<b>Predictors of glycemic worsening in the next year in adults with screen-detected type 2 diabetes</b>

<jats:p>&lt;p dir="ltr"&gt;Introduction: Predicting which individuals with mild dysglycemia will progress to frank type 2 diabetes is challenging. Identifying simple markers for impending worsening glucose can allow clinicians to target therapeutic interventions for those at highest risk. We aimed to determine which routine clinical measures herald near-term glycemic worsening in early type 2 diabetes(T2D). Research design and methods: The Early Diabetes Intervention Program (EDIP) was a clinical trial in individuals with asymptomatic, screen-detected T2D [HbA1C 6.3+0.63%(45+5mmol/mol)]. We investigated the time course of FBG, HbA1c, weight, and other clinical factors to determine predictors of glycemic worsening over the next year. Results: Of 219 participants, 62 (28.5%) progressed. Progressors had higher FBG than non-progressors at baseline [130 vs 118mg/dL (7.2 vs 6.6 mmol/L), p=&lt;0.001]. FBG remained stable until the year of progression, when progressors exhibited a large 1-year rise [mean change 14.2mg/dL(0.79 mmol/L)]. Current FBG and antecedent year change in FBG were associated with progression(p&lt;0.01), although the magnitude of change was not clinically useful (0.19 mg/dL; 0.01 mmol/L). Neither current or antecedent year change in HbA1c, weight, TG or HDL were associated with progression. In the year of glycemic worsening, rising glucose was strongly associated with a concurrent increase in weight (p&lt;0.001). Conclusions: Elevated FBG but not HbA1c identified individuals at risk for imminent glycemic worsening; the subsequent large rise in glucose was associated with a short-term increase in weight. Weight maintenance—even without weight loss—is associated with favorable glycemic patterns and may provide an actionable goal for managing early diabetes. &lt;/p&gt;&lt;p dir="ltr"&gt;Article Highlights · Why did we undertake this study? Timely interventions to prevent near-term glycemic worsening is crucial for those with early diabetes, yet we lack predictors of an individual’s imminent decline. Readily-available clinical measures could identify individuals at imminent risk of glycemic worsening, enabling more targeted and timely intervention. · What specific question(s) did we want to answer? Which routine clinical measures (FBG, HbA1c, weight, and lipids) predict imminent glycemic worsening in individuals with early diabetes? · What did we find? Elevated FBG, but not HbA1c, identified individuals at near-term risk. Glycemic worsening was strongly associated with concurrent weight gain. · What are the implications? FBG and HbA1c monitoring improves risk stratification. For those unable to lose weight, avoiding weight gain may be a more attainable, clinically-meaningful goal associated with lower risk of glycemic progression.&lt;/p&gt;</jats:p>