Conventional glycemic measures remained stronger predictors of prediabetes remission than newer oral glucose tolerance test (OGTT)-derived metrics during long-term lifestyle intervention, according to a post-hoc analysis published in Cardiovascular Diabetology. The findings suggest that fasting glucose and glycosylated hemoglobin (HbA1c) continue to provide the most useful baseline information when estimating remission potential.

The analysis used longitudinal data from the 3-year multinational PREVIEW randomized trial, which enrolled adults with overweight or obesity and predominantly impaired fasting glucose (IFG). Participants completed an 8-week weight-loss phase followed by 148 weeks of lifestyle-based weight maintenance. Conventional glycemic markers included fasting glucose, 2-hour glucose, and HbA1c. Novel OGTT-derived measures included 1-hour glucose, time to glucose peak, maximum glucose excursion, peak glucose, area under the curve, and curve shape. Prediabetes remission was assessed at 1, 2, and 3 years.

A total of 1,187 participants were included, comprising 262 remitters and 925 non-remitters at 1 year. Baseline fasting glucose showed a nonlinear association with remission at 1 year (P=0.008) and inverse linear associations at 2 and 3 years, independent of 2-hour glucose and HbA1c. Higher baseline HbA1c, but not 2-hour glucose, was associated with a lower likelihood of remission at all time points. After adjustment for conventional markers, none of the novel OGTT metrics showed significant associations with remission. Adding individual OGTT metrics also did not significantly improve model fit, discrimination, area under the receiver operating characteristic curve, or net reclassification improvement.

The analysis showed that novel OGTT measures did not add significant predictive value beyond standard glycemic metrics for remission during long-term lifestyle intervention.