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Diabetes 54:166-174, 2005
© 2005 by the American Diabetes Association, Inc.

Predictors of and Longitudinal Changes in Insulin Sensitivity and Secretion Preceding Onset of Type 2 Diabetes

Valeriya Lyssenko1, Peter Almgren1, Dragi Anevski1,2, Roland Perfekt1, Kaj Lahti3, Michael Nissén4, Bo Isomaa5, Björn Forsen6, Nils Homström7, Carola Saloranta8,9, Marja-Riitta Taskinen8, Leif Groop1, and Tiinamaija Tuomi8,9 for the Botnia Study Group

1 Department of Endocrinology, Wallenberg Laboratory, University Hospital MAS, Lund University, Malmö, Sweden
2 Fraunhofer Chalmers Centre, Gothenburg, Sweden
3 Vasa Health Care Center, Vasa, Finland
4 Vasa Central Hospital, Vasa, Finland
5 Jakobstad Hospital, Jakobstad, Finland
6 Närpes Care Health Center, Närpes, Finland
7 Korsholm Health Care Center, Korsholm, Finland
8 Department of Medicine, Helsinki University Hospital, Helsinki, Finland
9 Folkhälsan Research Center, Helsinki, Finland

Identification of individuals at high risk of developing type 2 diabetes is a prerequisite for prevention of the disease. We therefore studied risk factors predicting type 2 diabetes in the Botnia Study in western Finland. A total of 2,115 nondiabetic individuals were prospectively followed with repeated oral glucose tolerance tests. After a median follow-up of 6 years, 127 (6%) subjects developed diabetes. A family history of diabetes (hazard ratio [HR] 2.2, P = 0.008), BMI (HR for comparison of values below or above the median 2.1, P < 0.001), waist-to-height index (2.3, P < 0.001), insulin resistance (2.1, P = 0.0004), and ß-cell function adjusted for insulin resistance (2.7, P < 0.0001) predicted diabetes. Marked deterioration in ß-cell function with modest changes in insulin sensitivity was observed during the transition to diabetes. The combination of FPG ≥5.6 mmol/l, BMI ≥30 kg/m2, and family history of diabetes was a strong predictor of diabetes (3.7, P < 0.0001). Of note, using FPG ≥6.1 mmol/l or 2-h glucose ≥7.8 mmol/l did not significantly improve prediction of type 2 diabetes. In conclusion, a marked deterioration in ß-cell function precedes the onset of type 2 diabetes. These individuals can be identified early by knowledge of FPG, BMI, and family history of diabetes.

Address correspondence and reprint requests to Valeriya Lyssenko, MD, PhD, Department of Endocrinology, Wallenberg Laboratory, University Hospital MAS, 205 02 Malmö, Sweden. E-mail: valeri.lyssenko{at}endo.mas.lu.se


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