Alanine Transaminase and Waist to Hip Ratio as Predictors of Dysglycemia and Regression to Normoglycemia in Adult Patients with Prediabetes

Abstract

<p>Current evidence suggests that both prediabetes and diabetes can reverse to normoglycemia; however, predictors of remission of these conditions are poorly understood. We performed analyses on 1,209 people with impaired fasting glucose and/or impaired glucose tolerance treated with placebo rosiglitazone and placebo ramipril in the DREAM trial. Normoglycemia was defined as a fasting plasma glucose <5.6 mmol/L and 2-hour plasma glucose <7.8 mmol/L on a 75 g oral glucose tolerance test (OGTT).</p> <p>The effects of baseline ALT and waist to hip ratio (WHR) on regression of prediabetes to normoglycemia 2 years later were found to be interdependent (p-value for interaction 0.01). Adjusted odds ratios ORs (95% CI) of regression to normoglycemia per 10 U/L increase in ALT were 0.79 (0.66-0.94) when WHR was at the mean minus 1 standard deviation (SD), 0.90 (0.80-1.02) when WHR was at the mean of 0.91, and 1.03 (0.90-1.18) when WHR was at the mean plus 1 SD. Adjusted ORs of regression to normoglycemia per 0.1 unit increase in WHR were 0.75 (0.60-0.95) when ALT was at the mean minus 1 SD, 0.91 (0.76-1.08) when ALT was at the mean of 25 U/L, and 1.09 (0.89-1.35) when ALT was at the mean plus 1 SD.</p> <p>Similarly, the effects of baseline ALT and WHR on AUC_{glucose0-120 min} obtained from the OGTT were found to be interdependent (p-value for interaction 0.056). A 10 U/L increase in ALT was associated with an adjusted AUC_{glucose0-120 min} increase of 19.5 (95% CI 5.3 to 33.7) min*mmol/L when WHR was at the mean minus 1 SD, 11.0 (1.4 to 20.6) min*mmol/L when WHR was at the mean of 0.91, and 2.5 (-9.2 to 14.1) min*mmol/L when WHR was at the mean plus 1 SD. A 0.1 unit increase in WHR was associated with an adjusted AUC_{glucose0-120 min} increase of 30.3 (10.2 to 50.3) min*mmol/L when ALT was at the mean minus 1 SD, 18.3 (3.8-32.9) min*mmol/L when ALT was at the mean of 25 U/L, and 6.4 (-11.5 to 24.3) min*mmol/L when ALT was at the mean plus 1 SD.</p> <p>In conclusion, high baseline ALT and WHR predict a lower likelihood of regression of prediabetes to normoglycemia and an increase in AUC_{glucose0-120 min} 2 years later; however, the effects of ALT and WHR on these outcomes are interdependent.</p>