DISH May Signal Elevated Diabetes Risk in Cardiovascular Disease Patients, Study Finds

Published in Rheumatology, the research led by Dr. Netanja I. Harlianto and colleagues from the Department of Radiology at University Medical Center Utrecht assessed the potential of DISH as a predictor for future diabetes in a large cohort of heart patients. The findings point to a significantly higher risk of developing T2DM in individuals with DISH compared to those without the condition.

The study included 3,395 individuals from the ongoing Second Manifestation of ARTerial disease (SMART) cohort, all of whom had established cardiovascular disease but no prior diagnosis of diabetes at the time of enrollment. Chest X-rays were used to detect DISH at baseline, applying Resnick’s criteria to confirm the diagnosis. Over a median follow-up period of 11.1 years, 317 participants developed type 2 diabetes.

The study revealed the following findings:

• DISH was detected in 263 patients, representing 7.7% of the total study cohort.
• Patients with DISH had a diabetes incidence rate of 17.1 per 1,000 person-years, more than double that of those without DISH (7.8 per 1,000 person-years).
• After adjusting for conventional diabetes risk factors like obesity, hypertension, and hyperlipidemia, DISH still showed an independent association with a higher risk of developing type 2 diabetes.
• The adjusted incidence rate ratio (IRR) for patients with DISH was 1.47 (95% CI: 1.03–2.06).
• Individuals with more extensive spinal ossification had an even higher risk, with an IRR of 2.01 (95% CI: 1.15–3.29).
• The number needed to screen (NNS) over 11 years to detect one new case of diabetes in patients with DISH was 7.
• This NNS is comparable to other established diabetes risk markers such as obesity (NNS = 5), hypertension (NNS = 9), and hyperlipidemia (NNS = 13).

These findings emphasize the potential clinical value of using routine imaging results, often obtained for other reasons, as an early warning signal for metabolic disease. The authors propose that the incidental detection of DISH on chest radiographs could prompt more proactive diabetes screening and intervention in patients with cardiovascular disease.

"The study highlights DISH as a novel, imaging-based risk indicator for type 2 diabetes in individuals with cardiovascular disease. Incorporating DISH into routine risk assessments could enhance early identification and management of diabetes in this vulnerable population," the authors concluded.

Reference:

Harlianto, N. I., Foppen, W., Mohamed Hoesein, F. A., Hol, M. E., Verlaan, J., De Jong, P. A., Westerink, J., Cramer, M. J., G, M., Nathoe, H. M., Van Setten, J., Teraa, M., C, N., Van Smeden, M., H, M., De Jong, P. A., Lely, A. T., Haitjema, S., Mokhles, M. M., . . . Visseren, F. L. Diffuse idiopathic skeletal hyperostosis as a marker for incident diabetes mellitus in cardiovascular disease patients. Rheumatology. https://doi.org/10.1093/rheumatology/keaf268