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Lipids may know you have diabetes before your blood sugar does

Toronto, April 13, 2016

By Marc Dodsworth

Dr. Sagar Dugani
Dr. Sagar Dugani

Lipids, the fat-like substances found in the blood, may be able to predict whether someone is at risk of developing diabetes before their blood glucose changes.

That finding was published today in the journal JAMA Cardiology in a paper exploring why the popular cholesterol-lowering statin drugs were associated with a higher risk of developing Type 2 diabetes. Was it something about the drug or would it be possible to identify which people were at greatest risk of developing diabetes?

The researchers, including Dr. Sagar Dugani, a clinical fellow in general internal medicine at St. Michael’s Hospital, found that looking at six different characteristics of the particles that carry lipids in the bloodstream accurately predicted who would develop diabetes sooner than the typical test measuring blood glucose.

Significantly, the lipid test was accurate both for people taking statin drugs and those who were not, said Dr. Dugani, who worked on the research while at Brigham and Women’s Hospital/Harvard Medical School.

The researchers examined blood samples from the original JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) that found the association between statins and Type 2 diabetes. The current study involved almost 12,000 people from 1,315 sites in 26 countries.

Diabetes can be diagnosed by the A1C blood test that examines blood sugar levels over three months. The researchers used a new “lipoprotein insulin resistance score” or LPIR score that combines six measures of lipid particle size and concentration obtained from nuclear magnetic resonance spectroscopy.

“With the LPIR score, we can detect diabetes in patients much earlier,” said Dr. Dugani. “Many may think that they’re fine because their A1C test results were not alarming but their lipids could be telling a different story. In addition the LIPR doesn’t require people to fast overnight, which is easier for patients.”

Dr. Dugani said that with diabetes having reached epidemic proportions in Canada, anything that could be done to detect and manage it earlier would be better for patients and for the health-care system.

An estimated 3.4 million Canadians have Type 1 or Type 2 diabetes and that number is expected to reach 5 million by 2025. The Canadian Diabetes Association estimates that diabetes costs Canada $14 billion a year.

“Our findings indicate that a simple blood test that measures the size and number of cholesterol-carrying particles in the bloodstream predicts who goes on to develop future diabetes, even during statin treatment,” said Dr. Samia Mora, the senior investigator on this study, an associate professor at Harvard Medical School and a cardiologist at the Brigham and Women’s Hospital.

“This could provide an important opportunity for a woman or man with a normal blood glucose but an abnormal LPIR result to intervene early by following a healthy diet, losing weight and increasing physical activity, all known ways to reduce the chance of developing diabetes even years before getting a high glucose reading.”

This study received funding from the National Heart, Lung, and Blood Institute of the National Institutes of Health; AstraZeneca, which manufactures Crestor, the statin examined in the study; and LabCorp (LipoScience).

About St. Michael's Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.