title: A pattern of unspecific somatic symptoms as long-term premonitory signs of type 2 diabetes: findings from the population-based MONICA/KORA cohort study, 1984-2009.
abstract: BACKGROUND
  Unspecific symptoms often proceed a serious chronic disease condition long before the onset of the disease. The role of an unspecific premonitory symptom (UPMS) pattern as premonitory signs of subsequent type 2 diabetes mellitus (T2DM) diagnosis independent of established cardio-metabolic risk factors is unclear and therefore was examined in the present study.
  
  
  METHODS
  The study population consisted of 10,566 participants aged 25-74 years at baseline drawn from the population-based MONICA/KORA Cohort Study conducted in 1984-2009 in the Augsburg region (Germany). Unspecific premonitory symptoms were assessed following the Somatic Symptom Scale-8 (SSS-8). The impact of the score on T2DM risk within a mean follow-up time of 16 years was estimated by Cox regression.
  
  
  RESULTS
  Within follow-up, 974 newly diagnosed T2DM cases were observed. The risk for T2DM increased by a hazard ratio (HR) of 1.03 (95% CI 1.01-1.04, p value < 0.001) for a one unit increase of the UPMS score in a Cox model adjusted for age, sex and survey. Additional adjustment for cardio-metabolic risk factors attenuated this effect (HR = 1.02) but significance remained (p value = 0.01).
  
  
  CONCLUSIONS
  Suffering from an elevated burden of unspecific somatic symptoms is associated with T2DM long before the onset and independent of established cardio-metabolic risk factors. Further research is needed to obtain insight in potential underlying pathophysiological mechanisms.
authors.forename: Jens
authors.initials: J
authors.lastname: Baumert
authors.forename: Christa
authors.initials: C
authors.lastname: Meisinger
authors.forename: Karoline
authors.initials: K
authors.lastname: Lukaschek
authors.forename: Rebecca Thwing
authors.initials: RT
authors.lastname: Emeny
authors.forename: Ina-Maria
authors.initials: IM
authors.lastname: Rückert
authors.forename: Johannes
authors.initials: J
authors.lastname: Kruse
authors.affiliation: Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr, 1, Neuherberg 85764, Germany. ladwig@helmholtz-muenchen.de.
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Ladwig
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology*; D018450:Disease Progression; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000453:epidemiology / Q000503:physiopathology*; D015994:Incidence; D008019:Life Style; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires