title: Strength of association for incident diabetes risk factors according to diabetes case definitions: the Atherosclerosis Risk in Communities Study.
abstract: Prospective epidemiologic studies have characterized major risk factors for incident diabetes by a variety of diabetes case definitions. Whether different definitions alter the association of diabetes with risk factors is largely unknown. Using 1987-1998 data from the ongoing Atherosclerosis Risk in Communities (ARIC) Study, the authors assessed the relation of traditional risk factors with 3 different diabetes case definitions and 4 fasting glucose categories. They compared the study protocol case definition with 2 nested case definitions, self-reported diabetes and a multiple-evidence definition. Significant differences in risk factor associations by case definition and by screening cutpoints were observed. Specifically, the magnitude of the association between the risk factors (baseline metabolic syndrome, fasting glucose, blood pressure, body mass index, and serum insulin) and incident diabetes differed by case definition. Associations with these risk factors were weaker with a case definition based on self-report compared with other definitions. These results illustrate the potential limitations of case definitions that rely solely on self-report or those that incorporate measured glucose values to ascertain undiagnosed cases. Although the ability to identify risk factors of diabetes was consistent for the case definitions studied, tests of novel risk factors may result in different estimates of effect sizes depending on the definition used.
authors.affiliation: Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55909, USA. bielinski.suzette@mayo.edu
authors.forename: Suzette J
authors.initials: SJ
authors.lastname: Bielinski
authors.forename: James S
authors.initials: JS
authors.lastname: Pankow
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Rasmussen-Torvik
authors.forename: Kent
authors.initials: K
authors.lastname: Bailey
authors.forename: Man
authors.initials: M
authors.lastname: Li
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Selvin
authors.forename: David
authors.initials: D
authors.lastname: Couper
authors.forename: Gabriela
authors.initials: G
authors.lastname: Vazquez
authors.forename: Frederick
authors.initials: F
authors.lastname: Brancati
mesh_terms: D050197:Atherosclerosis / Q000453:epidemiology / Q000209:etiology; D001786:Blood Glucose / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D015340:Epidemiologic Research Design; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D057566:Self Report; D014481:United States / Q000453:epidemiology
chemical_list: D001786:Blood Glucose