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Using Handgrip Strength to Predict the Future Risk of T2D

Dec 5, 2020
Editor: Steve Freed, R.PH., CDE

Author: Destiny Reed, PharmD. Candidate, Florida A&M College of Pharmacy and Pharmaceutical Sciences

Handgrip strength could be an uncomplicated and inexpensive means of predicting a patient’s future risk of type 2 diabetes. 

Though there are many risk factors associated with T2D, it can be difficult to identify individuals at an increased risk for the condition. Handgrip strength is a strong indicator of adverse vascular outcomes and mortality, and is independently associated with a reduced risk of T2D. Though this association has been established, there is no evidence to support the potential use of handgrip strength measurements in predicting the risk of T2D.  


This study aimed to identify whether handgrip strength could be used to improve the risk prediction of T2D. Data from the Kuopio Ischemic Heart Disease (KIHD) study, a study investigating risk factors for vascular disease and related chronic diseases, was utilized in this analysis. This population-based prospective cohort study included adults between the ages of 53 and 74. After baseline examinations were completed, participants were reassessed at four years, 11 years, and 20 years after study entry. For this analysis, participants were excluded if they had a diabetes history or had no data available for handgrip strength. The average of two handgrip strength measurements was taken using a hand dynamometer at baseline and follow-up. All measurements were taken using the participant’s dominant hand and normalized to account for the influence of the individual’s body weight. Incidence of T2D was identified by either a documented or self-reported fasting blood glucose ≥126 mg/dL, a 2-hour OGTT of ≥200 mg/dL, or use of antihyperglycemic medication at follow-up.  

Baseline characteristics, including sociodemographic and lifestyle factors, medical history, and medication use, were self-reported using questionnaires. The median follow-up time was 18.1 yrs. The association of risk between handgrip strength and the incidence of T2D was analyzed using Cox proportional hazard models. The C-index, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to assess whether handgrip strength measurements to conventional risk factors improved T2D risk predictions using two different models. -2 log-likelihood test was used to test the differences in the C-index value. 

A total of 776 participates were included in the analysis, and 59 cases of T2D were reported after follow-up. Patients with higher fasting blood glucose, weight, waist circumference, BMI, and lower handgrip strength were more likely to develop T2D. 

After adjustment for age, sex, established risk factors, and other potential confounders, the risk of T2D was 51% lower per one standard deviation increase in the normalized handgrip strength (HR: 0.49; 95% CI 0.31 – 0.80). Overall, normalized handgrip strength was inversely associated with T2D risk. A strong inverse association between handgrip strength and T2D risk was seen in women, while no significant risk was seen in men.   

In both T2D risk prediction models, the difference in C-index showed a slight increase in risk prediction after the addition of the normalized handgrip strength (DESIR: C-index change 0.0383; 95% CI -0.0047 to 0.0814, p=0.08) (KORA S4/F4: C-index change 0.0182; 95% CI -0.0079 to 0.0443, p=0.17). Both models demonstrated a significant increase in C-index change for the difference when assessed using the -2 log-likelihood test (DESIR: p=0.01 for the difference in -2 log-likelihood) (KORA S4/F4: p=0.03 for the difference in -2 log-likelihood). 

This study provided evidence that handgrip strength could improve risk prediction of T2D and confirmed that it is inversely associated with T2D risk, with the risk being modified by sex. The data suggest that handgrip strength could be a more uncomplicated and inexpensive means of predicting the risk of T2D in patients. Participants in this study were older and predominately Caucasian; therefore, results may not be generalizable to other ages and ethnicities. The incidence of T2D was also low in this study. Further evaluation would be needed to assess whether the same results can be observed in a larger population.  

Practice Pearls: 

  • Per one standard deviation increase in the normalized handgrip strength measurements, the risk of T2D was reduced by 49%. 
  • The addition of normalized handgrip strength to conventional risk factors showed a slightly improved risk prediction of T2D. 
  • The data suggest that handgrip strength could be a more uncomplicated and inexpensive means of predicting the risk of T2D in patients. 


KunutsorSetor K. et al. “Handgrip Strength Improves Prediction Of Type 2 Diabetes: A Prospective Cohort Study”. Annals Of Medicine, vol 52, no. 8, 2020, pp. 471-478. Informa UK Limited, https://doi.org/10.1080/07853890.2020.1815078. Accessed October 21, 2020. 


Destiny Reed, PharmD. Candidate, Florida A&M College of Pharmacy and Pharmaceutical Sciences