• Setor K Kunutsor, Ari Voutilainen, and Jari A Laukkanen.
• National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK.
• Ann. Med. 2020 Dec 1; 52 (8): 471-478.

PurposeWe aimed to determine whether handgrip strength (HGS)improves type 2 diabetes (T2D) risk prediction beyond conventional risk factors.DesignHandgrip strength was assessed at baseline in 776 individuals aged 60-72 years without a history of T2D in a prospective cohort. Handgrip strength was normalized to account for the effect of body weight. Hazard ratios (HRs) (95% confidence intervals [CI]) and measures of risk discrimination for T2D and reclassification [net reclassification improvement (NRI), integrated discrimination index (IDI)] were assessed.ResultsDuring 18.1 years median follow-up, 59 T2D events were recorded. The HR (95% CI)for T2D adjusted for conventional risk factors was 0.49 (0.31-0.80) per 1 standard deviation higher normalised HGS and was 0.54 (0.31-0.95) and 0.53 (0.29-0.97) on adjustment for risk factors in the DESIR and KORA S4/F4 prediction models, respectively. Adding normalised HGS to these risk scores was associated with improved risk prediction as measured by differences in -2 log likelihood, NRI and IDI. Sex-specific HRs and risk prediction findings using sensitive measures suggested the overall results were driven by those in women.ConclusionAdding measurements of HGS to conventional risk factors might improve T2D risk assessment, especially in women. Further evaluation is needed in larger studies. KEY MESSAGES Handgrip strength (HGS) is independently associated with reduced risk of type 2 diabetes (T2D), but its utility in classifying or predicting T2D risk has not been explored. In this prospective cohort study of older Caucasian men and women, adding measurements of HGS to conventional risk factors improved T2D risk assessment, especially in women. Assessment of HGS is simple and inexpensive and could prove a valuable clinical tool in the early identification of people at high risk of future T2D.

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