Maria Inês Schmidt1, Paula Bracco2, Scheine Canhada2, Joanna M N Guimarães3, Sandhi Maria Barreto4,5, Dora Chor6, Rosane Griep6, John S Yudkin5, Bruce B Duncan2. 1. Postgraduate Program in Epidemiology, School of Medicine and Hospital de Clínicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil maria.schmidt@ufrgs.br. 2. Postgraduate Program in Epidemiology, School of Medicine and Hospital de Clínicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil. 3. National School of Public Health, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil. 4. School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil. 5. Division of Medicine, University College London, London, U.K. 6. Laboratory of Health and Environment Education, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
Abstract
OBJECTIVE: Glycemic regression is common in real-world settings, but the contribution of regression to the mean (RTM) has been little investigated. We aimed to estimate glycemic regression before and after adjusting for RTM in a free-living cohort of adults with newly ascertained diabetes and intermediate hyperglycemia (IH). RESEARCH DESIGN AND METHODS: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a cohort study of 15,105 adults screened between 2008 and 2010 with standardized oral glucose tolerance test and HbA1c, repeated after 3.84 ± 0.42 years. After excluding those receiving medical treatment for diabetes, we calculated partial or complete regression before and after adjusting baseline values for RTM. RESULTS: Regarding newly ascertained diabetes, partial or complete regression was seen in 49.4% (95% CI 45.2-53.7); after adjustment for RTM, in 20.2% (95% CI 12.1-28.3). Regarding IH, regression to normal levels was seen in 39.5% (95% CI 37.9-41.3) or in 23.7% (95% CI 22.6-24.3), depending on use of the World Health Organization (WHO) or the American Diabetes Association (ADA) definition, respectively; after adjustment, corresponding frequencies were 26.1% (95% CI 22.4-28.1) and 19.4% (95% CI 18.4-20.5). Adjustment for RTM reduced the number of cases detected at screening: 526 to 94 cases of diabetes, 3,118 to 1,986 cases of WHO-defined IH, and 6,182 to 5,711 cases of ADA-defined IH. Weight loss ≥2.6% was associated with greater regression from diabetes (relative risk 1.52, 95% CI 1.26-1.84) and IH (relative risk 1.30, 95% CI 1.17-1.45). CONCLUSIONS: In this quasi-real-world setting, regression from diabetes at ∼4 years was common, less so for IH. Regression was frequently explained by RTM but, in part, also related to improved weight loss and homeostasis over the follow-up.
OBJECTIVE: Glycemic regression is common in real-world settings, but the contribution of regression to the mean (RTM) has been little investigated. We aimed to estimate glycemic regression before and after adjusting for RTM in a free-living cohort of adults with newly ascertained diabetes and intermediate hyperglycemia (IH). RESEARCH DESIGN AND METHODS: The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) is a cohort study of 15,105 adults screened between 2008 and 2010 with standardized oral glucose tolerance test and HbA1c, repeated after 3.84 ± 0.42 years. After excluding those receiving medical treatment for diabetes, we calculated partial or complete regression before and after adjusting baseline values for RTM. RESULTS: Regarding newly ascertained diabetes, partial or complete regression was seen in 49.4% (95% CI 45.2-53.7); after adjustment for RTM, in 20.2% (95% CI 12.1-28.3). Regarding IH, regression to normal levels was seen in 39.5% (95% CI 37.9-41.3) or in 23.7% (95% CI 22.6-24.3), depending on use of the World Health Organization (WHO) or the American Diabetes Association (ADA) definition, respectively; after adjustment, corresponding frequencies were 26.1% (95% CI 22.4-28.1) and 19.4% (95% CI 18.4-20.5). Adjustment for RTM reduced the number of cases detected at screening: 526 to 94 cases of diabetes, 3,118 to 1,986 cases of WHO-defined IH, and 6,182 to 5,711 cases of ADA-defined IH. Weight loss ≥2.6% was associated with greater regression from diabetes (relative risk 1.52, 95% CI 1.26-1.84) and IH (relative risk 1.30, 95% CI 1.17-1.45). CONCLUSIONS: In this quasi-real-world setting, regression from diabetes at ∼4 years was common, less so for IH. Regression was frequently explained by RTM but, in part, also related to improved weight loss and homeostasis over the follow-up.
Authors: David Flood; Jacqueline A Seiglie; Matthew Dunn; Scott Tschida; Michaela Theilmann; Maja E Marcus; Garry Brian; Bolormaa Norov; Mary T Mayige; Mongal Singh Gurung; Krishna K Aryal; Demetre Labadarios; Maria Dorobantu; Bahendeka K Silver; Pascal Bovet; Jutta M Adelin Jorgensen; David Guwatudde; Corine Houehanou; Glennis Andall-Brereton; Sarah Quesnel-Crooks; Lela Sturua; Farshad Farzadfar; Sahar Saeedi Moghaddam; Rifat Atun; Sebastian Vollmer; Till W Bärnighausen; Justine I Davies; Deborah J Wexler; Pascal Geldsetzer; Peter Rohloff; Manuel Ramírez-Zea; Michele Heisler; Jennifer Manne-Goehler Journal: Lancet Healthy Longev Date: 2021-05-21