Abstract
Type 2 diabetes poses a major public health challenge. Here, we conducted a cohort study with a large sample size to determine the association of baseline serum ferritin (SF), a marker of iron status, with incident type 2 diabetes in primary healthcare patients in Catalonia, a western Mediterranean region. A total of 206,115 patients aged 35–75 years without diabetes and with available baseline SF measurements were eligible. The variables analyzed included sociodemographic characteristics, anthropometry, lifestyle, morbidity and iron status (SF, serum iron and hemoglobin). Incident type 2 diabetes during follow-up (2006–2016) was ascertained using the International Classification of Diseases, 10th edition. Cox proportional-hazards models adjusted for multiple baseline confounders/mediators were used to estimate hazard ratios (HRs). Over a median follow-up of 8.4 years, 12,371 new cases of type 2 diabetes were diagnosed, representing an incidence rate of 7.5 cases/1000 persons/year. Since at baseline, the median SF concentration was higher in subjects who developed type 2 diabetes (107.0 µg/L vs. 60.3 µg/L; p < 0.001), SF was considered an independent risk predictor for type 2 diabetes; the multivariable-adjusted HRs for incident type 2 diabetes across SF quartiles 1–4 were 1.00 (reference), 0.95 (95% CI = 0.85–1.06), 1.18 (95% CI = 1.65–1.31) and 1.51 (95% CI = 1.36–1.65), respectively. Our study suggested that higher baseline SF was significantly associated with an increased risk of new-onset type 2 diabetes in Catalan primary healthcare users, supporting the relevance of monitoring iron stores in order to improve the diagnosis and management of diabetes in clinical practice.
Highlights
Type 2 diabetes is a major public health concern globally due to its negative impact on quality of life, increased morbidity and mortality and growing healthcare costs [1]
Iron overload has been described as a possible cause of type 2 diabetes and its comorbidities, and various iron-related biomarkers have been repeatedly associated with type 2 diabetes [3,4]
The results are conflicting, with studies showing a positive association between serum ferritin (SF) levels and type 2 diabetes [4,6,7,8], while others fail to corroborate this association in both sexes [9,10,11], in men [11]
Summary
Type 2 diabetes is a major public health concern globally due to its negative impact on quality of life, increased morbidity and mortality and growing healthcare costs [1]. Effective public health and clinical preventive measures are urgently needed. Iron overload has been described as a possible cause of type 2 diabetes and its comorbidities, and various iron-related biomarkers have been repeatedly associated with type 2 diabetes [3,4]. Several prospective and case-control studies have examined the association between serum ferritin (SF), the most commonly used indicator of body iron stores, and the risk of type 2 diabetes [5]. The results are conflicting, with studies showing a positive association between SF levels and type 2 diabetes [4,6,7,8], while others fail to corroborate this association in both sexes [9,10,11], in men [11]
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