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Type2 diabetes starts years before diagnosis
November 5, 2018, 1:36 pm
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A new study from Japan could change the treatment for diabetes and even has the potential to help prevent type2 diabetes.

According to the World Health Organization (WHO), there are more than 420 million people living with diabetes across the world, with millions more having prediabetes, the precursor to becoming susceptible to diabetes. In 2016, there were an estimated 1.6 million deaths from diabetes, in addition to complications from the disease, such as blindness, kidney failure, heart attack, and stroke.

Despite the number of people affected by the condition, little has been known about exactly when the warning signs of a type 2 diabetes diagnosis first appear. The new study performed in Japan and presented at the recent at the European Association for the Study of Diabetes (EASD) Annual Meeting in Berlin, could change that.

Between 2005 and 2016, the research team tracked over 27,000 adults who did not have diabetes, looking at a few factors commonly associated with type 2 diabetes, such as fasting blood glucose levels, body mass index (BMI), and insulin sensitivity. Researchers tracked each participant until they received a diagnosis of prediabetes or type 2 diabetes or until the end of the study, whichever came first.

Throughout the 11 years of the study, 4,800 participants were diagnosed with prediabetes, while almost 1,100 developed type 2 diabetes. Participants who developed prediabetes and type 2 diabetes had similar risk factors early on. Those who ended up developing type 2 diabetes had even more risk factors than those who did not develop it, both 5 years and 10 years before the diagnosis.

Not only did those with diabetes show elevated risk factors, the differences in these risk factors between those with diabetes and those without widened over time. Participants who did not develop diabetes maintained a mean fasting glucose level of roughly 94 milligrams per deciliter (mg/dL) throughout the entire study.

In those who developed diabetes, that number steadily increased from a mean of 101.5 mg/dL 10 years before diagnosis to 110 mg/dL just one year before diagnosis. Those same warning signs were also observed in those who developed prediabetes on a smaller level more than a decade before their prediabetes diagnosis.

Previous studies have shown that typically there are approximately 10 to 15 years between a prediabetes diagnosis and a type 2 diagnosis, but that the condition can progress in less than five years.

As the name implies, prediabetes is the earliest stage of diabetes and the vast majority of people who develop type 2 diabetes go through the stage of prediabetes. However, from a disease process standpoint, there is not much of a difference between the two. People with prediabetes have only slightly elevated blood sugar compared to those without the condition, while those levels are drastically higher in those who have type 2 diabetes.

Researchers hypothesize that rising levels of blood glucose can be seen much earlier than even 10 years before a person is diagnosed. “Our findings suggest that elevated metabolic markers for diabetes are detectable more than 20 years before diagnosis,” said the study team.

If markers for prediabetes show up much earlier than diagnosis, then this would give patients and their doctors an opportunity to tackle the condition early on. Doctors point out that prediabetes does not necessarily progress into type 2 diabetes, and that it can even be reversed.

While this study’s results largely focus on fasting blood glucose levels, other factors also affect the onset of type 2 diabetes, including obesity. But then, not all obese patients get diabetes, and some patients who are only a little bit overweight become diabetic. There are clearly other factors involved in diabetes, such as genetics and age. A family history of diabetes predisposes a person to becoming diabetic, while about 25 percent of adults over 65 get diabetes.

The researchers pointed out that years and years of damage to the cells in the pancreas that make insulin can lead to diabetes that cannot be reversed. Being able to intervene much earlier than the prediabetes stage could help nip the disease in the bud, they added.

 

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