Differential association of family history of diabetes and subtypes of prediabetes Open Access

Abstract

Objective: Subtypes of prediabetes, isolated impaired glucose tolerance [iIGT] and isolated impaired fasting glucose [iIFG], are associated with different physiologic dysfunctions. The aim of the present analysis was to examine family history of type 2 diabetes (T2DM) as a risk factor for iIGT and iIFG among Asian Indians, a population that has innate susceptibility to reduced β-cell function.

Methods: We studied a population of 1,635 men and women from the Diabetes Community Lifestyle Improvement Program (D-CLIP) in Chennai, India. Family history was defined as a first-degree relatives including parents and siblings with T2DM. All subjects were given a 75g oral glucose tolerance test after an overnight fast. Fasting, 30-minute and 120-minute glucose and insulin were measured. Multinomial polytomous regression was used with glycemic status (normoglycemia [NGT], iIFG, iIGT, combined IFG and IGT, and T2DM) as the dependent variable according to American Diabetes Association guidelines. β-cell function was estimated using oral disposition index (DIO) and insulin resistance was estimated by homeostasis model assessment (HOMA-IR).

Results: There were 341 individuals who had NGT, 200 iIFG, 202 iIGT, 268 IFG/IGT and 252 individuals had T2DM. A positive family history was reported by 745 (59%) of the participants. The mean age was 44 years (SD 9.3), mean BMI 27.4 kg/m² (SD 3.8) with 803 (63.6%) male participants. A positive family history was not statistically associated with iIFG [odds ratio, OR, 1.28, 95% confidence interval (CI) 0.89 - 1.84] and iIGT (OR 1.18, CI 0.82 - 1.68) in an age-, sex-, BMI- adjusted model when compared to normoglycemia. When stratified across mean age (44 years), family history of diabetes was significantly associated with iIFG (OR 1.79, CI 1.02 - 3.17) but not iIGT (OR 0.98, CI 0.59 - 1.62) adjusted for sex, BMI and HOMA-IR. DIo explained a large component of the relationship of family history and iIFG in young adults but not HOMA-IR.

Conclusions: These results demonstrate that family history of T2DM is an important risk factor for Asian Indian young adults who develop the iIFG subtype of prediabetes. Future longitudinal studies are needed to explore the role of poor β-cell function in the early development of prediabetes, particularly iIFG.

Table of Contents

INTRODUCTION................................1

STATISTICAL METHODS....................4

Study participants.............................4

Study procedures..............................4

Key Measures...................................4

Covariates........................................5

Calculations.....................................6

Statistical Analysis...........................6

RESULTS..........................................8

DISCUSSION...................................10

REFERENCES..................................13

TABLES...........................................20

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	prediabetes impaired fasting glucose family history of diabetes impaired glucose tolerance
Committee Chair / Thesis Advisor	Venkat Narayan, K.M., Emory University Staimez, Lisa R, Emory University

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