Evidence map›Paper›PMID 42543246›Full record

ArticleDiabetes, obesity & metabolism2026

α-Hydroxybutyrate Association With Incident Type 2 Diabetes Over 10 Years Across Different Glycemic States.

Elena Fortin, Anna Norhammar, David Stadler, Peter L Herzog, Giulia Ferrannini, Ele Ferrannini

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Article in Diabetes, obesity & metabolism, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Elena FortinDivision of Cardiology, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden.
Anna NorhammarDivision of Cardiology, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden.ORCID 0000-0002-4467-0132
David StadlerDirectSens GmbH, Vienna, Austria.
Peter L HerzogDirectSens GmbH, Vienna, Austria.
Giulia FerranniniDivision of Cardiology, Department of Medicine K2, Karolinska Institutet, Stockholm, Sweden.ORCID 0000-0002-0318-7435
Ele FerranniniNational Research Council Institute of Clinical Physiology, Pisa, Italy.

Funding

DirectSens GmbH
6 · The paper itself

Abstract

aimTo investigate the association between baseline plasma α-hydroxybutyrate (α-HB), an organic acid derived from aminoacid catabolism and glutathione anabolism, and the 10-year incidence of Type 2 diabetes (T2DM). MATERIALS AND

methodsThis prospective study analysed 1349 participants from the Swedish PAROKRANK study. At baseline, participants without known diabetes underwent a standardised 2-h oral glucose tolerance test and were categorised into four groups: normoglycemia, impaired fasting glucose, impaired glucose tolerance and T2DM. Incident T2DM was identified over a 9.95-year median follow-up via national registries. Plasma α-HB concentrations were quantified using an enzymatic test kit (XpressGT). Risk of incident T2DM was analysed using uni- and multi-variate Cox regression models. Model performance was further assessed using the category-less Net Reclassification Improvement (NRI).

resultsα-HB levels showed a stepwise elevation across the spectrum of dysglycemia at baseline. During follow-up, 134 (11%) individuals developed T2DM. Each unit increase in log-transformed α-HB was associated with a nearly twofold increase in the risk of developing T2DM (HR 1.99; 95% CI 1.32-3.01) in the univariate analysis, which remained significant after adjustment for relevant clinical variables including BMI and fasting Hba1c (HR 1.78; 95% CI 1.19-2.67). The addition of α-HB to a clinical model yielded a significant NRI improvement (0.23; p = 0.01).

conclusionsPlasma α-HB is a robust, independent risk marker of incident T2DM over a decade, which identifies long-term metabolic risk not fully captured by glycaemic status alone. Its reliance on a single fasting measurement may offer a practical tool for refining early risk stratification.

Indexed as

Blood GlucoseDiabetes Mellitus, Type 2Glucose IntoleranceHydroxybutyratesAgedBiomarkersFemaleFollow-Up StudiesGlucose Tolerance TestHumansIncidenceMaleMiddle AgedProspective StudiesRisk FactorsSwedenBiomarkersBlood GlucoseHydroxybutyratesbiomarkerPAROKRANKType 2 diabetesα‐hydroxybutyrate

Identifiers

PMID42543246
PMCPMC13538760

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.