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Sunday, 25 February 2018

Type 2 Diabetes Can Begin 20 Years Prior to Diagnosis

Subtle elevations in fasting glucose and triglycerides associated with developing type 2 diabetes.

Risk of developing type 2 diabetes (T2D) is associated with subtle elevations of glucose and lipids more than 20 years before diagnosis, according to a study published online Feb. 5 in Diabetes, Obesity and Metabolism.

The cohort study group consisted of 812,073 individuals, about 95% Caucasians, who went through this study. All the individuals with at least one fasting glucose measurement in the baseline period, and without a documented diagnosis of T2D or a fasting glucose > 126 mg/dL.at the baseline period, and without a documented diagnosis of T2D or a fasting glucose > 126 mg/dL. at the baseline examination (n=14,000) were included in the current study population (n=296,439, 47% women). The first measurement that was taken during the baseline period constituted the index examination. The study population was followed from the index exam until a diagnosis of T2D, death or at end of 2012, whichever came first.

Development of T2D has been associated with subtle elevations of glucose and lipids more than 20 years before diagnosis. This suggests that the diabetes processes tied to chronic insulin resistance operate for decades prior to the development of T2D.

For years we have witnessed that blood sugars and lipids don’t rise overnight, that it could take years to actually become diagnosed with type 2 diabetes.

From a cohort they included about 300,000 individuals with a fasting glucose from a health examination during 1985-96. All the subjects were then followed for development of T2D through 2012. For the incident of T2D, the 20-year T2D risk based on age, sex, body mass index, fasting glucose and triglycerides was estimated for biomedical risk factors of T2D going back more than 20 years before diagnosis. And the difference in fasting glucose increased over time.

28,244 new cases of T2D occurred during the study period with an average 20-year risk of 8.1%. The risk was substantially increased in those who had excess weight or obesity.

Among the new T2D diagnoses, 63% were men and 37% were women. The mean age at diagnosis was 63.4 years. The average time from the index examination to the recorded diagnosis/selection as control was close to 14 years. Low socioeconomic status was more frequent in subjects who had diabetes. T2D cases had higher levels of glucose, lipids, and inflammation biomarkers at the index examination, versus controls.

For both men and women, the estimated 20-year risk of T2D increased markedly with higher BMI and was doubled with triglycerides >124 mg/dL irrespective of BMI and fasting glucose. With a BMi <25 kg/m2, fasting triglycerides <124 mg/dL and fasting glucose <81mg/dL the estimated 20-year risk was 2.2% and 1.3% respectively for men and women ages 40-49 years. The corresponding risk with a BMI>30kg/m2, fasting triglycerides>124mg/dL and a fasting glucose between 100-125mg/dL was 63.5% and 69.6% for men and women respectively. The total, for men and women, 15.58% and 5.8% respectively had a 20% or higher 20-year risk of T2D according to these estimates. Corresponding 10-year risks were in general lower.



Graham

10 comments:

peppylady (Dora) said...

I wonder how many people actual know there numbers. I usual only have complete blood work up once year, time of my physical.
Coffee is on

Linda said...

My goodness! Well, if we get years of advance warning, will we effectively change our lifestyle? For many of us, probably not.

Anonymous said...

Lifestyle for many should be changed.

laurie said...

wow, I had no idea!!!

Helen said...

Hard to read this as for years I had what I now realize as slightly elevated BG readings. Not one physician warned me. At age 75 I received the diagnosis with an a1c of 6.4. Happy to report that today my a1c is 5.5 and I have lost 45 pounds, no medication!!!

Love Affair with Food said...

I had no idea this is such a serious issue.

Magic Love Crow said...

I never knew!

Amy Purdy said...

Over a year ago I was told I was in the prediabetic range, but with diet and exercise I was able to reverse it before it became actual diabetes. Since then I got sloppy with my eating habits, but I have recently shaped up again.I am hoping my next check up will be good news.

Kay said...

This sounds like me. I had elevated triglycerides and high cholesterol about 15 years ago followed by higher glucose levels 10 years ago. I'm not obese, but I'm definitely borderline and often definite type 2 diabetic. I'm trying now to watch what I eat and get some exercise in. It's a struggle.

RO said...

With a history of diabetes in my family, I probably should have asked about this years ago. And I was totally shocked when I received the actual diagnosis. This information is quite fascinating and very useful. Hugs...RO