RESUMO
AIMS: To assess the impact of metabolic syndrome (MetS) on the incidence of type 2 diabetes in middle-aged Japanese individuals with impaired insulin secretion (IIS). METHODS: This cohort study included 1,702 individuals aged 40-59 without diabetes at baseline who underwent a comprehensive medical check-up between April 2008 and March 2009 at Saku Central Hospital. Participants were classified according to their IIS and insulin resistance (IR) status [normal, isolated IR (i-IR), or isolated IIS (i-IIS)] and MetS (presence or absence). They were followed up until March 2014. Type 2 diabetes was defined based on fasting and 2-h post-load plasma glucose concentrations and by the receipt of medical treatment for diabetes. RESULTS: During 7,572 person-years of follow-up, 92 individuals developed type 2 diabetes. The incidence rates (/1,000 person-years) for type 2 diabetes in the normal without MetS, normal with MetS, i-IR without MetS, i-IR with MetS, i-IIS without MetS, and i-IIS with MetS groups were 5.3, 3.7, 11.3, 24.7, 16.7, and 59.5, respectively. The multivariable-adjusted hazard ratios (HRs) and 95 % confidence intervals (CIs) for type 2 diabetes in the normal with MetS, i-IR with MetS, and i-IIS with MetS groups, relative to the normal without MetS group, were 0.52 (0.12-2.25), 3.78 (1.93-7.42), and 7.94 (3.96-15.91), respectively. Additionally, a positive association of MetS with type 2 diabetes was observed in the i-IIS group [HR (95 % CI) 3.56 (1.88-6.73)] but not in the normal and i-IR groups. CONCLUSIONS: The prevention of MetS is important, particularly in individuals with low insulin secretion.
RESUMO
OBJECTIVE: To investigate the risk of decreased estimated glomerular filtration rate (eGFR) and proteinuria among individuals with borderline diabetes. METHODS: This 5-year cohort study involved 2849 participants aged 30-79 years without diabetes or chronic kidney disease at baseline (April 2008-March 2009). Participants were categorized into two groups-normoglycemia and borderline diabetes-based on the results of a 75-g oral glucose tolerance test at baseline. Participants underwent annual comprehensive medical check-ups during the follow-up period until March 2014. Main outcomes were defined as proteinuria ≥[1+] or eGFR <60 ml/min/1.73 m2. Cox proportional hazards regression was used to estimate the hazard ratio (HR) and 95 % confidence interval (CI) of eGFR <60 ml/min/1.73 m2 and proteinuria ≥[1+] for the borderline diabetes group compared with the normoglycemia group. RESULTS: During the follow-up period, 335 individuals developed eGFR <60 ml/min/1.73 m2 and 136 individuals developed proteinuria ≥[1+]. Participants in the borderline diabetes group did not have a significantly higher risk of eGFR <60 ml/min/1.73 m2 or proteinuria ≥[1+] after multivariable adjustment. However, participants with borderline diabetes who were also diagnosed with borderline diabetes at the endpoint examination had a significantly higher risk of proteinuria ≥[1+] compared with participants with normoglycemia who also had normoglycemia at the endpoint examination; the HR (95 % CI) was 1.76 (1.11-2.78). CONCLUSIONS: Persistent borderline diabetes significantly increases the risk of proteinuria.
