NMR-Based Index Helps Identify Normal-Weight Individuals at High Risk for Type 2 Diabetes

Data suggests that a new, nuclear magnetic resonance (NMR)-based diabetes risk index would improve risk assessment and intervention for at-risk patients, potentially preventing or slowing their progression to type 2 diabetes.

LipoScience, Inc. (Raleigh, NC, USA), a company pioneering a new field of personalized NMR diagnostics, has announced data demonstrating the utility of its NMR-based diabetes risk index (DRI) in identifying normal-weight individuals at high risk of progressing to type 2 diabetes (T2D). The data, presented in a poster session (1417-P) at the 74th Scientific Sessions of the American Diabetes Association (ADA) on June 13–17, 2014, in San Francisco (CA, USA), suggest that the DRI may enable more timely and focused risk assessment and intervention in at-risk individuals regardless of body weight.

"Many clinicians are challenged about how to effectively manage patients with 'intermediate' blood glucose levels ranging from 90–110 mg/dL, as within this range there is often ambiguity as to whether a patient will progress to type 2 diabetes," commented Margery Connelly, PhD, Vice President, Translational Research of LipoScience, "The ambiguity is particularly pronounced in normal-weight individuals, who do not typically present with overtly visible risk factors. With our simple-to-use diabetes risk index, clinicians now have a tool to help them identify high-risk patients."

The DRI test uses LipoScience's proprietary NMR-derived markers of insulin resistance, inflammation, and potentially impaired B-cell function to determine a patient's risk of progressing to T2D. The DRI provides a means to assess this risk at any given level of fasting plasma glucose (FPG), glycosylated hemoglobin (HbA1c), or body mass index (BMI).

To develop the DRI assay, the investigators used NMR data collected at baseline from participants in the Multi-Ethnic Study of Atherosclerosis (MESA), then used data from the Insulin Resistance Atherosclerosis Study (IRAS) to verify its ability to stratify a patient's risk of progressing to T2D. To determine whether the DRI score was capable of identifying high-risk normal-weight individuals, they compared the percentage of patients progressing to T2D across quartiles of the DRI score in three BMI categories – normal weight (BMI <25), overweight (BMI 25–30), and obese (BMI ≥30). Regardless of the BMI category, as the DRI score increased there was an increased likelihood of becoming diabetic, even for subjects whose BMI was within the normal range. Furthermore, DRI added predictive value independently of BMI in both the MESA and IRAS populations.

"Even in the absence of being overweight, DRI can help healthcare providers make a more timely prediction of whether a patient is on the path toward developing diabetes, before blood glucose reaches so-called 'pre-diabetes' levels," noted William C. Cromwell, MD, Chief Medical Officer of LipoScience, "By providing more precise risk-assessment information, DRI can facilitate initiation of individualized patient management strategies, while motivating high-risk patients to take steps to lower their risk."

The 2014 ADA meeting also featured additional poster presentations (1196-P, 1345-P, 1415-P), in which LipoScience's NMR spectroscopy was used to develop inflammation and diabetes risk assessment tools.

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