Diabetes Metab J.  2020 Apr;44(2):295-306. 10.4093/dmj.2019.0020.

Multiple Biomarkers Improved Prediction for the Risk of Type 2 Diabetes Mellitus in Singapore Chinese Men and Women

• Wang Y
• Koh WP
• Sim X
• Yuan JM
• Pan A

• KMID: 2502411
• DOI: http://doi.org/10.4093/dmj.2019.0020

Abstract

Background
Multiple biomarkers have performed well in predicting type 2 diabetes mellitus (T2DM) risk in Western populations. However, evidence is scarce among Asian populations.
Methods
Plasma triglyceride-to-high density lipoprotein (TG-to-HDL) ratio, alanine transaminase (ALT), high-sensitivity Creactive protein (hs-CRP), ferritin, adiponectin, fetuin-A, and retinol-binding protein 4 were measured in 485 T2DM cases and 485 age-and-sex matched controls nested within the prospective Singapore Chinese Health Study cohort. Participants were free of T2DM at blood collection (1999 to 2004), and T2DM cases were identified at the subsequent follow-up interviews (2006 to 2010). A weighted biomarker score was created based on the strengths of associations between these biomarkers and T2DM risks. The predictive utility of the biomarker score was assessed by the area under receiver operating characteristics curve (AUC).
Results
The biomarker score that comprised of four biomarkers (TG-to-HDL ratio, ALT, ferritin, and adiponectin) was positively associated with T2DM risk (P trend <0.001). Compared to the lowest quartile of the score, the odds ratio was 12.0 (95% confidence interval [CI], 5.43 to 26.6) for those in the highest quartile. Adding the biomarker score to a base model that included smoking, history of hypertension, body mass index, and levels of random glucose and insulin improved AUC significantly from 0.81 (95% CI, 0.78 to 0.83) to 0.83 (95% CI, 0.81 to 0.86; P=0.002). When substituting the random glucose levels with glycosylated hemoglobin in the base model, adding the biomarker score improved AUC from 0.85 (95% CI, 0.83 to 0.88) to 0.86 (95% CI, 0.84 to 0.89; P=0.032).
Conclusion
A composite score of blood biomarkers improved T2DM risk prediction among Chinese.

Keyword

Biomarkers; Case-control studies; Diabetes mellitus, type 2; Epidemiology; Prognosis

Figure

• 

  Fig. 1 Odds ratio for type 2 diabetes mellitus by the biomarker score and percentages of participants in each biomarker score category. The solid line represents the point estimates of relative risk for the association between the biomarker score and the risk of incident type 2 diabetes mellitus using conditional logistic regression model after adjustment for age at blood taken (years), smoking (never, ever smoker), alcohol intake (never, weekly, or daily), weekly activity (<0.5, 0.5 to 3, and ≥4 hr/wk), education level (primary school and below, secondary or above), history of hypertension (yes, no), body mass index (kg/m2), fasting status (yes, no), and levels of random glucose and random insulin, and the dotted lines represent the upper and lower bound of 95% confidence interval (CI). The light grey bars represent the percentage of controls within each category for the biomarker score (n=485), and the dark grey bars represent the percentage of cases within each category for the biomarker score (n=485).

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