Author ORCID Identifier

https://orcid.org/0000-0002-7615-0617

Date of Award

Summer 8-10-2021

Degree Type

Thesis

Degree Name

Master of Public Health (MPH)

Department

Public Health

First Advisor

Ike S Okosun, MS, MPH, PhD

Second Advisor

Dora Il’yasova, PhD

Abstract

Introduction: Diabetes is one of the leading causes of both morbidity and mortality worldwide and is a pressing concern since these figures are on the rise. The International Diabetes Federation indicated that approximately 463 million adults currently have diabetes globally, with an additional 374 million individuals living in prediabetic state (IDF, 2019). Diabetes is also at the forefront with regard to costs in that it has risen from $245 billion in 2012 (American Diabetes Association, 2018) to an estimated $327 billion in 2017—the latter of which is comprised of $237 billion in direct medical costs along with the remaining $90 billion incurred as a result of absenteeism, a reduced ability to work, and a general reduction in overall productivity (American Diabetes Association, 2018). While the transition from a state of prediabetes (i.e., impaired glucose tolerance) to overt diabetes has been heavily studied, there is a dearth of existing literature targeting the reversal from a state of impaired glucose tolerance (IGT) to one of normal glucose tolerance (NGT). Preventative measures undertaken to circumvent the likelihood of developing type 2 diabetes can more adeptly be accomplished by transitioning from a state of IGT back to a state of NGT before it is too late. Evaluating cardiovascular, glucoregulatory, lifestyle, and demographic characteristics along with urinary biomarkers, the baseline lipid profile, and anthropometric measures occurring amongst subjects in a state of IGT at baseline may shed light on potential predictors involved in the reversal back to NGT.

Aim: The goal of this study is to evaluate the possible predictors that may incite the regression from a state of impaired glucose tolerance (IGT) to one of normal glucose tolerance (NGT).

Methods: This study analyzed existing epidemiological data from the total insulin resistance atherosclerosis study (IRAS) cohort of 1,625 participants using an exploratory data analysis (EDA) approach. This study evaluated only participants with Impaired Glucose Tolerance (IGT) when measured at baseline (n=303). Subjects who transitioned from IGT to NGT (n=81) were compared to those who remained in a state of IGT during both visits (n=121) along with subjects who progressed from IGT to a state of overt type 2 diabetes at follow-up (n=101). Group differences for continuous and categorical variables were assessed using the Wilcoxon Rank Sum/Kruskal Wallis chi-square tests, respectively.

Results: Male participants were more likely to experience a successful reversal from a state of IGT to one of NGT compared to their female peers. Menopausal status was a statistically significant characteristic serving as an impediment in the transition from a state of IGT to one of NGT. Subjects with elevated BMIs were significantly less likely to reverse from IGT to NGT compared to those with lower BMIs.

Conclusion: The results suggest that female participants are less likely to experience a reversal from a state of impaired glucose tolerance to one of normal glucose tolerance compared to male participants. This finding appears to be contingent upon menopausal status when measured during both baseline and follow-up visits, respectively.

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