Luiz Sérgio F. Carvalho, Isabela M. Benseñor, Ana C. C. Nogueira, Bruce B. Duncan, Maria I. Schmidt, Michael J. Blaha, Peter P. Toth, Steven R. Jones, Raul D. Santos, Paulo A. Lotufo, Andrei C. Sposito, on behalf of the ELSA-Brasil study
Little is known regarding risk prediction of type 2 diabetes before the detection of glucose abnormalities; however, up to 3% of individuals in the general population who are not in the impaired fasting glucose range develop diabetes each year. In this issue, Carvalho et al (https://doi.org/10.1007/s00125-020-05322-1) hypothesise that, among the pathophysiological processes that play a role in type 2 diabetes, the loading of triacylglycerol-enriched remnant lipoproteins (TRLs) with lipids (resulting in large particles) could be useful for risk prediction. The authors report that, when included in a risk prediction model, TRL particle diameter improved the risk prediction of diabetes after 3.7 years of follow-up as compared with a model that did not include this variable, particularly in individuals with normal HbA1c levels at baseline. These data support TRL particle size as a risk factor that is changed early in the pathophysiological processes that lead to the development of type 2 diabetes, even before glucose abnormalities are established.