Endocrinology · General Practice · 1 h ago
Prediabetes criteria and insulin measures distinguish long-term diabetes risk
A community-based Korean cohort study followed 7,186 adults for up to 20 years to compare progression to type 2 diabetes across prediabetes subtypes. Risk was highest when participants met all three glycaemic criteria, and was also elevated with low insulin secretion or sensitivity.
- Diabetes risk rose with the number of glycaemic criteria met.
- All three criteria were associated with an adjusted HR of 15.3.
- Low insulin secretion or sensitivity further distinguished risk.
- The cohort findings do not establish benefit from routine testing.
Prediabetes can be defined by impaired fasting glucose (IFG), impaired glucose tolerance (IGT) or elevated HbA1c, but these groups may differ in their risk of progression. Researchers analysed 7,186 Korean adults aged 40–69 years in the community-based Korean Genome and Epidemiology Study, with biennial oral glucose tolerance tests and HbA1c measurements over up to 20 years. They used Cox regression and multistate Markov models to assess diabetes risk and transitions between glycaemic states, including stratification by insulinogenic index (IGI) and insulin sensitivity index (ISI).
Compared with normoglycaemia, adjusted hazard ratios for diabetes were 5.84 for IFG, 4.60 for IGT and 4.68 for HbA1c-defined prediabetes. Risk rose with the number of criteria met: hazard ratios were 3.10 for one, 7.33 for two and 15.3 for all three. Participants meeting all three criteria had an estimated prediabetes duration of 1.7 years and a 5.4% probability of regression. Low IGI or ISI was associated with higher risk; dual impairment had an adjusted hazard ratio of 4.06.
The findings suggest that glycaemic and physiological measures can distinguish risk within prediabetes. However, this observational study involved Korean adults, and does not establish that adding IGI or ISI to routine assessment improves outcomes or should change clinical practice.
In practice
For adults with prediabetes, the number of abnormal glycaemic criteria and measures of insulin secretion or sensitivity were associated with different long-term risks of type 2 diabetes in this Korean cohort. The results may help identify risk variation that is not captured by a single prediabetes definition. They do not show that routinely measuring IGI or ISI, or using these measures to guide intervention, improves outcomes; applicability beyond the studied population is also uncertain.
AI-generated clinical interpretation · Not editor-reviewed
Is this summary clinically accurate?
Help fellow clinicians: your rating sends inaccurate summaries straight to our editors.
Sign in to rate this summary →Source
Diabetologia: Prediabetes subtype-based stratification reveals distinct long-term risks for type 2 diabetes ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.