title: Changes in Weight and Glucose Can Protect Against Progression in Early Diabetes Independent of Improvements in β-Cell Function.
abstract: Evidence-based strategies to prevent progression of dysglycemia in newly diagnosed type 2 diabetes are needed.
  
  
  
  To undertake a secondary analysis of the Early Diabetes Intervention Program (EDIP) in order to understand the features that were protective against worsening glycemia.
  
  
  
  EDIP was a randomized, placebo-controlled trial.
  
  
  
  Two university diabetes centers.
  
  
  
  A total of 219 overweight individuals with fasting glucose < 7.8 mmol/L and 2-hour oral glucose tolerance test (OGTT) glucose > 11.1 mmol/L.
  
  
  
  Acarbose versus placebo, on a background of dietary recommendations, with quarterly visits to assess glycemia and intervention adherence for up to 5 years.
  
  
  
  Progression of fasting glucose ≥ 7.8 mmol/L on two consecutive quarterly visits. Cox proportional hazards modeling and ANOVA were performed to evaluate determinants of progression.
  
  
  
  Progression-free status was associated with reductions in weight, fasting glucose, 2-hour OGTT glucose, and increases in the high-density lipoprotein/triglyceride ratio. The reduction in fasting glucose was the only effect that remained significantly associated with progression-free status in multivariable Cox modeling. The reduction in fasting glucose was in turn primarily associated with reductions in weight and in 2-hour OGTT glucose. Acarbose treatment did not explain these changes.
  
  
  
  In early diabetes, reductions in glucose, driven by reductions in weight, can delay progressive metabolic worsening. These observations underscore the importance of lifestyle management including weight loss as a tool to mitigate worsening of glycemia in newly diagnosed diabetes.
authors.affiliation: Indiana University School of Medicine (Y.R.P., M.S.K., R.V.C., T.S.H., K.J.M.), Indianapolis, Indiana 46202; Harvard University (Y.R.P.), Cambridge, Massachusetts 02138; and University of North Carolina (M.S.K.), Chapel Hill, North Carolina 27599.
authors.forename: Y R
authors.initials: YR
authors.lastname: Patel
authors.affiliation: Indiana University School of Medicine (Y.R.P., M.S.K., R.V.C., T.S.H., K.J.M.), Indianapolis, Indiana 46202; Harvard University (Y.R.P.), Cambridge, Massachusetts 02138; and University of North Carolina (M.S.K.), Chapel Hill, North Carolina 27599.
authors.forename: M S
authors.initials: MS
authors.lastname: Kirkman
authors.affiliation: Indiana University School of Medicine (Y.R.P., M.S.K., R.V.C., T.S.H., K.J.M.), Indianapolis, Indiana 46202; Harvard University (Y.R.P.), Cambridge, Massachusetts 02138; and University of North Carolina (M.S.K.), Chapel Hill, North Carolina 27599.
authors.forename: R V
authors.initials: RV
authors.lastname: Considine
authors.affiliation: Indiana University School of Medicine (Y.R.P., M.S.K., R.V.C., T.S.H., K.J.M.), Indianapolis, Indiana 46202; Harvard University (Y.R.P.), Cambridge, Massachusetts 02138; and University of North Carolina (M.S.K.), Chapel Hill, North Carolina 27599.
authors.forename: T S
authors.initials: TS
authors.lastname: Hannon
authors.affiliation: Indiana University School of Medicine (Y.R.P., M.S.K., R.V.C., T.S.H., K.J.M.), Indianapolis, Indiana 46202; Harvard University (Y.R.P.), Cambridge, Massachusetts 02138; and University of North Carolina (M.S.K.), Chapel Hill, North Carolina 27599.
authors.forename: K J
authors.initials: KJ
authors.lastname: Mather
mesh_terms: D020909:Acarbose / Q000008:administration & dosage / Q000494:pharmacology*; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000628:therapy*; D050528:Diet, Carbohydrate-Restricted / Q000379:methods*; D004038:Diet, Reducing / Q000379:methods*; D018450:Disease Progression; D005260:Female; D065089:Glycoside Hydrolase Inhibitors / Q000008:administration & dosage / Q000494:pharmacology*; D006801:Humans; D050417:Insulin-Secreting Cells / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D050177:Overweight / Q000097:blood* / Q000628:therapy*; D015431:Weight Loss
chemical_list: D001786:Blood Glucose; D065089:Glycoside Hydrolase Inhibitors; D020909:Acarbose