Additional contribution of emerging risk factors to the prediction of the risk of type 2 diabetes: evidence from the Western New York Study.
OBJECTIVE
To examine whether several biomarkers of endothelial function and inflammation improve prediction of type 2 diabetes over 5.9 years of follow-up, independent of traditional risk factors.


METHODS
A total of 1,455 participants from the Western New York Study, free of type 2 diabetes at baseline, were selected. Incident type 2 diabetes was defined as fasting glucose exceeding 125 mg/dl or on antidiabetic medication at the follow-up visit. Sixty-one people who met the case definition (8/1,000 person years) were identified and individually matched with up to three controls on gender, race, year of study enrollment, and baseline fasting glucose (<110 or 110-125 mg/dl). Biomarkers were measured from frozen baseline samples.


RESULTS
In conditional logistic regression analyses accounting for traditional risk factors (age, family history of diabetes, smoking, drinking status, and BMI), E-selectin was positively related (3rd vs. 1st tertile: odds ratio 2.77, 95% confidence interval (CI) 1.13-6.79, P for linear trend = 0.023) and serum albumin was inversely related (3rd vs. 1st tertile: odds ratio 0.36, 95% CI 0.14-0.93, P for linear trend = 0.032) to type 2 diabetes incidence. The addition of E-selectin, serum albumin, and leukocyte count to a basic risk factor model including only traditional risk factors significantly increased the area under the receiver operating characteristic curve (AUC) (from 0.646 to 0.726, P value = 0.04).


CONCLUSIONS
These results support the role of endothelial dysfunction and subclinical inflammation as important mechanisms in the etiopathogenesis of type 2 diabetes; moreover, they indicate that novel biomarkers may improve the prediction of type 2 diabetes beyond the use of traditional risk factors alone.
Stranges
Saverio
S
Department of Social and Preventive Medicine, The State University of New York at Buffalo, Buffalo, New York, USA.
Rafalson
Lisa B
LB
Dmochowski
Jacek
J
Rejman
Karol
K
Tracy
Russell P
RP
Trevisan
Maurizio
M
Donahue
Richard P
RP
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000453:epidemiology; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology* / Q000503:physiopathology*; D019040:E-Selectin / Q000097:blood; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000503:physiopathology*; D007958:Leukocyte Count; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D011237:Predictive Value of Tests; D012372:ROC Curve; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism
D015415:Biomarkers; D019040:E-Selectin; D012709:Serum Albumin