Automated computed tomography scans can accurately predict type 2 diabetes and related cardiometabolic conditions, with visceral fat measurements emerging as a strong indicator, especially in women, according to a recent study published in Radiology.

The retrospective study, conducted from 2012 to 2015, evaluated the ability of automated CT-derived markers to predict the risk of type 2 diabetes and associated cardiometabolic comorbidities in 32,166 Korean adults. Various computed tomography (CT) parameters, including visceral and subcutaneous fat, muscle mass, liver fat, and aortic calcification, were assessed to identify participants at risk for diabetes and related conditions such as metabolic syndrome, sarcopenia, and osteoporosis.

At baseline, 6% of participants had type 2 diabetes, with prevalence being 6% in men and 4% in women. Over a median follow-up period of 7.3 years, 9% of participants developed diabetes, resulting in an incidence rate of 13.4 cases per 1,000 person-years.

The visceral fat index, as measured by CT, was a strong predictor of both prevalent and incident diabetes. For men, the visceral fat index demonstrated an area under the receiver operating characteristic curve (AUC) of 0.70 for prevalent diabetes and a Harrell C-index of 0.68 for incident diabetes. In women, the predictive performance was higher, with an AUC of 0.82 and a C-index of 0.82.

Combining the visceral fat index with other CT-derived markers, such as muscle area, liver fat fraction, and aortic calcification, improved predictive accuracy. The resulting C-index for predicting new cases of diabetes was 0.69 (95% CI: 0.68, 0.71) in men and 0.83 (95% CI: 0.78, 0.87) in women.

CT markers also showed capability in identifying various comorbidities:

1. Metabolic syndrome: The visceral fat index demonstrated an AUC of 0.81 (95% CI: 0.80, 0.81) in men and 0.90 (95% CI: 0.88, 0.91) in women.
2. Fatty liver: Liver proton density fat fraction (PDFF) showed an AUC of 0.81 (95% CI: 0.80, 0.81) in men and 0.80 (95% CI: 0.78, 0.82) in women.
3. Coronary artery calcium scores greater than 100: Aortic calcification yielded an AUC of 0.95 (95% CI: 0.89, 1.00) in women.
4. Sarcopenia: The muscle area index at L3 showed an AUC of 0.90 (95% CI: 0.89, 0.91) in men and 0.88 (95% CI: 0.83, 0.94) in women.
5. Osteoporosis: L3 trabecular density had AUC values above 0.90 for both men and women.

The study's limitations include its focus on a specific population and the reliance on single-timepoint diagnostic methods for diabetes.

According to Seungho Ryu, MD, PhD, "the results are encouraging as they demonstrate the potential of expanding the role of CT imaging from conventional disease diagnosis to opportunistic proactive screening."

Full disclosures can be found in the published study.