<b>Objective </b>
<p>Glycemic regression is
common in real world settings, but the contribution of regression to the mean (RTM)
has been little investigated. We aimed to estimate glycemic regression before
and after adjusting for RTM in a free-living cohort of adults with newly
ascertained diabetes and intermediate hyperglycemia (IH). </p>
<p><b>Research Design and Methods</b></p>
<p>ELSA-Brasil is a cohort
study of 15,105 adults screened between 2008-2010 with standardized OGTT and HbA1c,
repeated after 3.84 (0.42) years.
After excluding those
receiving medical treatment for diabetes, we calculated partial or complete regression before and after adjusting baseline
values for RTM. </p>
<p><b>Results</b></p>
<p>Regarding newly
ascertained diabetes, partial or complete regression was seen in 49.4% (95%CI
45.2 – 53.7); after adjustment for RTM, in 20.2% (95%CI 12.1 – 28.3). Regarding IH, regression
to normal levels was seen in 39.5% (95%CI 37.9 – 41.3) or in 23.7% (95%CI 22.6%
– 24.3%) depending on the WHO or the ADA definition, respectively; after adjustment,
corresponding frequencies were 26.1% (95%CI 22.4 – 28.1) and 19.4% (95%CI 18.4 – 20.5). Adjustment for
RTM reduced the number of cases detected at screening: 526 to 94 cases of diabetes; 3118 to 1986 cases of WHO-defined IH; and 6182 to 5711
cases of AD-defined IH. Weight loss ≥2.6% was associated with greater regression from diabetes
(RR=1.52 95%CI 1.26-1.84) and IH (RR=1.30 95%CI 1.17-1.45). </p>
<p><b>Conclusions</b></p>
<p>In this quasi-real-world setting, regression from diabetes at ~4 years
was common, less so for IH. Regression was frequently explained by RTM, but, in
part, also related to improved weight loss and homeostasis over the follow-up. </p>