Diabetes can begin long before the diagnosis suggests this Japanese study, moreover its first signs are already identifiable more than 20 years before. Findings presented at the annual meeting of the European Association for the Study of Diabetes (EASD-Berlin) that argue for much earlier intervention, from the early stages of pre-diabetes, and both through changes in lifestyle and drug therapies.
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The team from Aizawa Hospital in Matsumoto (Japan) followed over 10 years more than 27,000 non-diabetic adults, aged 49 on average. The analysis reveals that an increase in fasting blood sugar, body mass index (BMI) and impaired insulin sensitivity are detectable indicators up to 10 years before the diagnosis of diabetes.
The researchers' theory is based on the assumption that the vast majority of patients with type 2 diabetes go through the prediabetic stage. However, the metabolic markers of diabetes are detectable more than 20 years before its diagnosis. Previous research has already shown that certain markers or risk factors including obesity and high fasting blood sugar can be present up to 10 years before the diagnosis of diabetes. However, until now, the detection threshold of the disease was unknown.
It is by evaluating the trajectories of fasting blood sugar, BMI and insulin sensitivity in 27,392 non-diabetic participants with normal fasting blood sugar and average blood sugar (HbA1c) at baseline, measured and followed up until until the diagnosis of type 2 diabetes or prediabetes, or until the end of the study that the researchers manage to determine the threshold of detection over time. Thus, during follow-up:
- 1,067 new cases of type 2 diabetes were identified;
- several risk factors were found to be more common in participants who developed type 2 diabetes: in particular, BMI, fasting blood glucose and insulin resistance increased up to 10 years before diagnosis and the differences have widened over time;
- of 15,778 participants with normal blood glucose levels at baseline, 4,781 developed prediabetes during the study and the same abnormalities, although to a lesser degree, are well detectable at least 10 years before diagnosis of prediabetes .
The implications are significant given the prevalence of diabetes , 425 million adults living with diabetes worldwide in 2017. A prevalence that could reach 629 million by 2045. “ We may need to intervene much more earlier than the prediabetes stage to prevent progression to diabetes” .
This track of a much earlier intervention, by medication or change of lifestyle is to be followed, concludes the main author of the study.
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