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Id like to express my deep appreciation for your interest and comments on our article entitled "GDF15 Is a Novel Biomark- er for Impaired Fasting Glucose," which was published in Dia- betes and Metabolism Journal (1). In our study, we showed that the serum level of growth differ - entiation factor-15 (GDF15), which belongs to transforming growth factor-β (TGF-β) superfamily, increased in patients with prediabetes and type 2 diabetes mellitus (T2DM) compared with nondiabetic patients. Thus, GDF15 may be a novel bio- marker for detecting impaired fasting glucose (IFG) in nondia- betic patients. Our data are contradictory to the Xenical in the Prevention of Diabetes in Obese Subjects (XENDOS) trial, which suggest- ed that serum level of GDF15 was not different between nondi - abetic control and IFG (2). As I mentioned in discussion ses- sion, the level of GDF15 in nondiabetic control was too high compared with other study's normal control population. Eligi- ble individuals of XENDOS trial were composed of obese peo- ple with BMI ≥ 30 kg/m 2 with a mean of 37.6 kg/m 2 . Further- more, although there are controversial opinions, people with impaired glucose tolerance (IGT) are more insulin-resistant than those of IFG (3). In our study, there were too few patients with IGT to compare the level of GDF15. Further study is re- quired to validate the effect of GDF15 with patients with isolat - ed IFG, isolated IGT, and both IFG and IGT. Following your comment, we reanalyzed the factors that af- fect GDF15 using multivariate regression model. The serum level of GDF15 was affected by the change in fasting glucose, homeostasis model assessment-insulin resistance, and serum triglyceride (Table 1). These data showed that GDF15 is asso - ciated with insulin resistance, accompanying hypertriglyceri- demia.

Response: GDF15 Is a Novel Biomarker for Impaired Fasting Glucose (Diabetes Metab J2014;38:472-9)