FEATURES OF THE METABOLIC SYNDROME PREDICT NEW-ONSET DIABETES AND
CONVERSION OF PREDIABETES TO DIABETES: EVIDENCE FROM A PROSPECTIVE,
COMMUNITY-BASED COHORT FOLLOW-UP STUDY
Abstract
Background There is limited data on the prevalence and outcome of
prediabetes (PDM) and the incidence of type 2 diabetes mellitus (T2DM)
in South Asia. We investigated these in a prospective, community-based
study involving a cohort of urban adults in Sri Lanka, with a seven-year
follow-up. Methods Participants were selected by age-stratified random
sampling, and were initially screened in 2007 and reevaluated in 2014.
To assess the participants, structured interviews, anthropometric
measurements, liver ultrasound, biochemical, and serological tests were
performed on both occasions. Results 2985 individuals were recruited in
2007 [54.8% women, median age (IQR) 53 (47-59)]; 737 had T2DM
[baseline prevalence 24.7% (95% CI: 23.1–26.2)] and 525 had PDM
[baseline prevalence 17.9% (95% CI: 16.2-19.6)]. 2148 (71.6%)
attended follow-up in 2014 [57.5% women; median (IQR) 60 (54–66)
years], which included 1650 who did not have T2DM in 2007. By 2014,
436/1650 (27.6%) had developed new T2DM [annual incidence 3.9% (95%
CI:3.0-4.9)]. On logistic regression, PDM, central obesity,
dyslipidemia, and nonalcoholic fatty liver disease (NAFLD) at baseline
showed significant association with new-onset T2DM. Of 525 with PDM in
2007, 365 (69.5%) presented for follow-up in 2014; 147/365 (40.3%)
remained in PDM, 201/365 (55.1%) had progressed to T2DM and 17/365
(4.6%) had reverted to normoglycemia. Annual conversion rate of PDM to
T2DM was 7.9%. Increase in waist circumference and low HDL from
baseline predicted progression to T2DM. Conclusions Presence of features
of the metabolic syndrome at baseline predicted new-onset T2DM and
conversion of PDM to T2DM. Targeted lifestyle interventions are
essential for individuals with metabolic risk to prevent future T2DM.