AACE ePoster Library

INCREASED SERUM FETUIN-A IS AN IMPORTANT ADVERSE PREDICTOR OF GLYCEMIC OUTCOMES IN PREDIABETES: A 4 YEAR PROSPECTIVE STUDY FROM INDIA
AACE ePoster Library. Dutta D. 05/15/15; 97742; 268
Dr. Deep Dutta
Dr. Deep Dutta
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Abstract
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Objective:
Fetuin-A worsens insulin resistance. This study evaluated its role in predicting progression to diabetes or reversal to normoglycemia in individuals with prediabetes (IPD).
Methods:
2119 individuals were screened using glucometer at health camps conducted from 2010-2014 from which 144 IPD, 50 normal individuals and 66 newly diagnosed diabetes were included after confirming diagnosis using 2 consecutive OGTT done within a week. Study participants underwent estimation of fasting insulin, fetuin-A, IL6, IL1β, TNFα, lipids, 25-hydroxyvitamin-D (25OHD), non-alcoholic fatty liver disease (NAFLD) assessment using ultrasonography and fatty liver index (FLI). All included individuals were advised therapeutic lifestyle interventions whose compliance was ensured using text messages weekly, monthly telephone calls and sessions with dietician 3 monthly. IPD were followed 3 monthly, when fasting and 2-hour post meal glucose levels were checked using glucometer and confirmed using OGTT. IPD with at least 12 months of follow-up were analyzed according to quartiles of fetuin-A and glycemic outcomes.
Results:
Fetuin-A, IL1β, IL6, TNFα, triglycerides and NAFLD increased across glycemic spectrum and were highest in diabetes. 32 IPD reverted to normoglycemia, 23 progressed to diabetes and 65 remained in prediabetes over 32.12±8.4 months. IPD progressing to diabetes had higher baseline glycemia, fetuin-A (482.77±121.74mcg/ml), IL1β (6.36±1.97pg/ml), FLI (60.02±29.77), NAFLD and lower 25OHD (45.33±22.56nmol/L). IPD in highest fetuin-A quartile [median: 549.5mcg/ml, range: 509.5-774.85mcg/ml) had highest progression to diabetes [Relative risk (RR): 2.68; 95% Confidence Interval (CI): 0.95–7.55; P=0.06] and lowest reversal to normoglycemia (RR: 0.27; 95% CI: 0.08–0.85; P=0.03). Fetuin-A levels correlated with IL1β (r=0.420; P<0.001), IL6 (r=0.231; P=0.022) and FLI (r=0.319; P<0.001). Cox regression revealed baseline fetuin-A (P=0.022), 25OHD (P=0.057) and BMI (P=0.073) to be predictive of reversal to normoglycemia. Every unit increase in fetuin-A, 25OHD and BMI were associated with 8.8% decreased, 6.5% increased and 19.7% decreased reversal to normoglycemia respectively. Age (P=0.02), triglycerides (P=0.024), IL6 (P=0.026), and IL1β (P=0.066) were predictive of progression to diabetes. Every unit increase in age, triglycerides, IL6 and IL1β were associated with 17.4% decreased, 2% increased, 15.7% increased and 17.1% increased progression to diabetes respectively.
Discussion:
Conclusion:
Increased fetuin-A in prediabetes is associated with increased progression to diabetes and decreased reversal to normoglycemia through increased insulin resistance and systemic inflammation.
Objective:
Fetuin-A worsens insulin resistance. This study evaluated its role in predicting progression to diabetes or reversal to normoglycemia in individuals with prediabetes (IPD).
Methods:
2119 individuals were screened using glucometer at health camps conducted from 2010-2014 from which 144 IPD, 50 normal individuals and 66 newly diagnosed diabetes were included after confirming diagnosis using 2 consecutive OGTT done within a week. Study participants underwent estimation of fasting insulin, fetuin-A, IL6, IL1β, TNFα, lipids, 25-hydroxyvitamin-D (25OHD), non-alcoholic fatty liver disease (NAFLD) assessment using ultrasonography and fatty liver index (FLI). All included individuals were advised therapeutic lifestyle interventions whose compliance was ensured using text messages weekly, monthly telephone calls and sessions with dietician 3 monthly. IPD were followed 3 monthly, when fasting and 2-hour post meal glucose levels were checked using glucometer and confirmed using OGTT. IPD with at least 12 months of follow-up were analyzed according to quartiles of fetuin-A and glycemic outcomes.
Results:
Fetuin-A, IL1β, IL6, TNFα, triglycerides and NAFLD increased across glycemic spectrum and were highest in diabetes. 32 IPD reverted to normoglycemia, 23 progressed to diabetes and 65 remained in prediabetes over 32.12±8.4 months. IPD progressing to diabetes had higher baseline glycemia, fetuin-A (482.77±121.74mcg/ml), IL1β (6.36±1.97pg/ml), FLI (60.02±29.77), NAFLD and lower 25OHD (45.33±22.56nmol/L). IPD in highest fetuin-A quartile [median: 549.5mcg/ml, range: 509.5-774.85mcg/ml) had highest progression to diabetes [Relative risk (RR): 2.68; 95% Confidence Interval (CI): 0.95–7.55; P=0.06] and lowest reversal to normoglycemia (RR: 0.27; 95% CI: 0.08–0.85; P=0.03). Fetuin-A levels correlated with IL1β (r=0.420; P<0.001), IL6 (r=0.231; P=0.022) and FLI (r=0.319; P<0.001). Cox regression revealed baseline fetuin-A (P=0.022), 25OHD (P=0.057) and BMI (P=0.073) to be predictive of reversal to normoglycemia. Every unit increase in fetuin-A, 25OHD and BMI were associated with 8.8% decreased, 6.5% increased and 19.7% decreased reversal to normoglycemia respectively. Age (P=0.02), triglycerides (P=0.024), IL6 (P=0.026), and IL1β (P=0.066) were predictive of progression to diabetes. Every unit increase in age, triglycerides, IL6 and IL1β were associated with 17.4% decreased, 2% increased, 15.7% increased and 17.1% increased progression to diabetes respectively.
Discussion:
Conclusion:
Increased fetuin-A in prediabetes is associated with increased progression to diabetes and decreased reversal to normoglycemia through increased insulin resistance and systemic inflammation.

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