Elevated fasting serum xylitol levels are associated with a lower risk of incident type 2 diabetes among individuals with prediabetes in the Chinese population

Background Detection of predictors of prediabetes progressing to diabetes are important for exploration the strategy of reversing diabetes. Although polyols have beneficial effects on glycometabolism in clinical intervention studies, little is known about the association between fasting serum polyols of participant with habitual diet and the risk of prediabetes progressing to type 2 diabetes. Methods In this nested case-control study, 180 participants with type 2 diabetes developed from prediabetes (progressors), and 180 matched controls (non-progressors) with prediabetes during a 3.5-year follow-up were enrolled. The baseline levels of serum polyols in the fasting state were quantified using time-of-flight mass spectrometry. Multivariate conditional logistic regression was performed to assess the effects of the differentially polyols levels on the risk of incident diabetes. Results Baseline fasting xylitol levels, but not sorbitol or erythritol levels, were higer in non-progressors than in progressors ( P  < 0.001). Non-progressors, compared with progressors, had significantly higer proportions within the third tertile of xylitol levels (71/180 non-progressors [39.4%] vs. 49/180 progressors [27.2%]). After adjusting for potential confounders, the odds ratio of risk for incident diabetes in the highest tertile of xylitol levels was 0.338 (95% confidence interval 0.182 – 0.628), compared with that in the lowest quartile. In addition, the association between xylitol levels and incident diabetes was persistent in the diabetes subtype with high fasting blood glucose and both high fasting and 2h-postprandial blood glucose, but disappeared in the isolated high 2h-postprandial blood glucose subtype. Conclusions Elevated baseline fasting serum xylitol levels are associated with a lower risk of prediabetes progressing to diabetes. This association was particularly evident in the high fasting blood glucose subtype. These findings suggest that fasting serum xylitol levels may serve as an important predictor and protective factor against diabetes development.