returned to normal glucose regulation vs. patients with consistent prediabetes (HR=0.44; 95% CI, 0.37-0.55) during the intervention phase of DPP. Surprisingly, treatment strategy was unimportant for risk reduction as long as the intervention could establish normal glucose regulation, if only transiently.

There were several factors that predicted the likelihood of a patient reaching normal glucose regulation. These included previous achievement of normal glucose regulation (OR=3.18; 95% CI, 2.71-3.72), higher insulin sensitivity (OR=1.16; 95% CI, 1.08-1.25) and increased beta-cell function (OR=1.28; 95% CI, 1.18-1.39). Factors that predicted regression to normal were generally protective for the development of diabetes.

However, Perrault reported this was not the case for the prediction of diabetes, in which increased beta-cell function (HR=0.80; 95% CI, 0.71-0.89) and insulin sensitivity (HR=1.31; 95% CI, 1.03-1.68) had a protective effect.

“Although these were exciting findings, the essential question remains: Does regression to normal glucose regulation change the long-term risk for diabetes?” Perreault said.

“This analysis draws attention to the significant long-term reduction of diabetes risk if someone with prediabetes returns to normal glycemia, supporting a shift in the standard care of early and aggressive glucose-lowering treatment in patients at highest risk.”

In an accompanying editorial, Natalia Yakubovich, MD, assistant professor of medicine at McMaster University and Hamilton Health Sciences Department of Medicine and Population Health Research Institute in Canada, said the findings suggest regression of poor glucose tolerance to normoglycemia to be either spontaneous or in response to treatment.

“Factors that predict regression to normoglycemia, what makes this regression temporary or sustained, and whether regression reduces long-term outcomes are all questions that need further research,” Yakubovich wrote.

“The results of such research might substantially change the therapeutic strategy from diabetes prevention and lifelong glucose-lowering treatment to induction of regression and monitoring use for relapse.” – by Samantha Costa