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Variability, mean, and baseline values of metabolic parameters in predicting the risk of type 2 diabetes.

CONTEXT
Impact of baseline and alteration of metabolic parameters (MPs), including plasma glucose (PGs) testing, insulin resistance surrogates, and lipid profile and their mutual interactions on the development of type 2 diabetes (T2DM) has not been investigated systematically.


OBJECTIVE
To access the association of the past variability (V), past mean (M), and the baseline (B) values of various MPs and their mutual interaction with the risk of T2DM.


DESIGN
Longitudinal analysis from the Korean Genome and Epidemiology Study.


SETTING
Community-based.


PARTICIPANTS
3829 non-diabetic participants with completed MPs measurements during three biannually visits were followed up over the next 10 years.


OUTCOMES
Incidence of T2DM during the follow up.


RESULTS
Among predictors, PG concentrations measured during the oral glucose tolerance test were the most prominent T2DM determinants, in which the M of the average value of fasting PG, 1-h, and 2-h PGs had the strongest discriminative power (hazard ratios and 95% CI for an increment of SD: 3.00 (2.5-3.26), AUC: 0.82). The M values of MPs were superior to their B and V values in predicting T2DM, especially among post-load PGs. Various mutual interactions between indices and among MPs were found. The most consistent interactants were the M values of high-density lipoprotein cholesterol and the M and V values of fasting PG. The findings were similar in normal tolerance glucose participants and were confirmed by sensitivity analyses.


CONCLUSION
The post-load PGs, past alteration of measurements, and mutual interactions among indices of MPs are important risk factors for T2DM development.