Predictive models for conversion of prediabetes to diabetes.
OBJECTIVE
To clarify the natural course of prediabetes and develop predictive models for conversion to diabetes.


METHODS
A retrospective longitudinal study of 2105 adults with prediabetes was carried out with a mean observation period of 4.7years. Models were developed using multivariate logistic regression analysis and verified by 10-fold cross-validation. The relationship between [final BMI minus baseline BMI] (δBMI) and incident diabetes was analyzed post hoc by comparing the diabetes conversion rate for low (< -0.31kg/m2) and high δBMI (≥ -0.31kg/m2) subjects after matching the two groups for the covariates.


RESULTS
Diabetes developed in 252 (2.5%/year), and positive family history, male sex, higher systolic blood pressure, plasma glucose (fasting and 1h- and 2h-values during 75g OGTT), hemoglobin A1c (HbA1c) and alanine aminotransferase were significant, independent predictors for the conversion. By using a risk score (RS) that took account of all these variables, incident diabetes was predicted with an area under the ROC curve (95% CI) of 0.80 (0.70-0.87) and a specificity of prediction of 61.8% at 80% sensitivity. On division of the participants into high- (n=248), intermediate- (n=336) and low-risk (n=1521) populations, the conversion rates were 40.1%, 18.5% and 5.9%, respectively. The conversion rate was lower in subjects with low than high δBMI (9.2% vs 14.4%, p=0.003).


CONCLUSIONS
Prediabetes conversion to diabetes could be predicted with accuracy, and weight reduction during the observation was associated with lowered conversion rate.
Diabetes Center, Aizawa Hospital, Matsumoto, 390-8510, Japan.
N
N
Yokota
Diabetes Center, Aizawa Hospital, Matsumoto, 390-8510, Japan.
T
T
Miyakoshi
Diabetes Center, Aizawa Hospital, Matsumoto, 390-8510, Japan.
Y
Y
Sato
Department of Medicine, Kamiichi General Hospital, Kamiichi 930-0391, Japan.
Y
Y
Nakasone
Diabetes Center, Aizawa Hospital, Matsumoto, 390-8510, Japan.
K
K
Yamashita
Health Center, Okaya City Hospital, Okaya, 394-8512, Japan.
T
T
Imai
Health Center, Aizawa Hospital, Matsumoto, 390-8510, Japan.
K
K
Hirabayashi
Health Center, Aizawa Hospital, Matsumoto, 390-8510, Japan.
H
H
Koike
Diabetes Center, Shinonoi General Hospital, 388-8004, Japan.
K
K
Yamauchi
Diabetes Center, Aizawa Hospital, Matsumoto, 390-8510, Japan. Electronic address: taizawax@ai-hosp.or.jp.
T
T
Aizawa
D044466:Asian People; D015992:Body Mass Index; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology / Q000208:ethnology / Q000209:etiology*; D018450:Disease Progression; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D008954:Models, Biological; D050177:Overweight / Q000150:complications / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology*; D011236:Prediabetic State / Q000150:complications / Q000175:diagnosis / Q000208:ethnology / Q000503:physiopathology*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors
Body weight; Japanese; Prediabetes; Screening; Type 2 diabetes