Does normoglycemia reversion hold secret to preventing diabetes?

By Sally Robertson, B.Sc.Jun 22 2012

Individuals with prediabetes have a significantly reduced risk for progressing to full diabetes if they have a history of reverting to normal glucose regulation, show US study findings.

This reduction in risk applies irrespective of how the reversion was achieved or however transiently, say Leigh Perreault (University of Colorado, Denver) and colleagues.

"This analysis draws attention to the significant long-term reduction in diabetes risk when someone with prediabetes returns to normoglycemia, supporting a shift in the standard of care to early and aggressive glucose-lowering treatment in patients at highest risk," writes the team in The Lancet.

During a mean 5.4-year follow-up study of participants from the Diabetes Prevention Program (DPP), the investigators found that prediabetic individuals were 56% less likely to progress to diabetes if they had reverted to normal glucose regulation at least once during DPP.

"The magnitude of this risk reduction approximates that seen with intensive lifestyle intervention - the most potent intervention in DPP - but with a greater enduring effect on long-term diabetes prevention," the investigators remark.

Cox proportional hazard modeling showed that diabetes risk was reduced by 47% if the prediabetic individuals had achieved normal glucose regulation once, 61% if they had achieved it twice, and 67% if they had achieved it three times during DPP.

Furthermore, the risk reduction benefit with normoglycemia status was seen irrespective of which DPP treatment group the participants had been allocated to (lifestyle intervention, n=736; metformin, n=647; placebo, n=607).

This suggests that achievement of normal glucose regulation is more important than the method used to achieve it, says the team.

In an accompanying editorial Natalia Yakubovich and Hertzel Gerstein (McMaster University, Hamilton, Ontario, Canada) say: "Identification of regression to normoglycemia could be an important way to stratify people into those at higher and lower risk of progression to diabetes."

"Such stratification could therefore identify individuals for whom additional treatment might be needed to prevent diabetes or to slow down disease progression," they add.

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