This project will evaluate whether alternative glycemic markers add value to standard markers (fasting glucose and HbA1c) for long-term prognosis across a wide range of outcomes in a large representative cohort followed for 25-years from midlife to older age.
The aims are: 1) To assess the added prognostic value of novel glycemic markers to known measures for identifying populations and subgroups at high risk for microvascular and macrovascular outcomes;2) To investigate racial- and age-related differences in the associations of glycemic markers with health outcomes;3) To conduct a genome-wide association study of new glycemic markers to identify susceptibility genes important in glucose metabolism;and 4) To characterize the associations of hypo- and hyper-glycemic states with frailty, mood, and physical and cognitive impairment and dementia risk in the elderly. Design and Methods: We will analyze stored specimens and utilize data from the Atherosclerosis Risk in Communities (ARIC) Study, an ongoing NHLBI-funded community-based epidemiologic cohort of ~15,000 black and white adults followed for 25 years. The proposed research will build on the existing infrastructure of the parent study and utilize blood samples obtained during two phases of the participants'lifespan: during midlife (1990-92, 48-68 years old) and old age (2011-2013, 69-89 years old). The main outcomes of interest are microvascular disease (kidney and retinal disease), macrovascular (cardiovascular) disease, frailty, mood, physical and cognitive impairment, dementia, and all-cause mortality. Significance: If we demonstrate that novel markers of glycemia contribute additional prognostic information, our results will suggest the utility of these measures in clinical practice. Such results would challenge the definition of diabetes. We will also demonstrate whether documented racial disparities and age-related differences in levels of glycemia are clinically important. Our investigation of common genetic determinants will shed light on the biology of diabetes and the mechanisms by which glucose metabolism contributes to the development of complications. If this project is successful, our results will have direct relevance to clinical practice and inform strategies for the prevention of diabetes and its complications.

Public Health Relevance

This project will compare the effectiveness of alternative markers of glucose metabolism to current clinical measures (fasting glucose, hemoglobin A1c). We will assess whether these markers can improve prediction of health outcomes. We will also investigate racial and age-related disparities in diabetes risk and characterize genetic associations to inform the biology of diabetes. Our results should help prevent diabetes and its complications.

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project (R01)
Project #
Application #
Study Section
Special Emphasis Panel (ZDK1-GRB-B (O1))
Program Officer
Bremer, Andrew
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Johns Hopkins University
Public Health & Prev Medicine
Schools of Public Health
United States
Zip Code
Tin, Adrienne; Grams, Morgan E; Maruthur, Nisa M et al. (2015) Results from the Atherosclerosis Risk in Communities study suggest that low serum magnesium is associated with incident kidney disease. Kidney Int 87:820-7
Rebholz, Casey M; Grams, Morgan E; Coresh, Josef et al. (2015) Serum fibroblast growth factor-23 is associated with incident kidney disease. J Am Soc Nephrol 26:192-200
Folsom, Aaron R; Lutsey, Pamela L; Roetker, Nicholas S et al. (2014) Elevated hepatic enzymes and incidence of venous thromboembolism: a prospective study. Ann Epidemiol 24:817-821.e2
Selvin, Elizabeth; Parrinello, Christina M; Sacks, David B et al. (2014) Trends in prevalence and control of diabetes in the United States, 1988-1994 and 1999-2010. Ann Intern Med 160:517-25
Parrinello, Christina M; Selvin, Elizabeth (2014) Beyond HbA1c and glucose: the role of nontraditional glycemic markers in diabetes diagnosis, prognosis, and management. Curr Diab Rep 14:548
Selvin, Elizabeth; Rawlings, Andreea M; Grams, Morgan et al. (2014) Association of 1,5-anhydroglucitol with diabetes and microvascular conditions. Clin Chem 60:1409-18
Selvin, Elizabeth; Lazo, Mariana; Chen, Yuan et al. (2014) Diabetes mellitus, prediabetes, and incidence of subclinical myocardial damage. Circulation 130:1374-82
Schneider, Andrea L C; Lazo, Mariana; Selvin, Elizabeth et al. (2014) Racial differences in nonalcoholic fatty liver disease in the U.S. population. Obesity (Silver Spring) 22:292-9
Naik, Rakhi P; Derebail, Vimal K; Grams, Morgan E et al. (2014) Association of sickle cell trait with chronic kidney disease and albuminuria in African Americans. JAMA 312:2115-25
Lutsey, Pamela L; Alonso, Alvaro; Selvin, Elizabeth et al. (2014) Fibroblast growth factor-23 and incident coronary heart disease, heart failure, and cardiovascular mortality: the Atherosclerosis Risk in Communities study. J Am Heart Assoc 3:e000936

Showing the most recent 10 out of 20 publications