Family History of Diabetes Linked to Prediabetes

Nancy A. Melville

August 23, 2013

A family history of diabetes increases the risk for prediabetes; however, the effect seems significant mainly in people who are not obese, according to a meta-analysis published online August 21 in Diabetologia.

"This might indicate that the effect of a family history of diabetes on prediabetes becomes readily measurable only when not overshadowed by strong risk factors such as obesity," the authors write.

A positive family history of type 2 diabetes is well-known to be a risk factor for the disease, nearly doubling the risk for diabetes among offspring; however, research on the risk for prediabetes or for any subcategories such as impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), has been lacking.

For the study, a research team with the German Center for Diabetes Research, Neuherberg, led by Andreas Fritsche, MD, evaluated data on 8106 nondiabetic patients from 4 study centers. Among the patients, 5482 had normal glucose tolerance and 2624 had IFG and/or IGT.

Whereas a family history of diabetes was shown to be significantly associated with the risk for prediabetes, by about 40% (95% confidence interval [CI], 1.27–1.54), the risk dropped to 26% when a multivariable adjustment accounted for participants' age, sex, and body mass index (BMI).

In assessing the various prediabetes subtypes, the authors found the lowest odds ratio for a risk was among those with isolated IGT (odds ratio [OR], 1.25), compared with isolated IFG (OR, 1.37) or a combined IFG and IGT (OR, 1.64).

"Given that impaired glucose tolerance implies a higher conversion rate to diabetes than impaired fasting glucose, its weaker association with a family history of diabetes was surprising," the researchers wrote.

"As impaired fasting glucose is predominantly associated with hepatic insulin resistance, while impaired glucose tolerance is often associated with muscle insulin resistance as well as impaired insulin secretion, one may speculate that a family history of diabetes might have a stronger link to hepatic insulin resistance."

Overall, when adjusted for BMI, the association between a family history of diabetes and prediabetes was evident only in participants who were not obese (BMI <30 kg/m2).

The findings suggest that a patient's family history should play an important role on diabetes risk assessments, the authors said.

"Most diabetes risk questionnaires, including the German Diabetes Risk Score and the Finnish Findrisk, heavily rely on markers of obesity.

"The predictive value of such diabetes risk questionnaires is improved by adding information on family history of diabetes. This improvement could be more striking in the nonobese."

The study was funded by grant from the German Federal Ministry of Education and Research to the German Center for Diabetes Research. The authors have reported no relevant financial relationships.

Diabetologia. Published online August 21, 2013. Full text

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