Abstract
Background
The Finnish Diabetes Risk Score (FINDRISC) (FR) was developed in Europe to predict type 2 diabetes mellitus (T2DM) risk without need of laboratory tests. Since T2DM is associated with low-grade inflammation, we evaluated the ability of FR to predict either T2DM or elevation in high sensitivity C- reactive protein (CRP), a biomarker of higher cardiovascular risk.
Methods
We included 41,880 subjects (age 41.9±9.7 years; 31% female) who underwent health evaluation between 2008 and 2016 in a single centre in Brazil. The cross-sectional association of FR with T2DM and hs-CRP ≥2.0 mg/L was tested in multivariate models. During a follow-up of 5±3 years, the predictive value of FR for incident T2DM and elevated CRP was tested, respectively, in 10,559 non-diabetic individuals and a subset of 2,816 subjects with baseline low CRP, using logistic regression. Models were adjusted for confounders such as sex, use of medications for dyslipidemia, smoking, and baseline plasma levels of glucose, creatinine and lipids. A receiver operating characteristic (ROC) curve was used to evaluate the discriminative and predictive values of FR for T2DM and CRP ≥2.0 mg/L.
Results
In the cross-sectional analysis, 1,146 (2.7%) individuals had T2DM. In a subgroup of 26,667 individuals in which CRP was measured, 9,229 (34.6%) had CRP ≥2.0 mg / L. During follow-up, there were 364 cases (3.5%) of incidental T2DM, and in the subgroup in which CRP was reassessed (n=2,816 individuals), there were 520 individuals (18.5%) with CRP ≥2.0 mg/L. FR was associated with either T2DM or elevated CRP in cross sectional analysis (respectively, OR 1.24, 95% CI: 1.23–1.26, P<0.001; and OR 1.10, 95% CI: 1.09–1.11, P<0.001; per FR unit), and in longitudinal analysis (respectively OR 1.17, 95% CI: 1.14–1.20, P<0.001; and OR 1.04, 95% CI: 1.02–1.07, P<0.001; per FR unit). In comparison with individuals with low FR, those with moderate, high and very high values showed significant and proportional increases of 3 to 22 fold in the chance of current DMT2 (P<0.001) and 2 to 4 fold in the chance of high CRP (P<0.001). During follow-up, these increases were 2 to 8 fold in the chance of incidental T2DM (P<0.001) and 1.3 to 2 fold in the chance of high CRP (P<0.005). AUC from cross-sectional analysis for DMT2 and CRP ≥2.0 mg/L were respectively 0.82 (95% CI 0.80–0.83) and 0.63 (95% CI 0.63–0.64), and in longitudinal analysis 0.79 (95% CI 0.77–0.82) and 0.54 (95% CI 0.52–0.58), respectively.
Conclusion
FR was associated with the presence and onset of DMT2 and low-grade inflammation, but it predicted better T2DM risk than low-grade inflammation. Therefore, this inexpensive score can be useful for screening and prediction of T2DM. In addition, elevated serum inflammation in individuals with higher FR, may help explain the increased cardiovascular risk in this subset of patients.
Funding Acknowledgement
Type of funding source: None
The Finnish Diabetes Risk Score (FINDRISC) and incident diabetes and low-grade inflammation