Trastornos metabólicos asociados con la evolución hacia la diabetes mellitus tipo 2 en una población en riesgo

abstract introduction: the clinical and metabolic state of persons in risk of suffer type 2 diabetes mellitus (dm2) is very heterogeneous. objective: to identify the factors influencing in progression to diabetes in subgroups of patients with different types and the severity of metabolic disorders. methods: a prospective study was conducted in 209 subjects in high risk of progression to type 2 diabetes mellitus (backgrounds of disorders related to glucose tolerance without fasting hyperglycemia) to examine the metabolic disorders associating with progression to diabetes. glucose tolerance, insulin secretion and insulin sensitivity were studied at onset and two years later. results: we found that the risk to develop diabetes mellitus was in a significant dependence of the deterioration degree of glucose tolerance present in the initial study (normal glucose tolerance, 10 %; altered glucose tolerance, 14,6 %; altered glucose tolerance + altered fasting glycemia, 56,7 %). in the group with a normal glucose tolerance the fundamental predictive factor of evolution to diabetes mellitus was the failure of initial insulin secretory response (or: 8,13; 95 % ci; 1,83 to 36,0). in the subjects with altered glucose tolerance with fasting altered glycemia and without it, determinant factor was the fasting glycemia (or: 5,41; 95 % ci; 2,15 to 13,6). the insulin resistance was not a significant predictive factor in any study subgroups. conclusions: postprandial glycemia disorders in early stages of evolution to type 2 diabetes mellitus are changeable or reversible and insufficient to base its early diagnosis and the preventive or therapeutical activities. appearance of an altered fasting glycemia is the onset of an accelerated progression stage to type 2 diabetes mellitus, thus, in this group it is necessary to intensify the measures to revert or slow the metabolic deterioration. in group with a high risk of diabetes and a normal glucose tolerance the only metabolic factor identif