Objective: Evaluate the ability of the Diabetes Risk Index (DRI) to predict incident type 2 diabetes mellitus (T2DM) in a large cohort.
Methods: The DRI was developed by combining the 6 lipoprotein subfractions in the Lipoprotein Insulin Resistance Index (LP-IR) and the branched chain amino acids valine and leucine, all of which have been shown previously to be associated with future T2DM. DRI scores were calculated in a total of 6134 nondiabetic men and women in the Prevention of Renal and Vascular End-Stage Disease (PREVEND) Study. Cox proportional hazards regression was used to evaluate the association of DRI scores with incident T2DM.
Results: During a median follow-up of 8.5 years, 306 new T2DM cases were ascertained. In analyses adjusted for age and sex, there was a significant association between DRI scores and incident T2DM with the hazard ratio (HR) for the highest versus lowest tertile being 7.49 (95% confidence interval: 5.01-11.19), P <0.001. After additional adjustment for BMI, family history of T2DM, alcohol consumption, diastolic blood pressure, total cholesterol, triglycerides, HDL cholesterol and HOMA-IR, the HR was attenuated but remained significant (HR 1.67 [1.01-2.76], P = 0.04). Similar results were obtained when DRI was analyzed as HR per 1 SD increase (HR 1.37 [1.14-1.65], P = 0.001). The Kaplan-Meier plot demonstrated that patients in the highest tertile of DRI scores presented at higher risk (p-value for log-rank test <0.001).
Conclusions: Higher DRI scores are associated with an increased risk of T2DM. The association is independent of clinical risk factors for T2DM including HOMA-IR, BMI and conventional lipids.
J. Flores-Guerrero: None. M.A. Connelly: Employee; Self; LabCorp. I.Y. Shalaurova: None. E.G. Gruppen: None. J.D. Otvos: Employee; Self; LabCorp. R.P.F. Dullaart: None. S.J.I. Bakker: None.