Multiple Biomarker Prediction of Type 2 Diabetes

Type 2 diabetes is predictable and preventable. Obesity, familial diabetes, and higher-than-normal blood glucose levels are well-known risk factors for development of type 2 diabetes by middle age; recent prediction models have incorporated these with other readily measurable features of metabolic syndrome (elevated blood pressure, low HDL cholesterol, and elevated triglycerides) to generate validated prediction rules (1–3). In clinical care, a patient of European descent with a family history of diabetes, obesity, and features of metabolic syndrome is at ∼25-fold increased risk to develop type 2 diabetes in the next few years relative to a patient without these characteristics (4). With regard to the public health of the population, these characteristics very reliably discriminate groups at relatively high risk from those at low risk (3). Once high-risk patients are identified, those adherent to a program of ∼30 min of moderate physical activity per day and weight loss of 5–10% of initial body weight can expect that risk for type 2 diabetes will be reduced by at least 50% relative to patients not following a therapeutic lifestyle program (5).

The relatively simple recognition of pre-diabetes and prevention of its transformation to diabetes may be well-known to the readers of Diabetes Care. However, some will raise concerns regarding practical problems obtaining fasting or oral glucose tolerance blood tests, the high intraindividual variability in blood glucose levels (6), the fact that fewer than 20% of white people with obesity will progress to diabetes over subsequent years (7), and the fact that the genetics that presumably underlie familial type 2 diabetes do not seem to add much to its predictability (8). Perhaps less well-known is the expanding understanding of pathophysiological axes beyond the classic triumvirate of β-cell, skeletal muscle, and liver (9) that contribute to the pre-diabetic state. Abnormal adipocyte …