Pre‐diabetes tsunami: incidence rates and risk factors of pre‐diabetes and its different phenotypes over 9 years of follow‐up

• Published in: Diabetic medicine 2017-01, Vol.34 (1), p.69-78
• Main Authors: Hadaegh, F., Derakhshan, A., Zafari, N., Khalili, D., Mirbolouk, M., Saadat, N., Azizi, F.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Cohort Studies; Diabetes; Educational Status; Fasting; Female; Follow-Up Studies; Glucose; Health Promotion; Health risk assessment; Health Transition; Humans; Incidence; Iran - epidemiology; Male; Marital Status - ethnology; Middle Aged; Population; Prediabetic State - epidemiology; Prediabetic State - ethnology; Prediabetic State - physiopathology; Prediabetic State - prevention & control; Proportional Hazards Models; Prospective Studies; Risk Factors; Sex Factors; Smoking - adverse effects; Smoking - ethnology; Tsunamis; Waist-Height Ratio; Women; Young Adult
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.13034

Aims To investigate the incidence of pre‐diabetes and its different phenotypes and the related risk factors during 9 years of follow‐up. Methods A total of 5879 people (2597 men and 3282 women) aged ≥ 20 years, free of diabetes and pre‐diabetes, took part in the study. Multivariable Cox proportional hazard models were used to evaluate hazard ratios (HR) and 95% confidence intervals (CI) for all potential risk factors. Results Overall, 853 men and 902 women developed pre‐diabetes. Incidence rates of pre‐diabetes were 46.1 per 1000 person‐years in men and 36.8 per 1000 person‐years in women, while isolated impaired fasting glucose had the highest incidence rate among all pre‐diabetes phenotypes. In both sexes, age, family history of diabetes, fasting plasma glucose and 2–hour post‐challenge plasma glucose were related to incident pre‐diabetes. Among women, waist‐to‐height ratio [HR: 1.02 (1.00–1.03)] and being divorced/widowed compared with married [HR: 0.67 (0.52–0.87)] were significant predictors of pre‐diabetes; whereas among men, community‐based intervention [HR: 0.79 (0.68–0.90)], higher level of education and being single [HR: 0.77 (0.6–0.97)] were protective against progression to pre‐diabetes. Moreover, hip circumference among women [HR: 0.95 (0.93–0.98)] and current smoking among men [HR: 1.69 (1.15–2.48)] were related to incident combined impaired fasting glucose and impaired glucose tolerance. Conclusion More than 4% of the Iranian population develop pre‐diabetes each year, emphasizing the important role of socio‐economic factors (marital status, education and smoking habits) and community‐based intervention in progression to impaired glucose regulations. Thus, emergent intervention is necessary to halt the tsunami of pre‐diabetes among the Iranian population. What's new? This is the first study to investigate the risk factors of combined impaired fasting glucose/impaired glucose tolerance, isolated impaired fasting glucose and isolated impaired glucose tolerance separately in men and women in a long‐term population‐based cohort. A high annual incidence rate of pre‐diabetes was observed, with over 4% of the population developing the disease each year, indicating a need for a stronger approach to the prevention of pre‐diabetes. The differences between the risk factors for different pre‐diabetes phenotypes require specific intervention strategies.