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Measuring levels of a liver protein could offer a new approach to screening for patients with type-2 diabetes, US research suggests.

Patients who had high levels of the protein fetuin-A were almost twice as likely to develop the disease as patients with low levels of the protein.

The finding builds on earlier studies in mice which found a link between insulin resistance and fetuin-A, a protein associated with accumulation of essential fats in the liver.

The latest study involved 519 patients, aged 70 to 79, who were free from type-2 diabetes.

Fetuin-A levels were measured in blood serum samples taken from each patient. The patients also completed a questionnaire assessing other risk factors for type-2 diabetes such as BMI, levels of physical activity and ethnicity.

Over six years' follow-up, medical records were examined and 135 patients were found to have developed type-2 diabetes.

After adjusting for other risk factors, patients who had fetuin-A levels above 0.97g/l were 1.7 times more likely to develop diabetes than patients with levels below 0.76g/l.

Lead researcher Dr Joachim Ix, from the department of medicine at the University of California, proposed that high levels of fetuin-A could cause diabetes by binding to the insulin receptors found in muscle and fat, resulting in insulin resistance, the hallmark of diabetes

'If fetuin-A was used to screen for type-2 diabetes, it would be important to demonstrate that preventive strategies among people with higher fetuin-A levels are beneficial and cost-effective before routine screening is started,' he said. Further studies should evaluate whether the results may be generalised to middle-age individuals in whom diabetes incidence is highest, he added.

sanjay.tanday@haymarket.com

• JAMA 2008; 300: 182-8

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