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Do Adiponectin Levels Predict Prediabetes?

Adiponectin level is a powerful risk marker of incident prediabetes in healthy white and black adults with a parental history of type 2 diabetes, study findings showed.

Adiponectin, a protein that plays a role in regulating glucose levels, was the subject of a recent study. Adiponectin levels are known to be inversely associated with the risk of type 2 diabetes (T2DM) and also to show ethnic disparities. This study set out to examine whether adiponectin levels predict prediabetes risk in diverse populations. Researchers assessed baseline adiponectin levels in relation to incident prediabetes in a longitudinal biracial cohort.

According to the study authors, adiponectin, the most abundant secreted product of adipocytes, is strongly correlated with cardiometabolic risk. Several previous studies have shown that adiponectin levels are positively associated with insulin sensitivity, and inversely associated with the development of diabetes and progression from prediabetes to type 2 diabetes (T2DM). The development of T2DM in individuals at genetic risk is punctuated by a variable interlude of prediabetes, defined as impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT). Persons with IGT or IFG develop T2DM at an annual rate of approximately 10%. Although the evidence linking adiponectin to diabetes risk is strong, the chronology of the association between adiponectin status and glucose homeostasis has not been fully determined. Specifically, the potential role of adiponectin in modulating early glucose abnormalities during transition from normoglycemia to prediabetes is a subject of significant interest. Since both the prevalence of T2DM and the distribution of plasma levels of adiponectin display significant racial/ethnic disparities, it is important to assess the fidelity of the interaction between adiponectin and dysglycemia in a diverse population.

The Pathobiology of Prediabetes in A Biracial Cohort study followed non-diabetic offspring of parents with T2DM for the occurrence of prediabetes, defined as impaired fasting glucose and/or impaired glucose tolerance. Assessments at enrollment and during follow-up included a 75 g oral glucose tolerance test, anthropometry, biochemistries (including fasting insulin and adiponectin levels), insulin sensitivity and insulin secretion. Logistic regression was used to evaluate the contribution of adiponectin to risk of progression to prediabetes.

Among the 333 study participants (mean (SD) age 44.2 (10.6) year), 151(45.3%) were white and 182 (54.8%) were black. During approximately 5.5 (mean 2.62) years of follow-up, 110 participants (33%) progressed to prediabetes (N=100) or T2DM (N=10), and 223 participants (67%) were non-progressors. The mean cohort adiponectin level was 9.41+5.30 μg/mL (range 3.1–45.8 μg/mL); values were higher in women than men (10.3+5.67 μg/mL vs 7.27+3.41 μg/mL, p<0.0001) and in white than black offspring (10.7+5.44 μg/mL vs 8.34+4.95  μg/mL, p<0.0001). Adiponectin levels correlated inversely with adiposity and glycemia, and positively with insulin sensitivity and high-density lipoprotein cholesterol levels. Baseline adiponectin strongly predicted incident prediabetes: the HR for prediabetes per 1 SD (approximately 5 μg/mL) higher baseline adiponectin was 0.48 (95% CI 0.27 to 0.86, p=0.013).

Researchers concluded that in this large sample of healthy African-American and Caucasian offspring of parents with type 2 diabetes, higher adiponectin levels are associated with a favorable cardiometabolic profile, characterized by lower measures of adiposity and glycemia, lower triglyceride levels, and higher high-density lipoprotein cholesterol levels.

Further, the researchers concluded that their study, using the rigorous methodologies of hyperinsulinemic euglycemic clamp and frequently sampled intravenous glucose tolerance test, demonstrates that plasma adiponectin levels are correlated directly with insulin sensitivity and inversely with insulin secretion in healthy African-Americans and Caucasians.

The researchers note their study is the first to demonstrate that baseline plasma adiponectin levels predict progression from normoglycemia to prediabetes in African-Americans and Caucasians, despite the known ethnic differences in adiponectin levels.

The study authors conclude that, among healthy African Americans and European Americans with parental history of T2DM enrolled in the POP-ABC study, baseline adiponectin levels were inversely related to the risk of incident prediabetes. This predictive relationship was evident, despite gender and ethnic differences in baseline adiponectin levels. Based on our finding, it can be predicted that interventions that boost adiponectin levels may offer protection against the risk of dysglycemia, regardless of gender or ethnicity.Thus, the well-known association of adiponectin with diabetes risk is evident at a much earlier stage in pathogenesis, during transition from normoglycemia to prediabetes.

Practice Pearls:

  • African Americans and European Americans with parental history of T2DM baseline adiponectin levels were inversely related to the risk of incident prediabetes.
  • This study is the first to demonstrate that baseline plasma adiponectin levels predict progression from normoglycemia to prediabetes.
  • Adiponectin level is a powerful risk marker of incident prediabetes.

Researched and prepared by Steve Freed, BPharm, Diabetes Educator, Publisher and reviewed by Dave Joffe, BSPharm, CDE

 

Adiponectin and adiponectin receptors in insulin resistance, diabetes, and the metabolic syndrome. J Clin Invest 2006;116:178492. doi:10.1172/JCI29126 Jiang Y, et al. BMJ Open Diabetes Res Care. 2016;doi:10.1136/bmjdrc-2016-000194. March 18, 2016