Novel Risk Prediction Model Identifies Patients at Increased Risk for Diabetes

Novel biochemical risk prediction models were found to accurately identify patients with prediabetes and diabetes who may benefit from lifestyle modifications, according to study results presented at the National Lipid Association (NLA) Scientific Sessions 2023, held in Atlanta, Georgia, between June 1 and June 4, 2023.

Researchers developed a diabetes risk prediction model and assessed its ability in accurately identifying individuals with prediabetes and diabetes who would benefit from lifestyle modifications.

Data for the model were sourced from the longitudinal Framingham Offspring Study. The study included 2414 patients (mean age, 58 years) who were diabetes-free at baseline. Variables entered into the model included cholesterol-lowering medication use, parental history of diabetes, body mass index; and high-density lipoprotein cholesterol, triglycerides, total cholesterol, glycated serum albumin, insulin, adiponectin, and glucose levels. The researchers assessed the occurrence of new diabetes during a mean follow-up period of 10 years.

Diabetes risk models were subsequently developed using step-wise multivariate analysis and applied to a large fasting population (N=133,764) along with lifestyle modification. Homeostasis model assessment of insulin resistance (HOMA_IR) and insulin sensitivity and production (HOMA_β) were calculated in all patients.

Among the fasting population, 2017 (7.5%) were diabetic (predicted 10-year diabetes risk rate, 100.0%), 9738 (36.2%) were prediabetic (10-year risk rate, 5.5%), and 56.3% were neither (10-year risk rate, 0.3%).

There were significant differences in the degree of insulin resistance and insulin production among patients with diabetes indicated via HOMA evaluations. Further analysis showed that some patients with diabetes required insulin therapy due to markedly decreased insulin production.

For patients with diabetes, 10.7% received a lifestyle modification plan. Following receipt, 8.2% of patients were no longer diabetic vs 3.4% of control patients (P <.001). For patients with prediabetes, 12.0% requested a lifestyle modification plan. After receipt, the risk for diabetes among these patients decreased from 5.7% to 3.1%, with no change in diabetes risk observed in control patients (P <.001).

Overall, lifestyle modifications were associated with reduced insulin resistance but did not result in significantly increased insulin production. In addition, both HOMA-IR and HOMA_β were effective for identifying patients who require insulin therapy due to reduced insulin production.

According to the researchers, “Our biochemical model was useful in targeting pre-diabetic and diabetic subjects for lifestyle change.”