A primary care register for impaired glucose handling (IGH): impact on cardiometabolic profile.

Objective: Diet and exercise reduce the incidence of diabetes in high-risk individuals as does metformin, although less dramatically. Here we evaluated if lifestyle and pharmacological intervention, for people at risk of diabetes, resulted in an improvement in their cardiometabolic risk profile.

Research Design/methods: In a primary care based study, 92 individuals screened opportunistically and identified to have impaired glucose handling were offered detailed lifestyle advice, at 6 monthly intervals, with targeting of cardiovascular risk factors. Duration of follow-up was 4 years. The relation between fasting and 2h glucose with different cardio-metabolic risk factors over time was assessed using multi-level modeling.

Results: There was no significant weight reduction. At 24 months, mean fasting glucose level (6.4 mmol/L (95% CI 6.0-6.8)) was slightly lower than at baseline (6.6 mM (95% CI: 6.4-6.9), F=3.67; p<0.001). For men and women combined, systolic blood pressure (mean difference=-6 mmHg, p=0.013), total cholesterol (-0.66 mmol/L, p<0.0001) and triglycerides (-0.13 mmol/L, p=0.133) fell, whilst HDL-cholesterol (0.12 mmol/L, p=0.047) rose. Diabetes developed in 18/92 participants during follow-up (up to 4 years). Five per cent of participants were started on metformin, 88.5% on lipid lowering agents and 85.4% on anti-hypertensive agents. After adjusting for age, sex and BMI, 2 h glucose was independently and negatively associated with HDL-cholesterol (β=-2.17, p=0.041), and positively with systolic BP (β=0.24, p=0.004, per 5 mmHg).

Conclusions: Targeted intervention had an effective role in improving lipid and BP profile in individuals with impaired glucose handling, with limited impact on glycaemia and no impact on weight. More work needs be done to evaluate the potential benefit of insulin sensitizing agents in this setting.