OR17-4 Plasma glucose trajectories of up to forty-five years prior to the diagnosis of type 2 diabetes or prediabetes in the Baltimore Longitudinal Study of Aging

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: OR17-Diabetes: New Diagnostic & Treatment Modalities
Clinical
Sunday, June 16, 2013: 11:15 AM-12:45 PM
Presentation Start Time: 12:00 PM
Room 307 (Moscone Center)
David Dongqi Liu*, Jenny Pena Dias, Luigi Ferrucci, Josephine Mary Egan and Chee Wei Chia
NIA/NIH, Baltimore, MD
Background: Metabolic changes occurred many years prior to the diagnosis of type 2 diabetes or prediabetes.  A recent analysis from the Whitehall II study found that both fasting plasma glucose (FPG) and 2-hr plasma glucose (2hrG) levels from oral glucose tolerance test (OGTT) in individuals with diabetes were already significantly higher than those of healthy individuals at 13 years prior to the diagnosis of diabetes1. The time of onset of the difference in FPG and 2hrG levels between the group with diabetes and the healthy group is unknown.  We therefore sought to characterize the trajectories of FPG and 2hrG in the Baltimore Longitudinal Study of Aging (BLSA) subjects who developed prediabetes or type 2 diabetes.

Method: In this retrospective analysis, FPG and/or 2hrG from OGTT were available from 2994 Baltimore Longitudinal Study of Aging (BLSA) subjects (Male = 1775, 59.3%; average number of visits = 4.5 ± 4.3) from 1964 to 2012. Subjects were diagnosed with prediabetes or diabetes using the 2011 American Diabetes Association diagnostic criteria2.   Of the 2994 subjects, 1085 subjects developed prediabetes and 410 subjects developed type 2 diabetes during one of their follow-up visits while the glucose tolerance of 1499 subjects remained normal during their last follow-up visits. We assessed the retrospective trajectories of FPG and 2hrG for up to 45 years before the diagnosis of diabetes, prediabetes, or at the last follow-up visit for the healthy group.  ANCOVA was used to compare the differences among the 3 groups.

Results: The age of diagnosis was significantly different (P<0.001) among the three groups: 60±19, 59±16, and 66±12 yrs, for healthy, prediabetes, and diabetes group respectively.  Analysis of covariance adjusted for the age at diagnosis revealed that compared to the healthy group, the diabetes group had significantly higher FPG and 2hrG at least 32 and 27 years, respectively, prior to diagnosis (P < 0.05). The prediabetes group when compared to the healthy group has significantly higher FPG and 2hrG at least 14 and 5 years, respectively, prior to diagnosis (P < 0.05).

Conclusion: In this study of BLSA subjects, we found that the changes in FPG and 2hrG occurred at least 25 to 30 years prior to the diagnosis of diabetes, and at least 5 to 15 years prior to the diagnosis of prediabetes. Thus, much earlier screening and intervention in high-risk individuals are needed to deter the development of diabetes.

(1)Tabak AG, Jokela M, Akbaraly TN, Brunner EJ, Kivimaki M, Witte DR 2009 Trajectories of glycaemia, insulin sensitivity, and insulin secretion before diagnosis of type 2 diabetes: an analysis from the Whitehall II study. Lancet 373:2215-2221   (2)American Diabetes Association 2006 Diagnosis and Classification of diabetes mellitus. Diabetes Care 29 Suppl 1:S43-48

Nothing to Disclose: DDL, JPD, LF, JME, CWC

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

Sources of Research Support: Acknowledgement: This research was supported entirely by the Intramural Research Program of the NIH, NIA.