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OBJECTIVE To explore the association of serum retinol-binding protein 4 (RBP4) levels and risk for the development of type 2 diabetes in individuals with prediabetes. RESEARCH DESIGN AND METHODS A population-based prospective study was conducted among 1,011 Chinese participants with prediabetes (average age 55.6 ± 7.2 years). Incident type 2 diabetes was diagnosed according to the American Diabetes Association 2010 criteria. Serum RBP4 levels were measured using a commercially available ELISA. We analyzed the association of serum RBP4 levels with the risk of incident type 2 diabetes using the Cox proportional hazards model. RESULTS During a median follow-up period of 3.1 years, 153 participants developed incident type 2 diabetes. A U-shaped association was observed between serum RBP4 levels and the risk of incident type 2 diabetes, with the lowest risk in the RBP4 range of 31–55 μg/mL. Multivariate Cox regression model analysis showed that serum RBP4 levels &amp;lt;31 μg/mL and RBP4 levels &amp;gt;55 μg/mL were associated with an increased risk of incident type 2 diabetes. The adjusted hazard ratios (95% CI) were 2.01 (1.31–3.09) and 1.97 (1.32–2.93), respectively, after adjusting for age, sex, BMI, waist circumference, γ-glutamyltransferase, HOMA of insulin resistance index, fasting plasma glucose, 2-h plasma glucose, and glycated hemoglobin (HbA1c) levels. CONCLUSIONS A U-shaped relationship exists between serum RBP4 levels and the risk of incident type 2 diabetes in subjects with prediabetes.

Association of Serum Retinol-Binding Protein 4 Levels and the Risk of Incident Type 2 Diabetes in Subjects With Prediabetes