Pre-diabetic screening cuts global health costs

According to WHO, cardiovascular diseases (CVD) kill more people each year than any other disease. The extensive occurrence of CVD is directly related to lifestyle with high blood pressure, obesity and diabetes being considered among major risk factors.

EASD, ADA and the Endocrine Society are working together to improve understanding of how obesity relates to type 2 diabetes. A working group comprised of 32 experts in the field met in January 2011 to discuss this issue. Four major questions regarding this relationship were identified:

• Why is it that all people who develop obesity do not develop type 2 diabetes?
• What are the mechanisms responsible for obesity and insulin resistance resulting in beta-cell de-compensation and, if and when obesity prevention ensues, can we expect to see a reduction in the incidence of type 2 diabetes?
• How does the length of time an individual has had type 2 diabetes relate to the benefits of weight reduction through lifestyle changes, weight loss drugs and/or bariatric surgery and the effects on beta cell function and glucose control?
• What is necessary for regulatory approval of medications and possibly surgical approaches for the prevention of type 2 diabetes in obesity?

Prof. Steven Kahn at the University of Washington suggested the adoption of a chronic disease model linking obesity to diabetes care.

High blood glucose is associated with an increased risk of developing cardiovascular complications in type 2 diabetics. Glycosylation of proteins leads to vascular stiffness, inflammation and oxidative stress and glucose lowering therapies have been shown to be more beneficial for cardiovascular health compared to lipid lowering therapies in retrospective studies. Several drug companies presented results from glucose lowering therapies in early clinical phase trials at last years EASD meeting in Lisbon, Portugal.

The increasing prevalence for type 2 diabetes puts a significant burden on global health care, therefore justifying pre-diabetic screenings from a cost-effective perspective. However, impaired glucose metabolism occurs late in the disease progression and glucose alone does not give a complete picture of metabolic disorders arising from obesity, insulin resistance, beta-cell dysfunction and chronic inflammation.

Lyssenko and coworkers have validated a multi-marker model for prediction of type 2 diabetes. A Diabetes Risk Score (DRS) was developed on the Inter99 cohort and validated on the Botnia cohort. The DRS is based on seven circulating biomarkers, all associated with the pathogenesis of type 2 diabetes. The authors conclude that individually, no single marker improves upon current clini­cal tools, but the combination of biomarkers in a single score provides a more accurate assessment of T2DM risk than other methods.

Mercodia provides immunoassays for assessment of health conditions associated with pre-diabetes and the metabolic syndrome.

Diabetes & Cardiovascular Disease

Mercodia tools for risk assessment

Adiponectin ELISA – insulin sensitivity assessment

Proinsulin ELISA and Insulin ELISA – proinsulin-to-insulin ratio for determination of beta-cell status

Oxidized LDL ELISA – measurement of oxidative stress

MPO ELISA – marker of inflammation

Lyssenko et al. (2012) Diab Vasc Dis Res 9:59-67