Metabolic Predictors of Progression to Diabetes Among Individuals With Impaired Glucose Regulation

Abstract

Individuals with impaired glucose regulation have an increased risk of developing type 2 diabetes, although progression rates vary substantially between individuals. This study evaluated metabolic predictors associated with progression from impaired glucose regulation to type 2 diabetes during a 24-month follow-up period. A prospective observational study included 184 adults aged 35–70 years with impaired fasting glucose and/or impaired glucose tolerance. Baseline measurements included fasting glucose, 2-hour glucose, HbA1c, fasting insulin, HOMA-IR, triglycerides, HDL cholesterol, waist circumference, and blood pressure. Participants underwent metabolic reassessment at 12 and 24 months. During follow-up, 42 participants progressed to type 2 diabetes. Individuals who progressed had higher baseline fasting and 2-hour glucose, HbA1c, HOMA-IR, triglycerides, and waist circumference and lower HDL cholesterol than those who remained free of diabetes. In multivariable analysis, baseline 2-hour glucose, HOMA-IR, HbA1c, and waist circumference were independently associated with progression. The combination of elevated post-load glucose and insulin resistance demonstrated the strongest association with subsequent diabetes development. These findings suggest that multiple metabolic characteristics may help identify individuals with impaired glucose regulation who are at particularly high risk of progression.