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. 2023 May;42(5):636-643.
doi: 10.1016/j.clnu.2023.02.023. Epub 2023 Mar 7.

Differences between HbA1c and glucose-related variables in predicting weight loss and glycaemic changes in individuals with overweight and hyperglycaemia - The PREVIEW trial

Marta P Silvestre  1 , Mikael Fogelholm  2 , Marta Alves  3 , Ana Papoila  3 , Tanja Adam  4 , Amy Liu  5 , Jennie Brand-Miller  6 , J Alfredo Martinez  7 , Margriet Westerterp-Plantenga  4 , Teodora Handjieva-Darlenska  8 , Ian A Macdonald  9 , Ruixin Zhu  10 , Elli Jalo  2 , Roslyn Muirhead  6 , Santiago Navas Carretero  11 , Svetoslav Handjiev  8 , Moira A Taylor  12 , Anne Raben  13 , Sally D Poppitt  5
Affiliations

Differences between HbA1c and glucose-related variables in predicting weight loss and glycaemic changes in individuals with overweight and hyperglycaemia - The PREVIEW trial

Marta P Silvestre et al. Clin Nutr. 2023 May.

Abstract

Aims: To examine the differences between HbA1c and glucose related variables in predicting weight loss and glycaemic changes following 8 weeks of low energy diet (LED) in individuals with overweight and hyperglycaemia.

Research design and methods: 2178 individuals with ADA-defined pre-diabetes - impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) - who started an 8 week LED weight loss diet, were included in this analysis. Participants were enrolled in the PREVIEW (PREVention of diabetes through lifestyle interventions and population studies In Europe and around the World) clinical trial. Multivariable linear mixed effects regression models and generalised additive mixed effect logistic models were used.

Results: Only 1 in 3 participants (33%) had HbA1c levels defined as pre-diabetes. Neither baseline HbA1c, IFG or IGT were associated with body weight change at 8 weeks. Higher baseline body weight, baseline fasting insulin and weight loss predicted normalisation of fasting plasma glucose (FPG), whilst higher baseline fasting insulin, C-reactive protein (hsCRP) and older age predicted normalisation of HbA1c. Additionally, male sex and higher baseline BMI, body fat and energy intake were positively associated with weight loss, whereas greater age and higher HDL-cholesterol predicted less weight loss.

Conclusions: Whilst neither HbA1c nor fasting glucose predicts short-term weight loss success, both may impact the metabolic response to rapid weight loss. We propose a role of inflammation versus total body adiposity since these variables are independent predictors of the normalisation of HbA1c and fasting glucose, respectively.

Keywords: Hemoglobin A(1c); Impaired fasting glucose; Impaired glucose tolerance; Prediabetes; Weight loss/ reduction.

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Conflict of interest statement

Declaration of competing interests AR has received honorariums from the International Sweeteners Association and Unilever. IAM was a member of the UK Government Scientific Advisory Committee on Nutrition, Treasurer of the Federation of European Nutrition Societies, Treasurer of the World Obesity Federation, member of the Mars Scientific Advisory Council, member of the Mars Europe Nutrition Advisory Board, and Scientific Adviser to the Waltham Centre for Pet Nutrition. He was also a member of the Nestle Research Scientific Advisory Board, and of the Novozymes Scientific Advisory Board. He withdrew from all of these roles in 2020 and on August 1 2020 became Professor Emeritus at the University of Nottingham and took up the post of Scientific Director of the Nestle Institute of Health Sciences in Lausanne, Switzerland. JB-M is President and Director of the Glycemic Index Foundation, oversees of a glycemic index testing service at the University of Sydney and is a co-author of books about diet and diabetes. She is also a member of the Scientific Advisory Board of the Novo Foundation and of ZOE Global. SDP was the Fonterra Chair in Human Nutrition during the PREVIEW intervention. TL is employed by NetUnion sarl, who contributed to the data collection process in the absence of commercial or financial conflict of interest with the study analysis.

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