Predictors of rapid type 2 diabetes progression revealed
medwireNews: Researchers have used data from the UK Biobank to uncover predictors of rapid progression to insulin dependence, including pulse rate and maternal diabetes.
The results were presented at the 54th EASD Annual Meeting in Berlin, Germany, last week, by Xuan Wang from the University of Dundee, UK.
The type of diabetes was self-reported by the Biobank participants, but all were genotyped, so the researchers used a genetic risk score to exclude those likely to have type 1 diabetes, therefore requiring them to limit their analysis to Caucasian participants. From the initial 18,837 people with diabetes, they identified 429 who had type 2 diabetes of less than 10 years’ duration but who required insulin (ie, had progressed rapidly) and 429 matched participants whose diabetes had progressed slowly.
There was no significant difference in type 2 diabetes genetic risk score between the two groups; however, on multivariate analysis, a high risk score was associated with an increased risk for rapid progression to insulin. The team also found that risk scores were more tightly distributed in the fast- than slow-progressing people.
Fast-progressing patients were significantly younger at diagnosis and had a higher BMI and waist-to-hip ratio, which Wang said is consistent with the team’s previous work using the GoDARTS population.
The use of statins and fibrates was also associated with an increased risk for progression, but she suggested this was likely due to confounding by indication, that is, rapid progression triggering intensive treatment strategies, although she also noted the established slightly increased risk for diabetes associated with statin treatment.
People with rapid progression had significantly higher pulse rate than those who progressed more slowly. Wang said this association has not previously been shown, but is in line with the reported association between heart rate and diabetes risk. The rapid progression group also had significantly lower blood pressure than the slow progression group.
Finally, people in the rapid progression group were 1.47-fold more likely to have been exposed to maternal diabetes.
There is an already established associated between maternal diabetes and risk for diabetes in the offspring, but Wang stressed that “what is new here is our data indicate an impact of maternal diabetes on offspring diabetes progression.”
The finding requires replication in a different cohort, she noted.
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