Predictor Of Incident Diabetes Research Articles

Insulin Resistance and Impaired Insulin Secretion Predict Incident Diabetes: A Statistical Matching Application to the Two Korean Nationwide, Population-Representative Cohorts.

To evaluate whether insulin resistance and impaired insulin secretion are useful predictors of incident diabetes in Koreans using nationwide population-representative data to enhance data privacy. This study analyzed the data of individuals without diabetes aged >40 years from the Korea National Health and Nutrition Examination Survey (KNHANES) 2007-2010 and 2015 and the National Health Insurance Service-National Health Screening Cohort (NHIS-HEALS). Owing to privacy concerns, these databases cannot be linked using direct identifiers. Therefore, we generated 10 synthetic datasets, followed by statistical matching with the NHIS-HEALS. Homeostasis model assessment of insulin resistance (HOMA-IR) and homeostasis model assessment of β-cell function (HOMA-β) were used as indicators of insulin resistance and insulin secretory function, respectively, and diabetes onset was captured in NHIS-HEALS. A median of 4,580 (range, 4,463 to 4,761) adults were included in the analyses after statistical matching of 10 synthetic KNHANES and NHIS-HEALS datasets. During a mean follow-up duration of 5.8 years, a median of 4.7% (range, 4.3% to 5.0%) of the participants developed diabetes. Compared to the reference low-HOMA-IR/high-HOMA-β group, the high-HOMA-IR/low- HOMA-β group had the highest risk of diabetes, followed by high-HOMA-IR/high-HOMA-β group and low-HOMA-IR/low- HOMA-β group (median adjusted hazard ratio [ranges]: 3.36 [1.86 to 6.05], 1.81 [1.01 to 3.22], and 1.68 [0.93 to 3.04], respectively). Insulin resistance and impaired insulin secretion are robust predictors of diabetes in the Korean population. A retrospective cohort constructed by combining cross-sectional synthetic and longitudinal claims-based cohort data through statistical matching may be a reliable resource for studying the natural history of diabetes.

Association between physical activity level and diabetes incidence among Chinese middle-aged and older adults: a cross-sectional study from the China health and retirement longitudinal study.

It has been shown that diabetes is associated with insufficient physical activity among middle-aged and older adults, but the association between different physical activity levels (PAL) and diabetes incidence needs to be further explored. This study aims to explore the correlation and dose-response relationship between different PAL and the diabetes incidence in middle-aged and older adults. Utilizing data from the 2018 China Health and Retirement Longitudinal Study (CHARLS), this cross-sectional analysis included 17,226 middle-aged and older adults aged 45 and above. Binary logistic regression models and restricted cubic spline (RCS) were used to explore the correlation and dose-response relationship between different PAL and the incidence of diabetes in the total middle-aged and older adults population as well as in subgroups. Sensitivity analyses were also performed to verify the robustness of the findings. In the entire study population, compared with the lowest PAL, participants in the third and fourth quartiles PAL saw diabetes incidence significantly reduced by 16% (p = 0.005) and 33% (p < 0.001), respectively (p for trend < 0.001). In subgroup analyses, the fourth quartile PAL significantly reduced the diabetes incidence among females, individuals aged 60-69, and rural residents by 25% (p = 0.011), 38% (p < 0.001) and 28% (p < 0.001), respectively. For males, middle-aged (45-59 years), and urban residents, the third quartile PAL reduced diabetes incidence by 22% (p = 0.004), 24% (p = 0.012), 21% (p = 0.013), respectively. When the fourth quartile PAL was reached, the diabetes incidence was significantly reduced in these populations by 41% (p < 0.001), 39% (p < 0.001), and 41% (p < 0.001), respectively. There was a negative dose-response relationship between physical activity and diabetes incidence in specific Chinese middle-aged and older adults population. In addition, sensitivity analyses indicated the robustness of the findings. Higher PAL was associated with lower diabetes incidence in specific Chinese middle-aged and older adults population. It is feasible to use physical activity to predict diabetes incidence in this demographic, and high PAL may be an effective means of preventing and controlling diabetes.

PS-BPC02-8: EARLY VASCULAR AGING IN HYPERTENSION IS A PREDICTOR OF INCIDENT DIABETES

Objective: Diabetes is associated with vascular aging and arteriosclerosis. Arterial stiffness can be used to assess vascular aging and is an independent predictor of cardiovascular events and mortality. However, the role of arterial stiffness in the incidence of diabetes and especially in patients under treatment with statins has not been investigated. We sought to investigate the role of carotid-femoral pulse wave velocity (PWV) in the prediction of incident diabetes in hypertensives and hypertensives under treatment with statins. Design and method: 376 never treated hypertensives (mean age 53 ± 13 years, 175 females) without a known history of diabetes or cardiovascular disease at baseline, were included in the study. Markers of target organ damage [carotid femoral PWV, aortic augmentation index (AIx), and estimated glomerular filtration rate (eGFR)] were evaluated at baseline in all patients. eGFR was estimated using the Cockcroft Gault formula. Hemoglobin A1c (HbA1c) and blood glucose were measured in venous blood samples. Patients were followed up prospectively for the incidence of diabetes as defined by the American Diabetes Association criteria. One hundred and thirty-nine patients received statins during follow up. Results: During a median of 13.5 years of follow up, 46 patients (12.2%) patients were diagnosed with diabetes. In multivariable logistic regression analysis, only higher PWV (Odds Ratio [OR] = 1.271, 95% Confidence intervals [CI]: 1.002 to 1.612, P = 0.048) was associated with a higher risk of incident diabetes, which was independent of age, sex, pulse pressure, HbA1c, fasting blood glucose and eGFR (Figure). In further analysis, receiver operating characteristic (ROC) curves were generated to evaluate the ability of PWV to discriminate subjects with diabetes. The area under the curve (AUC) and 95% CIs of the ROC curve was AUC = 0.66 (95% CI: 0.58 to 0.74, P = 0.001) for PWV. In the subgroup of patients under treatment with statins, higher PWV (OR = 1.51, 95% CI: 1.09 to 2.11, P = 0.014) was associated with higher risk of incident diabetes, which was independent of the abovementioned confounders. AIx was not associated with the incidence of diabetes. Conclusions: Higher arterial stiffness, a marker of early vascular aging, is associated with the incidence of diabetes and also can identify subjects under treatment with statins that are more likely to present with diabetes in the future.

Dyslipidemia and 10-year diabetes incidence in Japanese people: Population-based Panasonic cohort study 9.

Low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and LDL/HDL ratio have been associated with new-onset diabetes; however, their cut-off levels have not been determined. We clarified the association between dyslipidemia and the incidence of diabetes. People who underwent a health checkup under a program conducted by Panasonic Corporation from 2008 to 2018 were included. In total, 87,570 participants were included, of whom 5,110 developed type 2 diabetes. Cox regression analyses and time-dependent receiver operating characteristic (ROC) curves were used to evaluate the association between LDL cholesterol, HDL cholesterol, or LDL/HDL ratio and incident diabetes and to identify the cut-off values for incident diabetes. Multivariate analysis showed that LDL cholesterol, HDL cholesterol, and LDL/HDL ratio were significantly associated with the risk of incident type 2 diabetes. Further, the area under the ROC curve and optimized cut-off values for LDL cholesterol, HDL cholesterol, and LDL/HDL ratio for incident type 2 diabetes at 10 years were 0.613 and 124 mg/dl, 0.640 and 54 mg/dl, and 0.662 and 2.4 mg/dl, respectively. The LDL/HDL ratio with a cut-off value of 2.4 was a better predictor of incident diabetes within 10 years than LDL and HDL cholesterol.

905-P: Simulation Model Estimating Lifetime Health and Economic Outcomes of Prediabetes Screening by One-Hour Plasma Glucose

Background: One of the current methods to diagnose prediabetes and predict diabetes incidence is based on 2-h plasma glucose (2-hPG) value following 75-g oral glucose tolerance test. Evidence demonstrates that 1-hour post-load plasma glucose (1-hPG) ≥ 155 mg/dl (8.6 mmol/L) in those with normal glucose tolerance at 2-hPG is highly predictive for T2D incidence. We conducted a health economic analysis to estimate long-term cost-effectiveness of using 1-hPG as compared to 2-hPG to screen and assess diabetes risk. Methods: The main outcome of the study was cost per quality-adjusted life-year (QALY) gained. We used a Monte Carlo-based Markov simulation model to simulate long-term effects of the two screening strategies on clinical and cost-effectiveness outcomes. The base case model included 20.000 simulated patients over 35-years. Transition probabilities were retrieved from landmark studies. Direct medical costs were sourced from the literature and inflated to 20Euros. Results: In the lifetime analysis, 1-hPG was projected to increase the number of years free from disease (2yr/patient) ; to delay the onset of T2D (1yr/patient) ; to reduce the incidence of T2D complications (0.6 Relative Risk/patient) and to increase the QALY gained (0.58/patient) . Though testing the 1-hPG resulted in higher initial costs owing to a larger number of preventive treatments, long-term diabetes and complications costs were reduced leading to -31,225,719.82€ saving over a lifetime as compared to 2-hPG. The incremental cost-effectiveness ratio was -8,214.7€ per each QALY gained for the overall population. Conclusions: Screening prediabetes by using 1h-PG is feasible and cost-effective resulting in QALYs gained and reduced costs. Notwithstanding the higher initial costs of 1-hPG compared to 2-hPG, due to the incremental number of preventive treatments, long-term diabetes and complications costs were reduced expecting an overall cost saving of -8,214.7€ per each QALY gained. Disclosure M.Andellini: None. M.Manco: None. M.Esposito: None. A.Tozzi: None. M.Bergman: None. M.Ritrovato: None.

Predictors of incident diabetes in two populations: framingham heart study and hispanic community health study / study of latinos

BackgroundNon-genetic factors contribute to differences in diabetes risk across race/ethnic and socioeconomic groups, which raises the question of whether effects of predictors of diabetes are similar across populations. We studied diabetes incidence in the primarily non-Hispanic White Framingham Heart Study (FHS, N = 4066) and the urban, largely immigrant Hispanic Community Health Study/Study of Latinos (HCHS/SOL, N = 6891) Please check if the affiliations are captured and presented correctly.MethodsClinical, behavioral, and socioeconomic characteristics were collected at in-person examinations followed by seven-day accelerometry. Among individuals without diabetes, Cox proportional hazards regression models (both age- and sex-adjusted, and then multivariable-adjusted for all candidate predictors) identified predictors of incident diabetes over a decade of follow-up, defined using clinical history or laboratory assessments.ResultsFour independent predictors were shared between FHS and HCHS/SOL. In each cohort, the multivariable-adjusted hazard of diabetes increased by approximately 50% for every ten-year increment of age and every five-unit increment of body mass index (BMI), and was 50–70% higher among hypertensive than among non-hypertensive individuals (all P < 0.01). Compared with full-time employment status, the multivariable-adjusted hazard ratio (HR) and 95% confidence interval (CI) for part-time employment was 0.61 (0.37,1.00) in FHS and 0.62 (0.41,0.95) in HCHS/SOL. Moderate-to-vigorous physical activity (MVPA) was an additional predictor in common observed in age- and sex-adjusted models, which did not persist after adjustment for other covariates (compared with MVPA ≤ 5 min/day, HR for MVPA level ≥ 30 min/day was 0.48 [0.31,0.74] in FHS and 0.74 [0.56,0.97] in HCHS/SOL). Additional predictors found in sex- and age-adjusted analyses among the FHS participants included male gender and lower education, but these predictors were not found to be independent of others in multivariable adjusted models, nor were they associated with diabetes risk among HCHS/SOL adults.ConclusionsThe same four independent predictors – age, body mass index, hypertension and employment status – were associated with diabetes risk across two disparate US populations. While the reason for elevated diabetes risk in full-time workers is unclear, the findings suggest that diabetes may be part of the work-related burden of disease. Our findings also support prior evidence that differences by gender and socioeconomic position in diabetes risk are not universally present across populations.

Creatinine-to-body weight ratio is a predictor of incident diabetes: a population-based retrospective cohort study

PurposeCreatinine to body weight (Cre/BW) ratio is considered the independent risk factor for incident type 2 diabetes mellitus (T2DM), but research on this relationship is limited. The relationship between the Cre/BW ratio and T2DM among Chinse individuals is still ambiguous. This study aimed to evaluate the correlation between the Cre/BW ratio and the risk of T2DM in the Chinese population.MethodsThis is a retrospective cohort study from a prospectively collected database. We included a total of 200,658 adults free of T2DM at baseline. The risk of incident T2DM according to Cre/BW ratio was estimated using multivariable Cox proportional hazards models, and a two-piece wise linear regression model was developed to find out the threshold effect.ResultsWith a median follow-up of 3.13 ± 0.94 years, a total of 4001 (1.99%) participants developed T2DM. Overall, there was an L-shaped relation of Cre/BW ratio with the risk of incident T2DM (P for non-linearity < 0.001). When the Cre/BW ratio (× 100) was less than 0.86, the risk of T2DM decreased significantly as the Cre/BW ratio increased [0.01 (0.00, 0.10), P < 0.001]. When the Cre/BW ratio (× 100) was between 0.86 and 1.36, the reduction in the risk of developing T2DM was not as significant as before [0.22 (0.12, 0.38), P < 0.001]. In contrast, when the Cre/BW ratio (× 100) was greater than 1.36, the reduction in T2DM incidence became significantly flatter than before [0.73 (0.29,1.8), P = 0.49].ConclusionThere was an L-shaped relation of Cre/BW ratio with incidence of T2DM in general Chinese adults. A negative curvilinear association between Cre/BW ratio and incident T2DM was present, with a saturation effect predicted at 0.86 and 1.36 of Cre/BW ratio (× 100).

Waist circumference and waist hip ratio as predictor of incident diabetes in young adults: A cross-sectional study

Waist circumference and waist hip ratio as predictor of incident diabetes in young adults: A cross-sectional study

C-reactive protein-to-albumin ratio and 8‐year incidence of type 2 diabetes: the Korean genome and epidemiology study

The C-reactive protein-to-albumin ratio (CAR) has been reported as a novel prognostic marker in serious illness and various inflammatory diseases. The aim of this study is to investigate the association of CAR with incidence risk of type 2 diabetes in adults without chronic disease. A total of 5904 participants aged 40 to 69years were selected from the Korean Genome and Epidemiology Study who were observed over 12years. Multivariable logistic regression was analyzed to examine the relationship between CAR tertiles and incident diabetes. The predictive power of new-onset diabetes by CAR and homeostasis model assessment-insulin resistance (HOMA-IR) were also measured using the random forest model. During a mean follow-up period of 7.6years, 701 subjects (11.9%) developed diabetes. Compared with the lowest CAR group, the highest CAR group was associated with incidence of diabetes (OR 1.60; 95% CI 1.24-1.89) after adjustment for other potential confounding factors. In the random forest model, CAR did not show a significant difference in prediction of new-onset diabetes compared with HOMA-IR (p = 0.561). CAR, which is a ratio of commonly used biomarkers and reflects both oxidative stress and antioxidants, is suggested as a predictor of incident diabetes.

366-P: Cystatin C Predicts Incident Diabetes in Angiographied Coronary Patients

Cystatin C is an established marker of renal function, and has also been found to be associated with cardiovascular disease. There is substantial overlap between risk factors for cardiovascular disease and type 2 diabetes; however, it is unclear whether cystatin C predicts new onset diabetes. This issue is addressed in the present study. We prospectively followed 481 consecutive nondiabetic patients undergoing coronary angiography for the evaluation of established or suspected stable coronary artery disease over a follow-up period of 5.5 ± 3.5 years. Overall, 135 patients (28.1%) newly developed diabetes. Cystatin C proved to be a strong predictor of incident diabetes univariately (standardized HR=1.80 [1.14-2.28], p=0.011) and after adjustment for age, gender, hypertension, smoking, LDL cholesterol, HDL cholesterol and fasting glucose (HR=1.86 [1.07-3.21], p=0.027). We conclude that cystatin C is a strong predictor of incident diabetes in angiographied coronary patients. Disclosure A. Mader: None. C. H. Saely: None. L. Sprenger: None. A. Vonbank: None. B. Larcher: None. M. Maechler: None. B. Mutschlechner: None. A. Leiherer: None. A. Muendlein: None. H. Drexel: None.

Abstract 17467: Early Vascular Aging Predicts the Incidence of Diabetes in Hypertensives

Introduction: Diabetes is associated with vascular aging. Arterial stiffness, a marker of vascular aging, is an independent predictor of cardiovascular events and mortality. However, the role of arterial stiffness in the incidence of diabetes has not been investigated. Hypothesis: We sought to investigate the role of carotid-femoral pulse wave velocity (PWV) in the prediction of incident diabetes in hypertensives and hypertensives under treatment with statins. Methods: 376 never-treated hypertensives (mean age 53±13 years, 175 females) without a known history of diabetes or cardiovascular disease at baseline, were included in the study. Markers of target organ damage [carotid-femoral PWV, aortic augmentation index corrected for heart rate (AIx@75) and estimated glomerular filtration rate (eGFR)] were evaluated at baseline in all patients. eGFR was estimated using the Cockcroft-Gault formula. Hemoglobin A1c (HbA1c) and blood glucose were measured in venous blood samples. Patients were followed-up prospectively for the incidence of diabetes as defined by the American Diabetes Association criteria. 139 patients received statins during follow-up. Results: During a median of 13.6 years follow-up, 55 patients (13.4%) patients were diagnosed with diabetes. In multivariable logistic regression analysis, higher PWV (Odds Ratio [OR] = 1.29, 95% Confidence intervals [CI]: 1.02-1.63, P = 0.034) was associated with a higher risk of incident diabetes, which was independent of relevant confounders. In further analysis, receiver operating characteristic (ROC) curves were generated to evaluate the ability of PWV to discriminate subjects with diabetes. The area under the curve (AUC) and 95% CIs of the ROC curve was AUC=0.67 (95% CI: 0.59-0.74, P&lt;0.001) for PWV. In the subgroup of patients under treatment with statins, higher PWV (OR = 1.69, 95% CI: 1.19-2.40, P = 0.004) was also independently associated with a higher risk of incident diabetes. AIx@75 was not associated with the incidence of diabetes. Conclusions: Higher arterial stiffness, a marker of early vascular aging, is associated with the incidence of diabetes and also can identify subjects under treatment with statins that are more likely to present with diabetes in the future.

Aortic stiffness and incident diabetes: the hard, bittersweet truth

Abstract Background/Introduction Aortic stiffness increases with advancing age and is a major risk factor for age-related morbidity and mortality. Aortic stiffness and glycaemic dysregulation are related; however, temporal relationships between aortic stiffness and incidence of diabetes have not been fully delineated. Purpose We sought to investigate the role of arterial stiffness in the prediction of incident diabetes. Methods 376 untreated hypertensive patients (mean age 52.6±12.5 years, 201 males) without known cardiovascular disease and without known history of diabetes, were included in the study. Markers of subclinical organ damage [carotid-femoral pulse wave velocity (PWV) and estimated glomerular filtration rate (eGFR)] were evaluated in all patients. eGFR was estimated using the Cockcroft-Gault formula. Hemoglobin A1c (HbA1c) and blood glucose were measured in venous blood samples. Patients were prospectively followed-up, for incidence of diabetes as defined by the American Diabetes Association criteria. Results During a median 13.5 years follow-up, forty-six patients (12.2%) patients were diagnosed with diabetes. In multivariable logistic regression analysis, only higher PWV (Odds Ratio [OR] = 1.271, 95% Confidence intervals [CI]: 1.002–1.612, P=0.048) was associated with higher risk of incident diabetes, which was independent of age, sex, pulse pressure, HbA1c, fasting blood glucose and eGFR. In further analysis, receiver operating characteristic (ROC) curves were generated to evaluate the ability of PWV to discriminate subjects with diabetes. The area under the curve (AUC) and 95% CIs of the ROC curve was AUC=0.66 (95% CI: 0.58–0.74, P=0.001) for PWV (Figure 1). Conclusions In our cohort, higher aortic stiffness was associated with higher risk of incident diabetes. Figure 1. ROC curve for the prediction of diabetes Funding Acknowledgement Type of funding source: None

Increased particle size of triglyceride remnant lipoproteins, but not their plasma concentration or lipid content, augment risk prediction of incident diabetes: prospective results from ELSA-Brasil

Abstract Importance Predicting risk of Type 2 Diabetes Mellitus (T2DM) accurately allows allocation of resources to prevent its development. Fasting blood triglycerides are highly predictive for T2DM. Triglyceride remnant lipoproteins (TRL) more accurately reflect pathophysiological changes that underlie progression to T2DM, such as pancreatic steatosis and inflammation. We hypothesized TRL-related factors could improve risk prediction for development of T2DM. Methods We included individuals aged 35–74 years from the ELSA-Brasil cohort who had HbA1c and an oral glucose tolerance test at baseline. Regression models were used to predict incident T2DM, starting with medical history, metabolic syndrome traits (age, sex, hypertension, waist circumference [WC], HbA1c, triglycerides) and hsCRP, adding TRL-related measurements, including plasma concentration, particle size, as well as cholesterol and triglyceride content. TRL features were measured by NMR spectroscopy. Discrimination was assessed with area under receiver operator curves (AUROCs). Results Among 4,466 individuals at-risk, there were 353 new cases of T2DM after 3.7 (SD=0.6) years follow-up. We derived an 8-variable model with AUROC 0.891 (95% CI: 0.870–0.913). Overall TRL-related markers did not improve predictive capacity for T2DM. However, TRL particle diameter (TRLZ) increased AUROC, particularly in individuals without glucose abnormalities at baseline (Hba1c &amp;lt;5.7%). In this subgroup, AUROC increased from 0.761 (95% CI: 0.739–0.798 – Baseline-model) to 0.823 (95% CI: 0.783–0.862 – TRLZ model) (p-value=0.00006). Consistently, the net reclassification improvent (NRI) of the model with TRLZ improved by 10.27% (95% CI: 1.0–24.1, p=0.00041). In subjects with pre-diabetes at baseline, TRLZ is highly correlated with obesity, insulin resistance and inflammation (sum of z-scores for WC + HOMA-IR + hsPCR: R2=0.25), but this was less important in individuals with Hba1c &amp;lt;5.7% (R2=0.15). Sensitivity analyzes confirmed the results with different inclusion criteria (pre-diabetes defined with TTGO only) and excluding patients diagnosed with DM2 incident based only on fasting blood glucose. Conclusions TRL particle diameter improves prediction of T2DM, particularly in subjects with no glycemic abnormalities at baseline. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Brazilian Ministry of Health (Department of Science and Technology), Ministry of Science, Technology and Innovation, and the National Council for Scientific and Technological Development (CNPq)

1460-P: Type 2 Diabetes Polygenic Score in Addition to Clinical Factors for Prediction of Diabetes Incidence in an Indigenous American Population

Background: Type 2 diabetes (T2D)-associated variants, derived from genome-wide association studies (GWAS), have largely been reproducible across populations, but there is limited information on how polygenic scores (PS) based on these variants add to clinical factors for predicting diabetes incidence, particularly in non-European populations. Methods: A longitudinal study of diabetes was conducted in an Indigenous study population native to the Southwestern U.S. At each exam, a 75-g oral glucose tolerance test was administered with measurement of fasting and 2-hour plasma glucose (FPG, 2hPG). Genotypes were available from a GWAS for 2783 participants aged ≥ 20 years without diabetes at baseline, with imputed genotypes based on whole genome sequence data from 296 individuals from the population. PSs for participants were constructed and weighted using genome-wide significant variants in a T2D GWAS meta-analysis in European-descent populations (n=245; Mahajan 2018). Survival analyses were conducted to predict diabetes incidence in 2 models: (1) age, sex, BMI, FPG; (2) age, sex, BMI, FPG, T2D PS. Area under the receiver-operating characteristic curve (AUC) was calculated using a nonparametric method for survival analysis. Results: 903 cases (32.5%) of diabetes occurred during 25,110 person-years of follow-up. The hazard ratio for T2D PS, controlled for age, sex, BMI and FPG, was 1.27 per SD (P=1.5×10-12). Cumulative incidence at 10 years was 0.076 in the lowest quartile for the prediction score based on clinical factors alone and 0.509 in the highest quartile. For the model including PS, corresponding values were 0.075 and 0.524. AUC was 0.710 for the model with clinical factors alone and 0.721 for the model including T2D PS. Conclusion: Weighted T2D PSs based on 245 variants were informative in predicting T2D incidence in Indigenous Americans; however, the improvement in prediction beyond clinical factors alone was modest. Disclosure L.E. Wedekind: None. S. Kobes: None. W. Hsueh: None. L. Baier: None. W.C. Knowler: None. A. Mahajan: None. M.I. McCarthy: Advisory Panel; Self; Illumina. Consultant; Self; Eli Lilly and Company, Novo Nordisk Inc., Zoe Global Ltd. Employee; Self; Genentech, Inc. Research Support; Self; AbbVie Inc., Merck &amp; Co., Inc., Sanofi-Aventis, Servier, Takeda UK. R.L. Hanson: None.

Waist hip ratio as predictor of incident diabetes in young adults

Obesity is associated with impaired glucose tolerance which is a risk factor for cardiovascular disease. Central obesity (approximated by waist/hip ratio) is more informative than general obesity (body mass index). Thus, central obesity markers can be used to predict diabetes. To find a correlation between blood sugar level and waist hip ratio in young adult males and females. A cross sectional study was conducted among 60 students (30 males and 30 females) of first year MBBS in the department of Physiology of Hind Institute of Medical Sciences. Their WHR was measured and their venous blood sample was drawn in fasting and 2 hr post lunch. Statistical analysis was done using SPSS 21. According to WHR criteria, post prandial blood sugar level was significantly raised in males ‘at risk level’ (WHR ≥ 0.90) as compared to males ‘below risk level’ (WHR ≤ 0.90). WHR is a good predictor of post prandial hyperglycemia and both are independent predictors of cardiovascular disease.

Validity of the FINDRISC as a prediction tool for diabetes in a contemporary Norwegian population: a 10-year follow-up of the HUNT study

ObjectiveThe Finnish Diabetes Risk Score (FINDRISC) is a recommended tool for type 2 diabetes prediction. There is a lack of studies examining the performance of the current 0–26 point FINDRISC...

Chronic Sleep Disturbances Are Predictive of Incident Diabetes in Older AdultsߞVariations by Gender and Race/Ethnicity

Study Objectives: The current study was conducted to determine whether self-reported chronic sleep disturbances are predictive of incident diabetes in older adults, as well as to determine variations by gender and race/ethnicity. Methods: 7446 participants from the Health and Retirement Study, a nationally-representative longitudinal cohort study of U.S. adults, were followed for eight years, between 20and 2014. Chronic sleep disturbance was defined as self-reported trouble falling asleep or staying asleep “most of the time.” Diabetes was based on self-reported doctor’s diagnosis or a Hemoglobin A1C value &amp;gt;=6.5mg/dl. Hazard ratios were calculated for baseline and on-going sleep disturbances. Results: The average age of participants was 63.5 years. Close to 30% of men and 40% of women reported having a chronic sleep disturbance at baseline. The cumulative incidence of diabetes was 17.7% among men and 15.2% among women. Both men and women who developed diabetes were more likely to report chronic sleep disturbances at baseline than those who did not develop diabetes (men: 32.2% vs. 27.3%; women: 44.2% vs. 36.0%). Women were more likely to develop diabetes within eight years than men after adjustment for demographic covariates (women: HR 1.40 95% CI 1.19-1.63; men HR 1.27 95% CI 0.98-1.66). Black and Hispanic men and women with chronic sleep disturbances had a greater likelihood of developing diabetes within eight years than white men and women. Conclusions: Self-reported chronic sleep disturbance is an independent predictor of incident diabetes in women. The likelihood of developing diabetes among those with chronic sleep disturbances is greater for women than men and greater for blacks and Hispanics than non-black/Hispanic older adults. This finding has both public health and clinical relevance in an aging society. Disclosure H. Guyer: None.

The Visceral Adiposity Index Is a Significantly Stronger Predictor of Incident Diabetes in Men than in Women

The visceral adiposity index (VAI) is a validated tool for the evaluation of visceral adiposity, using waist circumference, serum triglycerides, age and gender to diagnose this metabolic abnormality. We aimed at investigating the power of the VAI to predict diabetes incidence in men and in women. We prospectively recorded diabetes incidence in a large consecutive cohort of 1282 patients undergoing coronary angiography for the evaluation of established or suspected coronary artery disease who did not have diabetes at baseline. The VAI was calculated according to the Amato formula; diabetes was diagnosed according to ADA criteria. At baseline, the VAI score did not differ significantly between men (n=845) and women (230±199 vs. 238±239; p=0.247). Prospectively, 133 patients newly developed diabetes during a follow-up period of 3.7±0.9 years; diabetes incidence did not differ significantly between men and women (13.3 vs. 9.8%; p=0.093. The VAI significantly predicted incident diabetes in men but not in women both univariately (standardized odds ratios (ORs) of 1.71 [1.40-2.10]; p&amp;lt;0.001 and 1.09 [0.81-1.49]; p=0.565, respectively) and after multivariate adjustment (standardized adjusted ORs 1.56 [1.24-1.97]; p&amp;lt;0.001 and 1.[0.75-1.46]; p=0.790, respectively). An interaction term VAI x gender was statistically significant (p=0.017), indicating that the VAI was a significantly stronger predictor of diabetes incidence among men than women. We conclude that the VAI is a significantly stronger predictor of diabetes incidence in men than in women. Disclosure C.H. Saely: None. A. Vonbank: None. C. Heinzle: None. D. Zanolin: None. B. Larcher: None. A. Mader: None. A. Leiherer: None. A. Muendlein: None. H. Drexel: None.

Fatty liver index is a predictor of incident diabetes in patients with prediabetes: The PREDAPS study.

ObjectivesWe evaluated the ability of the Fatty Liver Index (FLI), a surrogate marker of hepatic steatosis, to predict the development of type 2 diabetes (T2D) at 3 years follow-up in a Spanish cohort with prediabetes from a prospective observational study in primary care (PREDAPS).MethodsFLI was calculated at baseline for 1,142 adult subjects with prediabetes attending primary care centers, and classified into three categories: FLI <30 (no steatosis), FLI 30–60 (intermediate) and FLI ≥60 (hepatic steatosis). We estimated the incidence rate of T2D in each FLI category at 3 years of follow-up. The association between FLI and incident T2D was calculated using Cox regression models adjusted for age, sex, educational level, family history of diabetes, lifestyles, hypertension, lipid profile and transaminases.ResultsThe proportion of subjects with prediabetes and hepatic steatosis (FLI ≥60) at baseline was 55.7%. The incidence rate of T2D at 3 years follow-up was 1.3, 2.9 and 6.0 per 100 person-years for FLI<30, FLI 30->60 and FLI ≥60, respectively. The most significant variables increasing the risk of developing T2D were metabolic syndrome (hazard ratio [HR] = 3.02; 95% confidence interval [CI] = 2.14–4.26) and FLI ≥60 (HR = 4.52; 95%CI = 2.10–9.72). Moreover, FLI ≥60 was independently associated with T2D incidence: the HR was 4.97 (95% CI: 2.28–10.80) in the base regression model adjusted by sex, age and educational level, and 3.21 (95%CI: 1.45–7.09) in the fully adjusted model.ConclusionsFLI may be considered an easy and valuable early indicator of high risk of incident T2D in patients with prediabetes attended in primary care, which could allow the adoption of effective measures needed to prevent and reduce the progression of the disease.

A Mobile App for Identifying Individuals With Undiagnosed Diabetes and Prediabetes and for Promoting Behavior Change: 2-Year Prospective Study

BackgroundTo decrease the burden of diabetes in society, early screening of undiagnosed diabetes and prediabetes is needed. Integrating a diabetes risk score into a mobile app would provide a useful platform to enable people to self-assess their risk of diabetes with ease.ObjectiveThe objectives of this study were to (1) assess the profile of Diabetes Risk Score mobile app users, (2) determine the optimal cutoff value of the Finnish Diabetes Risk Score to identify undiagnosed diabetes and prediabetes in the Chinese population, (3) estimate users’ chance of developing diabetes within 2 years of using the app, and (4) investigate high-risk app users’ lifestyle behavior changes after ascertaining their risk level from the app.MethodsWe conducted this 2-phase study among adults via mobile app and online survey from August 2014 to December 2016. Phase 1 adopted a cross-sectional design, with a descriptive analysis of the app users’ profile. We used a Cohen kappa score to show the agreement between the risk level (as shown in the app) and glycated hemoglobin test results. We used sensitivity, specificity, and area under the curve to determine the optimal cutoff value of the diabetes risk score in this population. Phase 2 was a prospective cohort study. We used a logistic regression model to estimate the chance of developing diabetes after using the app. Paired t tests compared high-risk app users’ lifestyle changes.ResultsA total of 13,289 people used the app in phase 1a. After data cleaning, we considered 4549 of these as valid data. Most users were male, and 1811 (39.81%) had tertiary education or above. Among them, 188 (10.4%) users agreed to attend the health assessment in phase 1b. We recommend the optimal value of the diabetes risk score for identifying persons with undiagnosed diabetes and prediabetes to be 9, with an area under the receiver operating characteristic curve of 0.67 (95% CI 0.60-0.74), sensitivity of 0.70 (95% CI 0.58-0.80), and specificity of 0.57 (95% CI 0.47-0.66). At the 2-year follow-up, people in the high-risk group had a higher chance of developing diabetes (odds ratio 4.59, P=.048) than the low-risk group. The high-risk app users improved their daily intake of vegetables (baseline: mean 0.76, SD 0.43; follow-up: mean 0.93, SD 0.26; t81=–3.77, P<.001) and daily exercise (baseline: mean 0.40, SD 0.49; follow-up: mean 0.54, SD 0.50; t81=–2.08, P=.04).ConclusionsThe Diabetes Risk Score app has been shown to be a feasible and reliable tool to identify persons with undiagnosed diabetes and prediabetes and to predict diabetes incidence in 2 years. The app can also encourage high-risk people to modify dietary habits and reduce sedentary lifestyle.