{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T05:14:34Z","timestamp":1788412474483,"version":"build-2803163510"},"reference-count":21,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,2]],"date-time":"2026-08-02T00:00:00Z","timestamp":1785628800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["dom-pubs.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Obesity Metabolism"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To investigate the association between baseline plasma \u03b1\u2010hydroxybutyrate (\u03b1\u2010HB), an organic acid derived from aminoacid catabolism and glutathione anabolism, and the 10\u2010year incidence of Type 2 diabetes (T2DM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>This prospective study analysed 1349 participants from the Swedish PAROKRANK study. At baseline, participants without known diabetes underwent a standardised 2\u2010h 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\u2010year median follow\u2010up via national registries. Plasma \u03b1\u2010HB concentrations were quantified using an enzymatic test kit (XpressGT). Risk of incident T2DM was analysed using uni\u2010 and multi\u2010variate Cox regression models. Model performance was further assessed using the category\u2010less Net Reclassification Improvement (NRI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      \u03b1\u2010HB levels showed a stepwise elevation across the spectrum of dysglycemia at baseline. During follow\u2010up, 134 (11%) individuals developed T2DM. Each unit increase in log\u2010transformed \u03b1\u2010HB was associated with a nearly twofold increase in the risk of developing T2DM (HR 1.99; 95% CI 1.32\u20133.01) 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\u20132.67). The addition of \u03b1\u2010HB to a clinical model yielded a significant NRI improvement (0.23;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Plasma \u03b1\u2010HB is a robust, independent risk marker of incident T2DM over a decade, which identifies long\u2010term 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dom.71155","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T02:30:49Z","timestamp":1785724249000},"page":"9493-9504","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<scp>\u03b1<\/scp>\n                    \u2010Hydroxybutyrate Association With Incident Type 2 Diabetes Over 10\u2009Years Across Different Glycemic States"],"prefix":"10.1111","volume":"28","author":[{"given":"Elena","family":"Fortin","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Medicine K2 Karolinska Institutet  Stockholm Sweden"},{"name":"Center for Diabetes Academic Specialist Center, Region Stockholm  Stockholm Sweden"},{"name":"Department of Molecular Medicine and Surgery Karolinska Institutet  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4467-0132","authenticated-orcid":false,"given":"Anna","family":"Norhammar","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine K2 Karolinska Institutet  Stockholm Sweden"},{"name":"Capio St G\u00f6rans Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Stadler","sequence":"additional","affiliation":[{"name":"DirectSens GmbH  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter L.","family":"Herzog","sequence":"additional","affiliation":[{"name":"DirectSens GmbH  Vienna Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0318-7435","authenticated-orcid":false,"given":"Giulia","family":"Ferrannini","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine K2 Karolinska Institutet  Stockholm Sweden"},{"name":"Internal Medicine Unit S\u00f6dert\u00e4lje Hospital  S\u00f6dert\u00e4lje Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ele","family":"Ferrannini","sequence":"additional","affiliation":[{"name":"National Research Council Institute of Clinical Physiology  Pisa Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,2]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"IDF Diabetes Atlas \u201cInternational Diabetes Federation \u201d(2025) https:\/\/diabetesatlas.org\/resources\/idf\u2010diabetes\u2010atlas\u20102025\/."},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60619-X"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199312303292703"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc15-2752"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-017-4325-0"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.3390\/metabo11120835"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.2337\/db12-1612"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0010883"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.2337\/db12-0707"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.020324"},{"key":"e_1_2_10_12_1","unstructured":"World Health Organization \u201cDefinition and Diagnosis of Diabetes Mellitus and Intermediate Hyperglycaemia: Report of a WHO\/IDF Consultation \u201d(2020) accessed June 13 2022 https:\/\/www.who.int\/diabetes\/publications\/diagnosis_diabetes2006\/en\/."},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.plabm.2024.e00398"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1177\/193229681300700112"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2011.03.013"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc05-2179"},{"issue":"3","key":"e_1_2_10_17_1","first-page":"205","article-title":"Clinical Applications of Urinary Organic Acids. 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