Use of Multiple Metabolic and Genetic Markers to Improve the Prediction of Type 2 Diabetes: the EPIC-Potsdam Study

  1. Matthias B. Schulze, DRPH1,2,
  2. Cornelia Weikert, MD2,3,
  3. Tobias Pischon, MD2,
  4. Manuela M. Bergmann, PHD2,
  5. Hadi Al-Hasani, PHD4,
  6. Erwin Schleicher, PHD5,
  7. Andreas Fritsche, MD5,
  8. Hans-Ulrich Häring, MD5,
  9. Heiner Boeing, PHD2 and
  10. Hans-Georg Joost, MD4
  1. 1Public Health Nutrition Unit, Technische Universität München, Freising, Germany;
  2. 2Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany;
  3. 3Institute for Social Medicine, Epidemiology, and Health Economics, Charité University Medicine, Berlin, Germany;
  4. 4Department of Pharmacology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany;
  5. 5Division of Endocrinology, Diabetology, Nephrology, Vascular Disease and Clinical Chemistry, the Department of Internal Medicine, University of Tübingen, Tübingen, Germany.
  1. Corresponding author: Matthias B. Schulze, matthias.schulze{at}wzw.tum.de.

Abstract

OBJECTIVE We investigated whether metabolic biomarkers and single nucleotide polymorphisms (SNPs) improve diabetes prediction beyond age, anthropometry, and lifestyle risk factors.

RESEARCH DESIGN AND METHODS A case-cohort study within a prospective study was designed. We randomly selected a subcohort (n = 2,500) from 26,444 participants, of whom 1,962 were diabetes free at baseline. Of the 801 incident type 2 diabetes cases identified in the cohort during 7 years of follow-up, 579 remained for analyses after exclusions. Prediction models were compared by receiver operatoring characteristic (ROC) curve and integrated discrimination improvement.

RESULTS Case-control discrimination by the lifestyle characteristics (ROC-AUC: 0.8465) improved with plasma glucose (ROC-AUC: 0.8672, P < 0.001) and A1C (ROC-AUC: 0.8859, P < 0.001). ROC-AUC further improved with HDL cholesterol, triglycerides, γ-glutamyltransferase, and alanine aminotransferase (0.9000, P = 0.002). Twenty SNPs did not improve discrimination beyond these characteristics (P = 0.69).

CONCLUSIONS Metabolic markers, but not genotyping for 20 diabetogenic SNPs, improve discrimination of incident type 2 diabetes beyond lifestyle risk factors.

Footnotes

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

    • Received February 3, 2009.
    • Accepted July 12, 2009.
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  1. Published online before print August 31, 2009, doi: 10.2337/dc09-0197 Diabetes Care November 2009 vol. 32 no. 11 2116-2119
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