Determinants of incident prediabetes and type 2 diabetes in a 7-year cohort in a developing country: The Isfahan Cohort Study

• Published in: Journal of diabetes 2015-09, Vol.7 (5), p.633-641
• Main Authors: Sadeghi, Masoumeh, Talaei, Mohammad, Parvaresh Rizi, Ehsan, Dianatkhah, Minoo, Oveisgharan, Shahram, Sarrafzadegan, Nizal
• Format: Article
• Language: English
• Subjects: Adult; Age Factors; Aged; Aged, 80 and over; Developing Countries; Diabetes Mellitus, Type 2 - epidemiology; Diabetes Mellitus, Type 2 - etiology; Diet; Female; Humans; Hypertension - complications; Incidence; Iran - epidemiology; Male; Middle Aged; obesity; Obesity - complications; prediabetes; Prediabetic State - epidemiology; Prediabetic State - etiology; risk factor; Risk Factors; type 2 diabetes; Waist Circumference; Waist-Hip Ratio; 关键词：肥胖，糖尿病前期，危险因素，2型糖尿病
• ISSN: 1753-0393; 1753-0407
• DOI: 10.1111/1753-0407.12236

Background This study aimed to identify determinants of new onset type‐2 diabetes (T2D) and prediabetes in a region with high rate of T2D but scarcity of evidence. Methods Participants free of T2D were identified in a population‐based study of adults older than 35 years living in the rural and urban areas of three districts in Iran in 2001 and were re‐examined after 7 years. Biochemical measurements, anthropometric data, blood pressure, smoking status and dietary intake were determined at both measurement points through identical protocols and procedures. Data analysis was done using multivariate ordered logistic regressions. Results Incidence rate of prediabetes and T2D was 32.3 (95%CI, 29.7–35.1) and 18.9 (17.1–20.9) per 1000 person‐year, respectively. Odds of progression to prediabetes and T2D were increased with ageing, living in rural area (OR = 1.28), unhealthy diet (OR = 1.32), overweight (OR = 1.45), obesity (OR = 1.97), waist gain (OR = 1.37), high waist‐to‐hip ratio (OR = 1.35), hypertension (OR = 1.35), and hypertriglyceridemia (OR = 1.50); but reduced with higher education (OR = 0.76) and weight loss (OR = 0.67) in the adjusted models. In those with prediabetes at baseline, parental history of T2D (OR = 2.26), obesity (OR = 2.59), high waist circumference (OR = 2.03), and hypertriglyceridemia (OR = 1.94) were associated with developing T2D. No factor was found to be associated with regression from prediabetes to normoglycemia in adjusted models. Conclusions Current data endorses proposed statistical projections for the future trend of diabetes, and highlights the potential role of obesity specifically visceral type. 摘要 背景： 这项研究的目的是在一个2型糖尿病（T2D）高发但是缺乏证据的地区鉴别新发T2D与糖尿病前期的影响因素。 方法： 这是一项基于人群的研究，参与者平时生活在伊朗三个区域的农村与城市，2001年开始研究时他们的年龄大于35岁并且没有T2D，7年之后再次对他们进行了检查。在两次测量时都通过相同的试验与步骤分别测定了生化指标、人体测量学指标、血压，并且记录了吸烟状态与饮食摄入情况。使用多元有序logistic回归法来分析数据。 结果： 糖尿病前期与T2D的每1000人‐年发病率分别为32.3（95%CI，29.7–35.1）与18.9（17.1–20.9）。在经校正的模型中，发生糖尿病前期与T2D的可能性的增加与以下因素相关：年龄增加、生活在农村地区（OR = 1.28)、不健康饮食（OR = 1.32）、超重（OR = 1.45）、肥胖（OR = 1.97）、腰围增加（OR = 1.37）、高腰‐臀比（OR = 1.35）、高血压（OR = 1.35）以及高甘油三酯血症（OR = 1.50）；而受过高等教育（OR = 0.76）以及体重减少（OR = 0.67）与发病率下降有关。在基线时就处在糖尿病前期的人群中，父母亲的T2D病史（OR = 2.26）、肥胖（OR = 2.59）、高腰围（OR = 2.03）以及高甘油三酯血症（OR = 1.94）都与T2D的发生有关。在校正过的模型中没有发现有因素与糖尿病前期人群恢复正常血糖有关。 结论： 当前的数据支持既往提出的对糖尿病未来趋势的预测统计结果，并且突出了肥胖（特别是内脏型）的潜在影响。