In the March 2017 issue of Diabetes, Muka et al. (1) report observational evidence for the associations of endogenous steroid sex hormones (including testosterone and estradiol) and sex hormone–binding globulin with the risk of type 2 diabetes in women. They used individual-level data (from the Rotterdam Study in the Netherlands) and also performed a meta-analysis of previous epidemiological observations including up to 1,912 incident cases (1). While the authors have meticulously taken into account several sensitivity analyses and noted sources of heterogeneity across the studies (e.g., variability in the measurement of biomarkers), such observational evidence can raise some questions regarding the potential implications for the prediction of type 2 diabetes (2,3). As previously reported (2), there are many studies on biomarkers that explore their predictive relevance, which remains inconclusive for diabetes prediction. In a clinical setting, the prediction of type 2 diabetes risk is based on validated and simple risk scores, and biomarker tests are commonly offered to those who benefit most (such as people classified at high risk for the disease) (2). Given that early identification of diabetes risk provides an opportunity to introduce preventive interventions to stop or delay disease onset, future studies should focus on which biomarkers may help to better characterize the disease risk and health care decision making. When implementing and reporting a meta-analysis of observational studies, hierarchical summary receiver operating characteristic curves and Fagan nomograms can be used to investigate the potential value of information on sex hormones for the prediction of type 2 diabetes and related outcomes (4). This approach will help to obtain the pooled estimates of sensitivity and specificity of hormone thresholds for the development of outcomes of interest and to develop clinically relevant insights derived from the observed associations. Consequently, findings from risk predictions can be translated to the potential utility in real practice.

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Duality of Interest. No potential conflicts of interest relevant to this article were reported.

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