High levels of amino acids may predict type 2 diabetes

Researchers find that the elevated readings indicate development of the disease 12 years before the first symptoms appear.

By Carolyne Krupa — Posted April 4, 2011

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By measuring levels of certain molecules in blood, physicians soon may be able to predict a patient's likelihood of developing type 2 diabetes more than a decade before the first symptoms appear.

Researchers have identified five amino acids linked to an increased chance of developing the disease, according to a study published online March 20 in Nature Medicine.

Such indicators could give physicians much stronger tools in predicting diabetes risk and preventing development of the disease than traditional risk factors such as obesity and family history, said Robert R. Henry, MD. He is president of medicine and science at the American Diabetes Assn. and professor of medicine at the University of California, San Diego, School of Medicine.

"It's something that we really badly need because of the epidemic prevalence of type 2 diabetes," Dr. Henry said.

More than 25.8 million Americans (8.3% of the population) have diabetes, with type 2 diabetes making up 90% to 95% of new cases, according to the Centers for Disease Control and Prevention. About 1.9 million people older than 20 were diagnosed with type 2 diabetes in 2010.

Identifying diabetes risk earlier would allow physicians to encourage patients to adopt preventive measures such as lifestyle changes, significantly reducing incidence of the disease, said Thomas Wang, MD, lead study author and associate professor of medicine at Harvard Medical School and Massachusetts General Hospital in Boston.

"These findings could provide insight into metabolic pathways that are altered very early in the process leading to diabetes," he said. "They also raise the possibility that, in selected individuals, these measurements could identify those at highest risk of developing diabetes so that early preventive measures could be instituted."

Finding indicators of diabetes

For the first part of the study, researchers analyzed data from the Framingham Offspring Study. Of 2,422 healthy participants initially examined in 1991 and 1995, 201 developed type 2 diabetes within 12 years. Researchers analyzed blood samples from 189 diabetes patients and 189 nondiabetes patients.

They found elevated levels of the branched-chain amino acids leucine, isoleucine and valine and the aromatic amino acids phenylalanine and tyrosine in participants who later developed diabetes.

In a replication study involving 326 participants in the Malmo Diet and Cancer Study, researchers confirmed the results by identifying elevated levels of leucine, valine, tyrosine and phenylalanine in 163 participants who later developed type 2 diabetes.

"The fact that it's predictive in a longitudinal study could have major implications down the road," Dr. Henry said.

Further analysis showed that individuals with the highest levels of three of the most predictive amino acids were four to five times more likely to develop diabetes within 12 years than those with the lowest levels.

Previous studies found a link between elevated levels of certain amino acids in patients who are obese or insulin-resistant, but this is the first study to look at whether amino acid levels could be used to predict future development of the disease, Dr. Wang said.

More research is needed to better understand the implications of the study before results are likely to be applied to clinical practice, said Robert Gerszten, MD, the study's senior author and director of Clinical and Translational Research for Massachusetts General Hospital's Heart Center.

Scientists still need to explore why the high levels of amino acids occur in people later diagnosed with diabetes, he said.

The next step is determining whether elevation of amino acids contributes to development of the disease, or whether the high levels are a result of other factors that lead to the disease, said Dr. Gerszten, associate professor of medicine at Harvard Medical School.

"The next thing we are interested in looking at is what is cart and what is horse," he said.

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External links

"Metabolite profiles and the risk of developing diabetes," Nature Medicine, published online March 20 (link)

Diabetes Public Health Resource, Centers for Disease Control and Prevention (link)

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