Journal
DIABETOLOGIA
Volume 56, Issue 1, Pages 60-69Publisher
SPRINGER
DOI: 10.1007/s00125-012-2715-x
Keywords
Family history; Genetics; Type 2 diabetes
Categories
Funding
- NL Agency [IGE05012]
- Board of the UMC Utrecht
- Wellcome Trust [098051, 083270/Z/07/Z]
- Murcia Regional Government [6236]
- MRC [G0601261]
- European Union [LSHM-CT-2006-037197]
- MRC [MC_U106179474, MC_UU_12015/3, MC_UU_12015/4, MC_U106179473] Funding Source: UKRI
- Medical Research Council [MC_UU_12015/3, G0601261, MC_U106179473, G1000143, G0401527, MC_U106179474, MC_UU_12015/4] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0512-10114] Funding Source: researchfish
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Although a family history of type 2 diabetes is a strong risk factor for the disease, the factors mediating this excess risk are poorly understood. In the InterAct case-cohort study, we investigated the association between a family history of diabetes among different family members and the incidence of type 2 diabetes, as well as the extent to which genetic, anthropometric and lifestyle risk factors mediated this association. A total of 13,869 individuals (including 6,168 incident cases of type 2 diabetes) had family history data available, and 6,887 individuals had complete data on all mediators. Country-specific Prentice-weighted Cox models were fitted within country, and HRs were combined using random effects meta-analysis. Lifestyle and anthropometric measurements were performed at baseline, and a genetic risk score comprising 35 polymorphisms associated with type 2 diabetes was created. A family history of type 2 diabetes was associated with a higher incidence of the condition (HR 2.72, 95% CI 2.48, 2.99). Adjustment for established risk factors including BMI and waist circumference only modestly attenuated this association (HR 2.44, 95% CI 2.03, 2.95); the genetic score alone explained only 2% of the family history-associated risk of type 2 diabetes. The greatest risk of type 2 diabetes was observed in those with a biparental history of type 2 diabetes (HR 5.14, 95% CI 3.74, 7.07) and those whose parents had been diagnosed with diabetes at a younger age (< 50 years; HR 4.69, 95% CI 3.35, 6.58), an effect largely confined to a maternal family history. Prominent lifestyle, anthropometric and genetic risk factors explained only a marginal proportion of the excess risk associated with family history, highlighting the fact that family history remains a strong, independent and easily assessed risk factor for type 2 diabetes. Discovering factors that will explain the association of family history with type 2 diabetes risk will provide important insight into the aetiology of type 2 diabetes.
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