Prediction of diabetes with body mass index, oral glucose tolerance test and islet cell autoantibodies in a regional population

Objective. Our aim was to test the hypothesis that a combination of markers for Type 1 diabetes (glutamate decarboxylase and IA-2 autoantibodies) and for Type 2 diabetes [oral glucose tolerance test (OGTT) and body mass index (BMI)], would predict clinical diabetes in a regional population. Design. A population-based follow-up cohort study. Setting. Participants visited the primary health care centre in Lycksele, S weden in 1988-92. Participants, A cohort of 2278 subjects (M/F 1149/1129) who were studied at follow-up in 1998, At base line there were 2314 subjects (M/F 1167/1147) w ho participated in the Vasterbotten Intervention Program on their birthday when turning either 30, 40, 50 or 60 years of age, Main outcome measurements. A clinically diagnosed diabetes at follow-up whe n the medical records were reviewed for diagnosis of diabetes, At base line , the participants were subjected to a standard OGTT and their BMI determin ed along with the autoantibodies. Results. At follow-up. 42/2278 (1.8%, 95% CI 1.2-2.3) (M/F 23/19) had devel oped diabetes: 41 subjects were clinically classified with Type 2 and one w ith Type 1 diabetes. There was no significant relation between autoantibody levels at base line and diabetes at follow-up. Stepwise multiple logistic regression showed that the odds ratio for developing diabetes was 10.8 (95% CI 6.3-18.9) in subjects in the fourth quartile of BMI (BMI > 27) compared with 7.8 (95% CI 4.8-12.6) in the fourth quartile of 2-h plasma glucose (> 7.5 mmol L-1) and 7.2 (95% CI 4.8-11.4) in the fourth quartile of the fast ing plasma glucose (>5.6 mmol L-1). Conclusion. Islet cell autoantibodies did not predict diabetes at follow-up . BMI measured at base line was as effective as 2-h plasma glucose and fast ing plasma glucose to predict diabetes in this adult population.