Risk of diabetes starts long before actual diagnosis

Sample blood for screening diabetic test

Current estimates suggest 8.8% of the global population has diabetes; 95% of cases are type 2 diabetes. This comes at an estimated cost of $1.3 trillion. A number that high is almost incomprehensible in terms of what it means to individual societies, but it is clear we need better preventive strategies to combat this global epidemic.

A new study out of Japan suggests we can determine who is more likely to develop type 2 diabetes ten years before the actual diagnosis. They followed over 27,000 people for up to eleven years and compared their blood glucose (BG) levels and insulin sensitivity (IS) scores. Those who eventually developed diabetes showed changes in their BG and IS ten years prior, with a gradual worsening until one year prior to the diagnosis at which point there was a sharp rise in BG and decline in IS.

Journal of the Endocrine Society: Type 2 diabetes: When does it start?

On the one hand, this isn’t all that surprising. We should all know that someone doesn’t just wake up with type 2 diabetes. It takes time to develop.

On the other hand, this study is likely the first to quantify just how early we can start to see metabolic alterations leading to type 2 diabetes. Given the dramatic rise in adults and teens with DM2, this provides insight into an earlier window for intervention and prevention.

Will this new information help us inform people of their risk for type 2 diabetes and convince them of the importance of healthy lifestyles?

I sure hope so.

It would be nice to think that we would all lead a healthy lifestyle, but clearly, that is not the case. Change is hard. Sometimes people need extra motivation. I hope this trial can help serve as part of that motivation for individuals.

In addition, I hope this study will remind healthcare providers that although we have a wide window to initiate preventive measures, we can’t prevent type 2 diabetes if we don’t recognize those at risk. A patient and his/her healthcare provider can no longer ignore fasting BG of 103 as being “not that bad.” Instead, we have to interpret that score as being “on the spectrum to type 2 diabetes.” That should trigger testing for insulin resistance and aggressive lifestyle modification with an appropriately designed low-carb diet.

Diabetes is not a foregone conclusion. We can track those at risk ten years before their diagnosis, thus giving us the power of prevention.

Thanks for reading,
Bret Scher, MD FACC


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  1. Dan
    Dr. Kraft verified.

    Do you (or anyone) know if there is documentation showing that pre-diabetes insulin resistance is associated with health risks?

  2. 1 comment removed
  3. Roger Smit
    Search: Dr. Joseph Kraft , diabetes in-situ , Kraft
    assay ,
  4. Cassieoz
    So how is 'insulin sensitivity' measured/calculated? The only notes i can find refer to BGL measured after an insulun dose in diabetics
  5. Kristin Parker Team Diet Doctor
    Cassie, generally speaking, doctors can order lab tests - fasting glucose and fasting insulin called HOMA-IR – Short for Homeostatic Model Assessment – Insulin Resistance.


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