Progression to diabetes and regression to normoglycemia in pre-diabetic subjects: results from a pragmatic community trial in a middle-income country

The incidence of prediabetes has been on the rise, indicating a growing public health concern, as individuals with prediabetes are at higher risk of developing type 2 diabetes. This study aimed to determine the effects of simple interventions on the regression of pre-diabetes status into normoglycemia and also prevent progression to diabetes in a pragmatic community trial.

A total of 2073 (761 intervention; 1,312 controls) participants with pre-diabetes were included in the present secondary data analysis; cases with diabetes or normoglycemia were identified during nine years of follow-up. We utilized multinomial logistic regression to calculate relative risk reductions (RRR, 95% CIs) for educational interventions targeting lifestyle changes in both men and women. Additionally, we employed a linear regression model that considered the ordinal outcomes ranging from normal to prediabetes and diabetes.

In men, after adjusting for confounders, the intervention group had a 53% (95% CI = 1.11–2.10) more significant chance of returning to normoglycemia than the control group after three years of follow-up. In addition, men in the intervention group also had an increased risk of developing type 2 diabetes than men in the control group (RRR = 1.53, 95% CI = 1.02–2.31) after three years of follow-up. These findings among men remained consistent even after a six-year follow-up period. In women, after adjusting for age, the chance of returning to normoglycemia after three years in the intervention group was 1.30 times higher than in women in the control group (95% CI = 1.00-1.69), which disappeared after adjusting for other covariates or after six years of follow-up. The results of the regression analysis showed that the intervention had no effect on changing the status of the outcome from normal to prediabetes and diabetes.

We could not demonstrate any effect of a simple intervention in improving prediabetes. This high-risk population may require more gender-specific intensive interventions and attention.