A new potential way to predict diabetes risk

A new study suggests that high levels of a blood protein may indicate that a person is at greater risk for type 2 diabetes. The study included about 400 people in their 70s. None of them had diabetes at the beginning of the study, but at the six-year mark, 135 did. People who had high levels of a protein called fetuin-A were twice as likely to develop diabetes as were people with the lowest levels of the protein. Below, my colleague, Dr. Robert Shmerling, comments on this interesting study.

It makes sense for researchers to explore novel ways to predict who will develop diabetes—a common and serious disease. Knowing who is at increased risk will give doctors a chance to test and treat them early. It may even allow prevention of the disease before it develops.

The best predictors we have now are the well-established risk factors for diabetes. They include:

·         Family history

·         Excess weight

·         Advanced age

·         Past history of diabetes during pregnancy (gestational diabetes)

·         A history of "pre-diabetes" or glucose intolerance—This means you've had above-normal blood sugar levels, but not high enough to qualify as diabetes.

·         Use of certain drugs (especially corticosteroids)

But predicting who will develop diabetes using these criteria is far from perfect. People with diabetes may have few of these risk factors, or none. Many people with risk factors never develop diabetes.

That's why the results of a new study published July 9, 2008, in the Journal of the American Medical Association, could be quite important. California researchers found a link between levels of a protein (called fetuin-A) and the risk of type 2 diabetes in older adults.

The study followed more than 400 people in their 70s. None had diabetes at the start of the study. Over a 6-year period, 135 developed the disease. Those with the highest levels of fetuin-A had twice the rate of new diabetes as those with the lowest levels.

Fetuin-A levels did not seem to be linked to other predictors, such as obesity. The protein was a good predictor of risk by itself.

I had never heard of fetuin-A before reading about this research. However, if other research confirms these findings, fetuin-A tests could become as common as cholesterol tests. If your fetuin-A is high, your doctor may tell you how you can reduce your risk of diabetes well before it develops.

In the meantime, use what we know about diabetes to reduce your risk of developing the disease and the health problems it causes:

·         Check your body mass index (BMI) to determine your ideal body weight. Do all you can to maintain your weight in the ideal range.

·         Change your diet. Pay attention to portion size and total calorie intake.

·         Get moving. Regular exercise (along with a healthy diet) can make it easier to keep your weight in an ideal range. Some people have slightly high blood sugar (often called "pre-diabetes"). For them, diet and exercise can delay the onset of diabetes.

·         Take medicine. For people with pre-diabetes, metformin (Glucophage) has been shown to reduce the development of diabetes.

·         Take care of your diabetes. If you've already been diagnosed with diabetes, you may be able to prevent or delay other health problems:

o        Keep your blood sugar under good control. You may have to cut calories and avoid sweets. Be sure to get regular exercise. You also may need medicine.

o        Lose excess weight. Some people taking medicines for diabetes (including insulin) are able to stop them after weight loss.

o        Reduce your risk of heart and artery disease. Don't smoke. Bring your cholesterol and blood pressure under control, with medicines if necessary. These are among the most important steps to take.

o        Take an aspirin each day (unless your doctor says otherwise).

o        Take medicine (ACE inhibitors or angiotensin-receptor blockers) to protect the kidneys. This is especially important if you have high blood pressure or evidence of diabetic kidney damage.

o        See your eye doctor, podiatrist and dentist regularly.

o        Get vaccinated against influenza (the flu) and pneumococcal pneumonia.

It's too early to say whether measuring fetuin-A should be part of assessing the risk of diabetes. And this test is not yet widely available. However, if you have a family history of diabetes or other risk factors for the disease, keep an eye on this story in the future.

Julie K. Silver, M.D., is an assistant professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School. She is also the Chief Editor of Books for Harvard Health Publications.

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