Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Oct 15, 2023; 14(10): 1551-1561
Published online Oct 15, 2023. doi: 10.4239/wjd.v14.i10.1551
Analysis of influencing factors and interaction of body weight and disease outcome in patients with prediabetes
Yan-Yan Li, Lin-Ping Tong, Xian-Dan Wu, Dan Lin, Yue Lin, Xiao-Yang Lin
Yan-Yan Li, Lin-Ping Tong, Xian-Dan Wu, Yue Lin, Department of General Practice, The First People’s Hospital of Wenling City, Wenling 317500, Zhejiang Province, China
Dan Lin, Department of Oncology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
Xiao-Yang Lin, Department of General Medicine, The First People’s Hospital of Wenling City, Wenling 317500, Zhejiang Province, China
Author contributions: Li YY designed and performed the research and wrote the paper; Lin XY designed the research and supervised the report; Tong LP, Wu XD, Lin D, and Lin Y provided clinical advice.
Supported by Wenling Science and Technology Plan Project, No. 2019S0180066.
Institutional review board statement: The study was reviewed and approved by The First People’s Hospital of Wenling City (Approval No. KY-2019-1024-01).
Informed consent statement: All patients signed informed consent forms.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The statistical data in this study can be obtained from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Yang Lin, MM, Associate Chief Physician, Department of General Medicine, The First People’s Hospital of Wenling City, No. 333 Chuanan Road, Chengxi Street, Wenling 317500, Zhejiang Province, China. xiaoyanglin001@163.com
Received: August 1, 2023
Peer-review started: August 1, 2023
First decision: August 16, 2023
Revised: August 22, 2023
Accepted: September 6, 2023
Article in press: September 6, 2023
Published online: October 15, 2023
Processing time: 69 Days and 10.5 Hours
Abstract
BACKGROUND

The trend of prediabetes progressing to type 2 diabetes mellitus (T2DM) is prominent, and effective intervention can lead to a return to prediabetes. Exploring the factors influencing the outcome of prediabetes is helpful to guide clinical intervention. The weight change in patients with prediabetes has not attracted much attention.

AIM

To explore the interaction between body weight and the factors affecting the progression of prediabetes to T2DM.

METHODS

We performed a retrospective analysis of 236 patients with prediabetes and 50 with normal glucose tolerance (NGT), and collected clinical data and follow-up results of all patients. Based on natural blood glucose outcomes, we classified 66 patients with progression to T2DM into the disease progression (DP) group, and 170 patients without progression to T2DM into the disease outcome (DO) group. We analyzed the factors that influenced prediabetes outcome and the influence of body weight on prediabetes blood glucose outcome by unconditional logistic regression. A general linear model (univariate) was used to analyze the inter-action between body weight and independent influencing factors.

RESULTS

There were 98 cases of impaired fasting glucose (IFG), 90 cases of impaired glucose tolerance (IGT), and 48 cases of coexistent IFG and IGT. The body weight, waist circumference, body mass index, fasting blood glucose, and 2 h plasma glucose of patients with IFG, IGT, and coexistent IFG and IGT were higher than those in patients with NGT (P < 0.05). Logistic regression analysis showed that body weight, glycosylated hemoglobin, uric acid, fasting insulin, and homeostatic model assessment for insulin resistance were independent factors affecting progression of prediabetes to T2DM (P < 0.05). Receiver operating characteristic curve analysis showed that the area under the curve predicted by the above indicators combined was 0.905 [95% confidence interval (CI): 0.863-0.948], which was greater than that predicted by each indicator alone. Logistic regression analysis with baseline body weight as an independent variable showed that compared with body weight 1, the odds ratio (95%CI) of body weight 3 was 1.399 (1.142-2.126) (P = 0.033). There was a multiplicative interaction between body weight and uric acid (β = 1.953, P = 0.005).

CONCLUSION

High body weight in patients with prediabetes is an independent risk factor for progression to T2DM, and the risk of progression is increased when coexisting with high uric acid level.

Keywords: Prediabetes; Type 2 diabetes mellitus; Body weight; Disease outcome; Influencing factors; Interactions; Low-carbohydrate diet

Core Tip: Progression of prediabetes to type 2 diabetes mellitus (T2DM) is severe, but effective interventions can delay or even reverse progression. High body weight is a common phenomenon in people with prediabetes. Unilateral weight-loss intervention may not be sufficient. We analyzed the interaction between body weight and the factors affecting prediabetes progression to T2DM and explored the influence of body weight and other factors, to better guide clinical intervention and reduce progression of prediabetes to T2DM.