Factors associated with progression to pre-diabetes: a recurrent events analysis

  • 1Department of Biostatistics and Epidemiology, Health School, Isfahan University of Medical Sciences, Isfahan, Iran.
  • 2Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
  • 3Isfahan Endocrine and Metabolism Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
  • 4Medical Education Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran. tjkoshki@gmail.com.
  • 5Road Traffic Injury research Center, Department of Statistics and Epidemiology, Faculty of Health, Tabriz University of Medical Sciences, Attar-Neyshabouri St., Tabriz, Iran. tjkoshki@gmail.com.
Eat Weight Disord


Aims: Pre-diabetes is a strong risk factor for type 2diabetes (T2D). The aim of this study was to explore factors associated with normal glucose maintenance and pre-diabetes prevention or delay.

Methods: Data of 1016 first-degree relatives of T2D patients were retrieved from the Isfahan Diabetes Prevention Study (IDPS). Association of various variables including nutrients, serum tests and physical activity with the risk of pre-diabetes was assessed using recurrent events approach.

Results: Cumulative incidence of diabetes was 8.17, 9.44, and 4.91% for total sample and individuals with and without pre-diabetes experience in the follow-up. Risk of progression to pre-diabetes was higher in women and older people (p < 0.01). Additionally, BMI and blood pressure had significant association with the risk (p < 0.01) and individuals with higher intake of fat were at higher risk (HR = 2.26; 95% CI 1.66-3.07 for high-intake and HR = 1.52; 95% CI 1.27-1.83 for medium-intake compared to low-intake group). Carbohydrates and protein intake were positively associated with the risk of pre-diabetes with HR = 8.63 per 49 g extra carbohydrates per day and HR = 1.32 per 6 g extra protein per day (p < 0.01). The association was also significant for triglyceride (TG) with 7% risk increase per 1 SD = 1.14 increase in TG level.

Conclusion: Despite frequent studies on lifestyle modification for pre-diabetes prevention, less information is available about the role of nutritional components. We observed direct effects for intake of macronutrients including fat, carbohydrates, and protein in first-degree relatives. Further research is warranted to assess these associations in general populations.

Level of evidence: Level III: Evidence obtained from a single-center cohort study.

Keywords: Pre-diabetes; Relatives; Risk factor; Type 2 diabetes.

How to Cite

Mansourian M, Yazdani A, Faghihimani E, Aminorraya A, Amini M, Jafari-Koshki T. Factors associated with progression to pre-diabetes: a recurrent events analysis. Eat Weight Disord. 2020 Feb;25(1):135-141. doi: 10.1007/s40519-018-0529-7. Epub 2018 Jun 22. PMID: 29931448.