title: Novel risk factors and the prediction of type 2 diabetes in the Atherosclerosis Risk in Communities (ARIC) study.
abstract: OBJECTIVE
  The objective of this study was to determine potential added value of novel risk factors in predicting the development of type 2 diabetes beyond that provided by standard clinical risk factors.
  
  
  METHODS
  The Atherosclerosis Risk in Communities (ARIC) Study is a population-based prospective cohort study in four U.S. communities. Novel risk factors were either measured in the full cohort or in a case-control sample nested within the cohort. We started with a basic prediction model, previously validated in ARIC, and evaluated 35 novel risk factors by adding them independently to the basic model. The area under the curve (AUC), net reclassification index (NRI), and integrated discrimination index (IDI) were calculated to determine if each of the novel risk factors improved risk prediction.
  
  
  RESULTS
  There were 1,457 incident cases of diabetes with a mean of >7.6 years of follow-up among 12,277 participants at risk. None of the novel risk factors significantly improved the AUC. Forced expiratory volume in 1 s was the only novel risk factor that resulted in a significant NRI (0.54%; 95% CI: 0.33-0.86%). Adiponectin, leptin, γ-glutamyl transferase, ferritin, intercellular adhesion molecule 1, complement C3, white blood cell count, albumin, activated partial thromboplastin time, factor VIII, magnesium, hip circumference, heart rate, and a genetic risk score each significantly improved the IDI, but net changes were small.
  
  
  CONCLUSIONS
  Evaluation of a large panel of novel risk factors for type 2 diabetes indicated only small improvements in risk prediction, which are unlikely to meaningfully alter clinical risk reclassification or discrimination strategies.
authors.affiliation: Department of Pediatrics, Division of Academic General Pediatrics, University of Minnesota, Minneapolis, MN, USA. rayno007@umn.edu
authors.forename: L A
authors.initials: LA
authors.lastname: Raynor
authors.forename: James S
authors.initials: JS
authors.lastname: Pankow
authors.forename: Bruce B
authors.initials: BB
authors.lastname: Duncan
authors.forename: Maria I
authors.initials: MI
authors.lastname: Schmidt
authors.forename: Ron C
authors.initials: RC
authors.lastname: Hoogeveen
authors.forename: Mark A
authors.initials: MA
authors.lastname: Pereira
authors.forename: J Hunter
authors.initials: JH
authors.lastname: Young
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
mesh_terms: D052242:Adiponectin / Q000378:metabolism; D050197:Atherosclerosis / Q000150:complications* / Q000453:epidemiology* / Q000235:genetics / Q000378:metabolism; D016022:Case-Control Studies; D003176:Complement C3 / Q000378:metabolism; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000209:etiology* / Q000235:genetics / Q000378:metabolism; D005169:Factor VIII / Q000378:metabolism; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D005838:Genotype; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000378:metabolism; D020738:Leptin / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D052242:Adiponectin; D003176:Complement C3; D020738:Leptin; D018799:Intercellular Adhesion Molecule-1; D005169:Factor VIII