Diabetes: Key Markers of Injury and Prognosis

Diabetes mellitus is a disease defined by biomarkers. The diagnostic criteria rely on elevated blood glucose and glycated hemoglobin levels that reflect risk of microvascular disease (kidney, eye, and peripheral nerves), but studies have not shown that improved glycemic control impacts macrovascular disease (cardiovascular death, coronary heart disease, and stroke). Therefore there is a need for blood-based biomarkers of injury and prognosis in diabetes that can aid the clinician in risk stratification, initiation and monitoring of treatment efficacy, and prognostication for long-term cardiovascular events. Nonglycemic biomarkers such as blood lipids and markers of kidney dysfunction, cardiac injury, hemodynamic stress, inflammation, and subclinical atherosclerosis have a role in cardiovascular disease prognostication. Several novel and emerging biomarkers are under investigation and hold promise for future clinical use. Recently published and ongoing cardiovascular outcomes trials in patients with diabetes will also help to inform the use of markers of injury and prognosis in this population.