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Increased physical activity may reverse impaired glucose tolerance in certain women
Increasing metabolic-equivalent hours of total physical activity per week may lead to a reversion to normoglycemia in women older than 50 years with isolated impaired fasting glucose or isolated impaired glucose tolerance, study data show.
Kristine Færch, MSc, PhD, of the Steno Diabetes Center Copenhagen, and colleagues evaluated data from the Whitehall II study on 957 adults with prediabetes defined by isolated IFG (n = 536), isolated IGT (n = 305) or both (n = 116) and 457 with prediabetes defined by HbA1c.
Participants defined as having prediabetes by HbA1c were divided into two groups based on HbA1c levels: 5.7% to 5.9% (n = 369) and 6% to 6.4% (n = 88).
Changes in fasting plasma glucose, 2-hour plasma glucose and HbA1c were not associated with changes in light-intensity physical activity, moderate to vigorous physical activity or total amount of physical activity. FPG levels of 5.6 to 6.9 mmol/L and 2-hour plasma glucose levels of less than 7.8 mmol/L defined isolated impaired fasting glucose; isolated impaired glucose tolerance was defined as FPG less than 5.6 mmol/L and 2-hour plasma glucose 7.8 to 11 mmol/L; participants with isolated IFG and isolated IGT combined had FPG at least 5.6 mmol/L and 2-hour plasma glucose at least 7.8 mmol/L.
Insulin sensitivity increased and homeostasis model of assessment beta reduced with a 5-year increase of 10 metabolic-equivalent hours per week of moderate to vigorous physical activity.
Five year changes in light-intensity physical activity, moderate to vigorous intensity physical activity and total amount of physical activity were not associated with HbA1c reductions in participants defined as having prediabetes by HbA1c.
Among participants defined as having prediabetes by glucose criteria, 42% of participants reverted to normal glucose tolerance during the follow-up period. Age was the most significant predictor of reversion to normal glucose tolerance. The 5-year probability of reversion to normal glucose tolerance was higher among women (26.9%) compared with men (21.5%) in participants younger than 50 years. In men older than 50 years, the 5-year probability of reversion to normal glucose tolerance was higher in those with isolated IFG (33.3%) than those with isolated IGT or combined IFG and IGT (25%). The amount of total physical activity was associated with the probability of reversion to normal glucose tolerance in women older than 50 years with isolated IFG or isolated IGT (P = .032). The mean 5-year probability of reversion to normal glucose tolerance was 34.3% among women older than 50 years with a weekly total physical activity level of 56 or fewer metabolic-equivalent hours, and the probability of reversion was 55.6% in those with weekly total physical activity levels of more than 56 metabolic-equivalent hours.
Among participants defined as having prediabetes by HbA1c, 4.4% of participants reverted to normoglycemia, and the 5-year reversion probabilities were 4.7% among those with HbA1c of 5.7% to 5.9% and 2.2% in those with Hba1c of 6% to 6.4%.
“These findings highlight that heterogeneity in prediabetes exists and that one-size fits all strategies for diabetes prevention may not be feasible,” the researchers wrote. “Our results also question whether results from large randomized diabetes prevention trials in individuals with IGT can be applied to individuals identified with prediabetes by HbA1c. Indeed, more evidence is needed regarding early prevention of type 2 diabetes in individuals identified with prediabetes by the HbA1c method.” – by Amber Cox
Disclosures: Færch reports financial receiving funding from the Novo Nordisk Foundation. Please see the full study for a list of all other authors’ relevant financial disclosures.