DISH as a marker for incident diabetes mellitus in cardiovascular disease patients

DISH is a common incidental finding in medical imaging characterized by continuous vertebral ossification, which is associated with prevalent type 2 diabetes mellitus (T2DM). We hypothesized that incidental screen-detected DISH may be an actionable marker for incident diabetes screening and aimed to assess the absolute incidence rate (ratio) for T2DM in cardiovascular patients with and without DISH.

Cardiovascular disease patients without diabetes (n = 3395) were included via the prospective Second Manifestation of ARTerial disease cohort. DISH was evaluated at baseline on chest radiographs using Resnick criteria. Incident T2DM was assessed by an adjudication committee. Adjusted incidence rate ratios (IRRs) and numbers needed to screen were calculated.

DISH was present in 263 (7.7%) patients. After a median follow-up of 11.1 years (IQR: 7.1-15.2), 317 patients developed T2DM. Patients with DISH had a higher incidence rate for T2DM compared with no-DISH patients (17.1 vs. 7.8 T2DM per 1000 person-years). DISH was associated with incident T2DM in multivariate analyses (IRR: 1.47; 95% CI: 1.03-2.06), with the highest IRR in the DISH group with the most extensive ossification (IRR: 2.01; 95% CI: 1.15-3.29). The number needed to screen for T2DM in patients with screen-detected DISH for 11.1 years was 7, similar to accepted risk markers overweight (n = 8), obesity (n = 5), hypertension (n = 9) and hyperlipidaemia (n = 13).

DISH is associated with higher rates of incident T2DM in cardiovascular disease patients, independent of accepted risk markers. DISH could be used as an imaging marker to identify cardiovascular disease patients with an increased risk for subsequent T2DM.