Osteocalcin and Risks of Incident Diabetes and Diabetic Kidney Disease: A 4.6-Year Prospective Cohort Study

<b>Objective</b> <p>We aimed to examine the relationship between osteocalcin (OC) and the risk of incident diabetes, as well as investigate for the first time the relationship between OC and the risk of incident diabetic kidney disease (DKD).</p> <p><b>Research Design and Methods</b></p> <p>5396 participants without diabetes (referred to as non-diabetes subcohort) and 1174 participants with diabetes and normal kidney function (diabetes subcohort) at baseline were prospectively followed up. The logistic regression and modified Poisson regression models were used to estimate the relative risk (RR) of baseline OC levels with incident diabetes and DKD. </p> <p><b>Results</b></p> <p>During a mean 4.6-year follow-up period, 296 cases of incident diabetes and 184 cases of incident DKD were identified. In the non-diabetes subpopulation, higher OC levels were linearly associated with a decreased risk of diabetes (RR for one unit increase of log_etransformed OC, 0.51 [95% CI, 0.35 to 0.76]; RR for the highest quartile versus the lowest quartile, 0.65 [95% CI, 0.44 to 0.95], P for trend <0.05). In the diabetes subpopulation, OC levels were linearly inversely associated with incident DKD (RR for one unit increase of log_etransformed OC, 0.49 [95% CI, 0.33 to 0.74]; RR for the highest quartile versus the lowest quartile, 0.56 [95% CI, 0.38 to 0.83] P for trend <0.05), even independent of baseline eGFR and UACR. No significant interactions between OC and different subgroups on incident diabetes or DKD were observed. </p> <p><b>Conclusions</b></p> <p>Lower OC levels were associated with an increased risk of incident diabetes and DKD.</p>