An international study revealed a blood biomarker that predicts type 2 diabetes up to 19 years before the disease onset, which is now published in Nature Communications, entitled "Elevated circulating follistatin associates with an increased risk of type 2 diabetes". This extensive study was an outstanding collaborative success between Shandong University and Lund University in Sweden, besides many leading diabetes scientists at 22 institutions in Europe, the US and China contributing to these findings. The first author of the paper is Wu Chuanyan, PhD student with Prof Gao Rui. Prof Gao Rui is currently working in the School of Control Science and Engineering, Shandong University.

Type 2 diabetes is a growing global epidemic, with 6% of the world population suffering from the disease. However, the risk of developing type 2 diabetes can be greatly reduced by weight control, eating well and exercising before the actual manifestation of the disease. Early detection of type 2 diabetes risk before symptoms could help minimize health complications related to diabetes.

This study reveals that higher levels of the protein follistatin circulating in the blood predict type 2 diabetes up to nineteen years before the onset of the disease, regardless of other known risk factors, such as age, body mass index (BMI), fasting blood glucose levels, diet or physical activity. This discovery is based on studies that followed 5,318 people over the course of 4 to 19 years in two different locations in Sweden and Finland.

The study also investigated what happens to the body when follistatin in blood circulation becomes too high. Using clinical data from the German Tubingen Diabetes Family Study and cell biology investigation, the researchers found that follistatin promotes fat breakdown from the adipose tissue, resulting in increased lipid accumulation in the liver. This in turn increases the risk of nonalcoholic fatty liver disease and type 2 diabetes.

To find out what regulates blood follistatin levels, the researchers performed genome-wide association study (GWAS) on 5,124 people from Sweden, the UK and Italy, and revealed that follistatin levels are genetically regulated by glucokinase regulatory protein (GCKR), which impact several metabolic traits.

This study shows that follistatin has the potential to become an important biomarker to predict future type 2 diabetes, and it also brings us one step closer to the understanding of the mechanisms behind the disease.

The School of Control Science and Engineering, Shandong University, keeps up with the goal of "Healthy China 2030" and Shandong University's "Double First-Class" construction. It has long adhered to the integration of medical and engineering, and is committed to solving related practical problems through engineering methods based on clinical needs. Professor Gao Rui's research group is mainly dedicated to the research of data mining, machine learning, complex system modeling and bioinformatics related issues, and has accumulated rich experience in the modeling and analysis of the development of diabetes. Dr Yang De Marinis is a long-time close collaborator of Prof Gao Rui and the lead author of the study. She is an adjunct professor in the Department of Clinical Sciences at Lund University, Sweden. She is also chair professor at Shandong University, and holds visiting academic chair at the Clinical Research Hospital, Chinese Academy of Sciences; the University of Science and Technology of China.