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Xiaoli Liu Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China

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Lanxiang Liu Department of Medical Imaging, The First Hospital of Qinhuangdao, Qinhuangdao, China

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Rui Wang Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China

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Xiaojiao Jia Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China

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Binbin Liu Department of Functional Examination, The First Hospital of Qinhuangdao, Qinhuangdao, China

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Ning Ma Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China

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Qiang Lu Department of Endocrinology, The First Hospital of Qinhuangdao, Qinhuangdao, China

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prediabetes and new-onset diabetes. As a basic characteristic of type 2 diabetes mellitus (T2DM), insulin resistance plays an important role in the development and progression of arteriosclerosis. Insulin resistance is present in prediabetes, and populations

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Xiang Hu Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

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Qiao Zhang Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

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Tian-Shu Zeng Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

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Jiao-Yue Zhang Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

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Jie Min Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

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Sheng-Hua Tian Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

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Hantao Huang Yiling Hospital, Yichang, China

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Miaomiao Peng Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

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Nan Zhang Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

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Mengjiao Li Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

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Qing Wan Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

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Fei Xiao Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

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Yan Chen Institute of Big Data and Internet Innovation, Hunan University of Commerce, Changsha, China

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Chaodong Wu Department of Nutrition and Food Science, Texas A&M University, College Station, Texas, USA

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Lu-Lu Chen Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China

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.1% may have had prediabetes, an important risk factor of overt diabetes and cardiovascular disease ( 2 ). Diabetes leads to complications that cause profound psychological and physical distress, putting a huge burden on health care systems ( 3 , 4 ). The

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T Grimmichova Institute of Endocrinology, Narodni, Prague, Czech Republic
2nd Department of Internal Medicine, University Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University in Prague, Srobarova, Prague, Czech Republic

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M Haluzik Institute of Endocrinology, Narodni, Prague, Czech Republic
Diabetes Centre, Institute for Clinical and Experimental Medicine (IKEM), Videnska, Prague, Czech Republic

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K Vondra Institute of Endocrinology, Narodni, Prague, Czech Republic

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P Matucha Institute of Endocrinology, Narodni, Prague, Czech Republic

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M Hill Institute of Endocrinology, Narodni, Prague, Czech Republic

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department from primary care mainly due to suspicions of thyropathy, other endocrinopathy or diabetes. Patients with negative history of prediabetes or diabetes were screened for diabetes following the standards of the American Diabetes Association and the

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Sakina H Bharmal School of Medicine, University of Auckland, Auckland, New Zealand

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Wandia Kimita School of Medicine, University of Auckland, Auckland, New Zealand

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Juyeon Ko School of Medicine, University of Auckland, Auckland, New Zealand

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Maxim S Petrov School of Medicine, University of Auckland, Auckland, New Zealand

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increases with time ( 8 ), there is a need for early identification of high-risk individuals to introduce targeted strategies for preventing and managing this sequela of AP. Prediabetes is one of the most prominent risk factors for new-onset diabetes

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Xun Gong Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China

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Lili You Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China

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Feng Li Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China

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Qingyu Chen Department of Medical Examination Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China

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Chaogang Chen Department of Clinical Nutrition, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China

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Xiaoyun Zhang Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China

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Xiuwei Zhang Department of Endocrinology, Dongguan People’s Hospital, Dongguan, People’s Republic of China

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Wenting Xuan Department of Endocrinology, Dongguan People’s Hospital, Dongguan, People’s Republic of China

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Kan Sun Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China

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Guojuan Lao Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China

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Chuan Wang Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China

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Yan Li Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China

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Mingtong Xu Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China

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Meng Ren Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China

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Li Yan Department of Endocrinology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, People’s Republic of China

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-sectional study, which included 75,880 Chinese adults showed that the prevalence of total diabetes and pre-diabetes, according to the American Diabetes Association (ADA) criteria, reached 12.8 and 35.2%, respectively ( 2 ). Moreover, 70% of patients with pre-diabetes

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Charlotte Janus Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Danish Diabetes Academy, Odense University Hospital, Odense, Denmark

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Dorte Vistisen Steno Diabetes Center Copenhagen, Gentofte, Denmark

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Hanan Amadid Steno Diabetes Center Copenhagen, Gentofte, Denmark
Department of Public Health, Research Unit of Epidemiology, Aarhus University, Aarhus, Denmark

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Daniel R Witte Danish Diabetes Academy, Odense University Hospital, Odense, Denmark
Department of Public Health, Research Unit of Epidemiology, Aarhus University, Aarhus, Denmark
Steno Diabetes Center Aarhus, Aarhus, Denmark

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Torsten Lauritzen Department of Public Health, Research Unit of Epidemiology, Aarhus University, Aarhus, Denmark

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Søren Brage MRC Epidemiology Unit, University of Cambridge, Cambridge, UK

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Anne-Louise Bjerregaard Department of Public Health, Research Unit of Epidemiology, Aarhus University, Aarhus, Denmark

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Torben Hansen Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark

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Jens J Holst Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark

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Marit E Jørgensen Steno Diabetes Center Copenhagen, Gentofte, Denmark
National Institute of Public Health, University of Southern Denmark, Odense, Denmark

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Oluf Pedersen Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark

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Kristine Færch Steno Diabetes Center Copenhagen, Gentofte, Denmark

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Signe S Torekov Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Copenhagen, Denmark

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responsible for up to 70% of the postprandial insulin response in healthy individuals whilst being severely impaired in patients with prediabetes and T2D ( 5 , 6 ). Furthermore, GLP-1 responses are lower in individuals with overweight and obesity

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Agnieszka Adamska Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Bialystok, Poland

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Vitalii Ulychnyi Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Bialystok, Poland

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Katarzyna Siewko Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Bialystok, Poland

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Anna Popławska-Kita Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Bialystok, Poland

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Małgorzata Szelachowska Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Bialystok, Poland

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Marcin Adamski Faculty of Computer Science, Bialystok University of Technology, Białystok, Poland

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Angelika Buczyńska Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland

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Adam Jacek Krętowski Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Białystok, Bialystok, Poland
Clinical Research Centre, Medical University of Bialystok, Bialystok, Poland

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patient evaluation including comorbidities and life expectancy is essential to reach treatment decisions ( 11 ). The classic cardiovascular risk factors are obesity, type 2 diabetes mellitus (T2DM), prediabetes (PD), hypertension, hyperlipidaemia and

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Lilit Egshatyan ‘Research of Age and Age-Associated Conditions’ Department, Laboratory of Bioinformatics, The ‘Russian Clinical Research Center for Gerontology’, ‘Chronic Noncommunicable Diseases Primary Prevention in the Healthcare System’ Department, Moscow Institute of Physics and Technology, National Research Centre for Preventive Medicine, National Research Centre for Preventive Medicine, Building 10, Petroverigskiy Lane, Moscow RF 101000, Russian Federation

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Daria Kashtanova ‘Research of Age and Age-Associated Conditions’ Department, Laboratory of Bioinformatics, The ‘Russian Clinical Research Center for Gerontology’, ‘Chronic Noncommunicable Diseases Primary Prevention in the Healthcare System’ Department, Moscow Institute of Physics and Technology, National Research Centre for Preventive Medicine, National Research Centre for Preventive Medicine, Building 10, Petroverigskiy Lane, Moscow RF 101000, Russian Federation

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Anna Popenko ‘Research of Age and Age-Associated Conditions’ Department, Laboratory of Bioinformatics, The ‘Russian Clinical Research Center for Gerontology’, ‘Chronic Noncommunicable Diseases Primary Prevention in the Healthcare System’ Department, Moscow Institute of Physics and Technology, National Research Centre for Preventive Medicine, National Research Centre for Preventive Medicine, Building 10, Petroverigskiy Lane, Moscow RF 101000, Russian Federation

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Olga Tkacheva ‘Research of Age and Age-Associated Conditions’ Department, Laboratory of Bioinformatics, The ‘Russian Clinical Research Center for Gerontology’, ‘Chronic Noncommunicable Diseases Primary Prevention in the Healthcare System’ Department, Moscow Institute of Physics and Technology, National Research Centre for Preventive Medicine, National Research Centre for Preventive Medicine, Building 10, Petroverigskiy Lane, Moscow RF 101000, Russian Federation

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Alexander Tyakht ‘Research of Age and Age-Associated Conditions’ Department, Laboratory of Bioinformatics, The ‘Russian Clinical Research Center for Gerontology’, ‘Chronic Noncommunicable Diseases Primary Prevention in the Healthcare System’ Department, Moscow Institute of Physics and Technology, National Research Centre for Preventive Medicine, National Research Centre for Preventive Medicine, Building 10, Petroverigskiy Lane, Moscow RF 101000, Russian Federation

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Dmitry Alexeev ‘Research of Age and Age-Associated Conditions’ Department, Laboratory of Bioinformatics, The ‘Russian Clinical Research Center for Gerontology’, ‘Chronic Noncommunicable Diseases Primary Prevention in the Healthcare System’ Department, Moscow Institute of Physics and Technology, National Research Centre for Preventive Medicine, National Research Centre for Preventive Medicine, Building 10, Petroverigskiy Lane, Moscow RF 101000, Russian Federation

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Natalia Karamnova ‘Research of Age and Age-Associated Conditions’ Department, Laboratory of Bioinformatics, The ‘Russian Clinical Research Center for Gerontology’, ‘Chronic Noncommunicable Diseases Primary Prevention in the Healthcare System’ Department, Moscow Institute of Physics and Technology, National Research Centre for Preventive Medicine, National Research Centre for Preventive Medicine, Building 10, Petroverigskiy Lane, Moscow RF 101000, Russian Federation

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Elena Kostryukova ‘Research of Age and Age-Associated Conditions’ Department, Laboratory of Bioinformatics, The ‘Russian Clinical Research Center for Gerontology’, ‘Chronic Noncommunicable Diseases Primary Prevention in the Healthcare System’ Department, Moscow Institute of Physics and Technology, National Research Centre for Preventive Medicine, National Research Centre for Preventive Medicine, Building 10, Petroverigskiy Lane, Moscow RF 101000, Russian Federation
‘Research of Age and Age-Associated Conditions’ Department, Laboratory of Bioinformatics, The ‘Russian Clinical Research Center for Gerontology’, ‘Chronic Noncommunicable Diseases Primary Prevention in the Healthcare System’ Department, Moscow Institute of Physics and Technology, National Research Centre for Preventive Medicine, National Research Centre for Preventive Medicine, Building 10, Petroverigskiy Lane, Moscow RF 101000, Russian Federation
‘Research of Age and Age-Associated Conditions’ Department, Laboratory of Bioinformatics, The ‘Russian Clinical Research Center for Gerontology’, ‘Chronic Noncommunicable Diseases Primary Prevention in the Healthcare System’ Department, Moscow Institute of Physics and Technology, National Research Centre for Preventive Medicine, National Research Centre for Preventive Medicine, Building 10, Petroverigskiy Lane, Moscow RF 101000, Russian Federation

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Vladislav Babenko ‘Research of Age and Age-Associated Conditions’ Department, Laboratory of Bioinformatics, The ‘Russian Clinical Research Center for Gerontology’, ‘Chronic Noncommunicable Diseases Primary Prevention in the Healthcare System’ Department, Moscow Institute of Physics and Technology, National Research Centre for Preventive Medicine, National Research Centre for Preventive Medicine, Building 10, Petroverigskiy Lane, Moscow RF 101000, Russian Federation

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Maria Vakhitova ‘Research of Age and Age-Associated Conditions’ Department, Laboratory of Bioinformatics, The ‘Russian Clinical Research Center for Gerontology’, ‘Chronic Noncommunicable Diseases Primary Prevention in the Healthcare System’ Department, Moscow Institute of Physics and Technology, National Research Centre for Preventive Medicine, National Research Centre for Preventive Medicine, Building 10, Petroverigskiy Lane, Moscow RF 101000, Russian Federation

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Sergey Boytsov ‘Research of Age and Age-Associated Conditions’ Department, Laboratory of Bioinformatics, The ‘Russian Clinical Research Center for Gerontology’, ‘Chronic Noncommunicable Diseases Primary Prevention in the Healthcare System’ Department, Moscow Institute of Physics and Technology, National Research Centre for Preventive Medicine, National Research Centre for Preventive Medicine, Building 10, Petroverigskiy Lane, Moscow RF 101000, Russian Federation

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deviation degree Patients without glucose intolerance, who had passed the preventive outpatient examination. Patients with prediabetes (preD) (impaired fasting glucose or impaired glucose tolerance or the level of HbA1c from 5.7 to 6.5%. Patients with newly

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Mojca Jensterle Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre, Ljubljana, Slovenia
University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia

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Nika Aleksandra Kravos Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre, Ljubljana, Slovenia
University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia

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Simona Ferjan Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre, Ljubljana, Slovenia
University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia

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Katja Goricar University of Ljubljana, Faculty of Medicine, Institute of Biochemistry, Pharmacogenetics Laboratory, Ljubljana, Slovenia

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Vita Dolzan University of Ljubljana, Faculty of Medicine, Institute of Biochemistry, Pharmacogenetics Laboratory, Ljubljana, Slovenia

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Andrej Janez Department of Endocrinology, Diabetes and Metabolic Diseases, University Medical Centre, Ljubljana, Slovenia
University of Ljubljana, Faculty of Medicine, Ljubljana, Slovenia

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Objective

Long-term efficacy of metformin in polycystic ovarian syndrome (PCOS) apart from in those with impaired glucose tolerance or diabetes remains unproven. We aimed to evaluate the impact of metformin in overweight-obese patients with PCOS and normal baseline glycemic homeostasis.

Methods

A 10-year longitudinal follow-up of a retrospective cohort comprising 159 patients with PCOS defined by Rotterdam criteria, BMI ≥25 kg/m2 and normal initial glucose homeostasis (age 28.4 ± 6.4 years, BMI 34.9 ± 6.6 kg/m2) that had been receiving metformin 1000 mg BID. Collection data contained 6085 time-points including anthropometric, hormonal and metabolic parameters.

Results

After the first year body mass (BM) decreased for 3.9 ± 6.8 kg (P < 0.001) and remained stable during the following 3 years. Menstrual frequency (MF) increased to 3.0 ± 3.9 bleeds/year (P < 0.001) after first year to over 11 bleeds/year in the following years. The total testosterone and androstenedione decreased to 15.4 ± 47.9% and 11.3 ± 46.4% within first year, with further decrease in total testosterone and androstenedione to 37.8 ± 61.8 and 24.8 ± 40.5% at the fifth year of the follow-up. The total conversion rate to prediabetes and diabetes was extremely low throughout observation period. Less than 25% of patients continued with metformin for more than 5 years with further dropout to only 6% on metformin therapy at the tenth year of follow-up.

Conclusions

Long-term metformin treatment of overweight-obese women with PCOS and normal baseline glycemic homeostasis resulted in reduction and stabilization of BM, improvements of MF and androgen profile and low conversion rate to diabetes.

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Chan Yang School of Nursing, Ningxia Medical University, Yinchuan, Ningxia, China
School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China

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Yadi Zhang School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China

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Juan Li School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China

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Xiaowei Liu School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China

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Jiangwei Qiu School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China

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Jiaxing Zhang School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China

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Xiuying Liu School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, Ningxia, China

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Yuhong Zhang School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, Ningxia, China

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Yi Zhao School of Public Health, Ningxia Medical University, Yinchuan, Ningxia, China
Key Laboratory of Environmental Factors and Chronic Disease Control, Ningxia Medical University, Yinchuan, Ningxia, China

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increased by approximately 19-fold ( 2 , 3 ). China now has the largest diabetic population worldwide, and the prevalence of prediabetes has been increasing over recent years ( 4 ). The condition of prediabetes occurs before the development of type 2

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