Four-biomarker score a useful predictor of type 2 diabetes risk in Chinese adults
A weighted score that consists of four blood biomarkers—triglyceride-to-high density lipoprotein (TG-to-HDL) ratio, alanine transaminase (ALT), ferritin and adiponectin—is strongly associated with the risk of type 2 diabetes mellitus (T2DM) among Chinese adults living in Singapore, as shown in a study.
“[O]ur finding suggests that this score is a promising … screening tool to identify at-risk individuals for targeted diet and lifestyle intervention,” according to the investigators.
To create the weighted biomarker score, the investigators used data from the Singapore Chinese Health Study. They measured plasma TG-to-HDL ratio, ALT, high-sensitivity C-reactive protein (hs-CRP), ferritin, adiponectin, fetuin-A and retinol-binding protein 4 (RBP4) in 485 T2DM patients and 485 matched controls.
Metabolic profiles appeared to be worse in T2DM patients than in controls. Patients were more likely to be heavier and hypertensive, and showed increased concentration of blood biomarkers that were T2DM risk factors (ALT, TG, TG-to-HDL ratio, hs-CRP, ferritin, fetuin-A, RBP4 and HbA1c) and lower levels of protective biomarkers (adiponectin and HDL-C). [Diabetes Metab J 2019;doi:10.4093/dmj.2019.0020]
In a multivariable logistic regression model, four biomarkers showed strong involvement in the risk of T2DM and were used to create the score. Positive associations were noted for TG-to-HDL ratio (odds ratio [OR], 1.48, 95 percent confidence interval [CI], 1.21–1.82), ALT (OR, 1.30, 95 percent CI, 1.08–1.57) and ferritin (OR, 1.24, 95 percent CI, 1.04–1.48). Conversely, adiponectin had a protective effect (OR per quartile increment, 0.72, 95 percent CI, 0.60–0.86).
The four-biomarker score was significantly associated with T2DM risk (p-trend<0.001). Individuals in the highest quartile of the score were 12 times as likely as those in the lowest quartile to develop T2DM (OR, 12.0, 95 percent CI, 5.43–26.6).
Furthermore, T2DM risk prediction significantly improved when the biomarker score was added to a base model that included smoking, history of hypertension, body mass index (BMI), and levels of random glucose and insulin, with the area under the curve [AUC] increasing from 0.81 (95 percent CI, 0.78–0.83) to 0.83 (95 percent CI, 0.81–0.86; p=0.002).
When random glucose levels were replaced with HbA1c in the base model, adding the biomarker score improved AUC from 0.85 (95 percent CI, 0.83–0.88) to 0.86 (95 percent CI, 0.84–0.89; p=0.032).
“[T]he biomarker score significantly improved the T2DM prediction, and it correctly reassigned 32.0 percent [patients] to higher T2DM risk and 15.5 percent controls to lower T2DM risk,” the investigators noted.
“To our best knowledge, only one cross-sectional study has conducted joint analysis of multiple biomarkers for identifying T2DM in a Chinese population,” which develops T2DM at lower body mass index (BMI), has lower β-cell function and is more insulin resistant compared with the Western populations, they said. [BMJ Open 2011;1:e000191]
Taken together, the present data confirm the usefulness of joint analysis of multiple biomarkers as a tool to predict T2DM risk.
“Future studies are warranted to further validate these findings in other populations to determine cutoff values for more precise risk prediction of T2DM and to investigate the upstream factors that influence the levels of the biomarkers, as well as to evaluate the cost-effectiveness of the biomarker score in the local setting and other Asian countries,” the investigators added.