Serial Metabolic Measurements and Conversion to Type 2 Diabetes in the West of Scotland Coronary Prevention Study Specific Elevations in Alanine Aminotransferase and Triglycerides Suggest Hepatic Fat Accumulation as a Potential Contributing Factor

To examine metabolic changes (lipids, liver enzymes, blood pressure, and weight) potentially associated with conversion to diabetes, we analyzed serial glucose and other metabolic measures obtained every 6 months within the West of Scotland Coronary Prevention Study trial. Changes in parameters for 86 men who converted to new-onset diabetes (“converters”: two consecutive glucose levels ≥7 mmol/l) were compared with 860 “nonconverters” matched for age and treatment allocation. Eighteen months before the diagnosis, converters to diabetes had elevated ( P P = 0.0005) and triglyceride ( P = 0.030) increased significantly more over the 18 months in converters compared with nonconverters, but neither parameter increased significantly in nonconverters with high baseline glucose concentrations (>6.1 mmol/l). Finally, only sustained increases in ALT predicted a higher risk for diabetes. We conclude that a relatively rapid rise in fasting glucose levels is frequent in converters to diabetes and that associated increases over time in ALT and potentially triglyceride suggest hepatic fat accumulation as a contributing factor for conversion to diabetes in men at risk.