Type 2 diabetes and its complications constitute a major worldwide public health problem, affecting almost all populations in both developed and developing countries with high rates of diabetes-related ill health and deaths.
The prevalence of type 2 diabetes has been increasing exponentially, and a high prevalence rate has been observed in developing countries and in populations undergoing “westernization” or modernization.
Multiple risk factors of diabetes, delayed diagnosis until complications arise, life-threatening complications, failure of the current therapies, and financial costs for the treatment of this disease make it necessary to develop new effective therapeutic strategies and appropriate prevention measures for the control of type 2 diabetes.
Now, researchers say that makers for Type-2 diabetes such as increased fasting glucose, higher body mass index (BMI) and impaired insulin sensitivity could be detectable 10 years before the diagnosis of diabetes as well as pre-diabetes.
This study presented at this year’s European Association for the Study of Diabetes (EASD) Annual Meeting in Berlin in Germany could give a leeway to appropriate prevention measures for the control of Type 2 diabetes.
At the beginning of the study, 27,392 non-diabetic individuals had a fasting glucose and average blood glucose (HbA1c) measured and were followed until a diagnosis of Type-2 diabetes or prediabetes.
Over the study period, the researchers identified 1,067 new Type-2 diabetes cases. Of the 15,778 individuals with normal blood glucose at the initial health exam, 4,781 developed prediabetes and the same abnormalities, although to a milder degree, were present at least 10 years before diagnosis of prediabetes.
Pre-diabetes is when the blood sugar level is higher than normal but not yet high enough to be classified as Type-2 diabetes. It is an indicator of the potential to progress to Type-2 diabetes.
People almost always develop prediabetes before they get Type-2 diabetes. Having pre-diabetes does not automatically mean an individual will get diabetes, but it does put the person at an increased risk.
Given that prevention of diabetes in people with pre-diabetes seems to be less successful over long-term follow-up, they suggested that intervening much earlier than the pre-diabetes stage to prevent progression to full-blown diabetes is needed.
The research has important implications given that an estimated 425 million adults (aged 20 to 79 years) were living with diabetes in 2017, and this is predicted to rise to 629 million by 2045.
Dr Joko Adeleye, a diabetes expert at the University College Hospital, Ibadan, Oyo State, affirmed that the time a person is diagnosed to have Type-2 diabetes is not the time when the processes that led to it started.
According to her, “the abnormalities may have been present even up to 15 years before the time of actual diabetes diagnosis. By the time Type-2 diabetes diagnosis is made, about 50 per cent their beta cell functions (the cells in the pancreas) could have been lost. So, the time the disease manifests is not the time the processes leading to it started.”
Dr Adeleye stated that the earliest recognisable sign of Type-2 diabetes is called insulin resistance, a condition where the usual amounts of insulin the body produces cannot move glucose out of the bloodstream and into the cells, which can predate the disease by many years.
She declared: “But we know that over time while the pancreatic beta islet cells tend to try and compensate for this defect, which is called insulin resistance in people that develop Type-2 diabetes, eventually that compensatory mechanism fails and frank diabetes results.
“So, you have persons who have not yet developed glucose levels high enough to call diabetes but also not normal. It has been shown that these persons are at a greater risk for developing not just type two diabetes alone but also cardiovascular diseases.
“They constitute a population, who you would call high risk and require that strategies should be put in place to reduce their risk of progressing to Type-2 diabetes and developing cardiovascular diseases and where possible, even revert it back to normal.
“So, identifying persons with pre-diabetes could be a tool to be able to accentuate particularly lifestyle-related factors that can reduce the risk for progression and may actually promote reverting back to normal glucose tolerance as well as reducing their risk for cardiovascular disease.
“There is evidence to show that a healthy lifestyle and in some cases, medicines can help prevent progression to diabetes and even promote reversion back to normalcy. But don’t forget it is not just about the blood glucose level alone; it is also about your overall health, of your heart and blood vessels.”
Dr Adeleye advised routine annual medical checks especially that after age 40 years are important.
“They should check their blood pressure, blood sugar, cholesterol levels.
These are conditions that often cluster and do not just give any warning signs until very late and can all increase the risk for heart disease, stroke, diabetes, premature deaths and disability,” she declared.
Professor Segun Fatunsi, a former provost, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Osun State, stated that for long, scientists have identified a number of factors that influence the development of non-communicable diseases like diabetes.
Factors such as smoking, use of alcohol cigarette and been obese are associated with a higher risk of developing many non-communicable diseases.
Professor Fatunsi stated: “As people grow older, diabetes has a higher occurrence. So, if earlier in life, you are overweight, it is almost natural that at an older age you will get diabetes, except you do something about it.”
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He said diabetes has a lifestyle dimension just like hypertension, adding that preventing diabetes, among other things, would require a reduction in excess body weight, increased physical activity and cutting down on use of sugar and alcohol.
Professor Fatunsi added: “Studies have shown that when people who have high body mass index (BMI) modify their lifestyle, they prevent or even delay frantic diabetes.
“Of course, diabetes can also be genetic; but for almost every condition, there is the interplay of gene and the environment. If a man knows that it runs in his family and particularly pay attention to his lifestyle, this may modify their risk. It may not eliminate totally his chances of having this disease, but it can reduce his risk level seriously.”
Professor Fatunsi declared that diabetes can be declared preventable in a way, as there are opportunities to prevent it at different stages in the populace.
When pointers to the possibility of it occurring such as obesity and elevated blood sugar are detected early, it is possible to prevent its early onset through diet and exercises.
Also, where diabetes has occurred, actions can also be taken to prevent long-term damage of end-organs associated with diabetes set in.
In a case where there is frank diabetes and possibly its complications, preventive measures can also be established to ensure it does not reduce the quality of life of the individual with diabetes.
Meanwhile, a systematic review of prospective studies in the 2014 edition of the Perm Journal confirms a strong, continuous association between HbA1c level and subsequent diabetes risk.
If untreated, 37 per cent of the individuals with prediabetes may have diabetes in four years. Lifestyle intervention may decrease the percentage of prediabetic patients in whom diabetes develops to 20 per cent.
Lifestyle changes such as weight loss (seven per cent of body weight) and moderate physical activity (150 minutes per week) can reduce the risk of diabetes by as much as 58 per cent.
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