title: Early improvement predicts reduced risk of incident diabetes and improved cardiovascular risk in prediabetic Asian Indian men participating in a 2-year lifestyle intervention program.
abstract: OBJECTIVE
  Objectives of this ancillary analysis of a prospective, prevention study among Asian Indians with impaired glucose tolerance (IGT) were a) to quantify the reduction in incident diabetes at 24 months in participants who achieved normal glucose tolerance (NGT) at 6 months (NGT-6 m) compared with the other participants, b) the factors influencing the reversal to NGT at the end of the study at 24 months (NGT-24 m), and c) to assess changes in cardiometabolic risk factors in different categories of dysglycemia at 24 months.
  
  
  METHODS
  Data from a 2-year primary prevention trial were used. Effect of reversion to NGT-6 m on incidence of type 2 diabetes mellitus (T2DM) was analyzed using the Cox proportional hazards model. Predictive variables for reversal to NGT were identified using multiple logistic regression analysis. Changes in cardiometabolic risk factors were estimated according to the final glycemic status using fixed-effect, mixed-linear regression modeling.
  
  
  RESULTS
  The risk of T2DM in 2 years was lower by 75% in NGT-6 m group (hazard ratio 0.25 [95% CI 0.12-0.52]). Predictive variables for reversal to NGT-24 m were good baseline β-cell function (odds ratio [OR] 2.79 [95% CI 2.30-3.40]) and its further improvement (OR 5.70 [95% CI 4.58-7.08]), and NGT-6 m (OR 2.10 [95% CI 1.14-3.83]). BMI decreased in those who reverted to NGT. Deterioration to T2DM was associated with an increase in the levels of cardiometabolic risk factors.
  
  
  CONCLUSIONS
  Early reversion to NGT by lifestyle intervention in prediabetic men was associated with a significant reduction in subsequent incidence of diabetes. Good baseline β-cell function and its further improvement and NGT-6 m were associated with reversion to NGT-24 months. Reversion to NGT was associated with modest improvements, whereas conversion to T2DM was associated with significant worsening of the cardiometabolic risk profile.
authors.affiliation: India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India.
authors.forename: Arun
authors.initials: A
authors.lastname: Nanditha
authors.affiliation: India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India.
authors.forename: Jagannathan
authors.initials: J
authors.lastname: Ram
authors.affiliation: India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India.
authors.forename: Chamukuttan
authors.initials: C
authors.lastname: Snehalatha
authors.affiliation: India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India.
authors.forename: Sundaram
authors.initials: S
authors.lastname: Selvam
authors.affiliation: India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India.
authors.forename: Susairaj
authors.initials: S
authors.lastname: Priscilla
authors.affiliation: India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India.
authors.forename: Ananth Samith
authors.initials: AS
authors.lastname: Shetty
authors.affiliation: India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India.
authors.forename: Raghavan
authors.initials: R
authors.lastname: Arun
authors.affiliation: Faculties of Medicine and Engineering, Imperial College, London, U.K.
authors.forename: Ian F
authors.initials: IF
authors.lastname: Godsland
authors.affiliation: Faculties of Medicine and Engineering, Imperial College, London, U.K.
authors.forename: Desmond G
authors.initials: DG
authors.lastname: Johnston
authors.affiliation: India Diabetes Research Foundation and Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India ramachandran@vsnl.com.
authors.forename: Ambady
authors.initials: A
authors.lastname: Ramachandran
mesh_terms: D000328:Adult; D044466:Asian People; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D018149:Glucose Intolerance / Q000453:epidemiology; D005951:Glucose Tolerance Test; D006801:Humans; D050417:Insulin-Secreting Cells / Q000378:metabolism; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011236:Prediabetic State / Q000503:physiopathology / Q000628:therapy*; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D040242:Risk Reduction Behavior