Diabetes is a disease where your blood sugar levels are too high. Glucose comes from the food we eat and insulin is a hormone that helps the glucose get into your cells to give them energy. In type 1 diabetes, your body does not make insulin. Type 2 diabetes, the more common type, your body does not make or use insulin well. Without enough insulin, the glucose stays in your blood. This is what makes your blood sugar levels high.
You can also have prediabetes, which means your blood sugar levels are high, but not high enough to be called diabetes. People with prediabetes are at higher risk of getting type 2 diabetes. People with this type of condition become increasingly resistant to the effects of insulin. The transition to type 2 diabetes happens when the pancreas can no longer compensate for this resistance by producing more insulin.
Based on numbers from the Centers for Disease Control and Prevention(CDC), around 88 million people in the US have prediabetes, which not only increases the risk of type 2 diabetes, but also of strokes and heart attacks. And about 84% of the individuals with prediabetes don’t know they have it.
For those who have prediabetes, they can lower levels by having a healthier diet, losing weight, exercising, and lowering stress levels. These may reduce the risk of getting type 2 diabetes by about 58%.And for those over 60 years of age, these lifestyle changes can reduce the risk further to up to 71%.
But, individuals with prediabetes are not a homogenous group. A new study has identified six basic categories, with essential differences in terms of outlook and the kinds of interventions that could prevent or delay diabetes. The study was led by researchers from various institutions in Germany, including the German Center for Diabetes Research, in Neuherberg, and the University of Tubingen.
The lead co-author of the study, Professor Hans-Ulrich Haring, said “For people with prediabetes, it has not been possible until now to predict whether they would develop diabetes and be at risk for serious complications such as kidney failure, or whether they would only have a harmless form with slightly higher blood glucose levels but without significant risk.”
899 individuals at risk of diabetes were tracked by the researchers for changes in the metabolism, they had enrolled in the Tubingen Family Study and Tubingen Lifestyle Program. Over 25 years, scientists conducted repeated laboratory and clinical tests, including MRI scans. They used a statistical technique called cluster analysis which identified six distinct groups with prediabetes based on several metabolic features. Among these were the amount of fat in the liver, blood glucose levels, blood lipid levels, overall fat distribution, and the genetic risk of diabetes.
The six subtypes of prediabetes were finally confirmed by the researchers by widely extending their analysis to around 7,000 people who are part of the Whitehall II study of civil servants in the UK.
The 6 clusters and risk profiles
Clusters 1,2, and 4 have a low risk of developing diabetes and low mortality, compared with the other 3 clusters.
Most of the individuals in cluster 2 are slim and have a very low risk of developing diabetes complications.
Cluster 4 have overweight people, but their metabolism is relatively healthy.
Cluster 3 produces too little insulin and has genetic risk factors for diabetes. They also have a high risk of kidney disease and cardiovascular complications. The mortality risk is moderate.
Cluster 5 individuals have high levels of fat in their liver, tissues are resistant to insulin, and have a high risk of diabetes, nephropathy, and cardiovascular complications. Mortality rate is higher than cluster 3.
Cluster 6 have high levels of fat in their kidneys and abdominal cavities , known as visceral fat. Unlike cluster 3 and 5, their risk of diabetes is low, however the risk of nephropathy and mortality are high.
The researchers explained that their findings only apply to groups and do not reflect individual risk or outlook. They plan to investigate if these categories can be used to identify people at high risk, and provide personalized treatment and prevention strategies.
Professor Andreas Fritsche, senior author of the research paper, of the Tubingen University Hospital, explained, “Next, in prospective studies, we will first seek to determine to what extent the new findings are applicable for the classification of individual persons into risk groups.”
The team also concluded in their paper, “Our results suggest that stratification of populations at increased risk of type 2 diabetes using simple clinical features could allow for precise and efficient prevention strategies [for] individuals at increased risk of developing type 2 diabetes.”
In addition, the research team acknowledged several limitations in the study. Specifically, the ethnic diversity of the groups they observed did not reflect that of the wider population. The findings are limited to white European populations. It is an important limitation, as the prevalence of prediabetes is higher among specific racial and ethnic groups. The US for example, people who are African American, Native American, Asian American, Latino, or Pacific Islander have a higher risk of prediabetes, but reasons are still unclear.
Another limitation was that only about half of the initial study population was available for follow-up investigations. They explained, “This high attrition rate could lead to a potential underestimation of the risk for diabetes and nephropathy.”
Still, whether the research is not conclusive, it shows us that prediabetes is a real thing, which most of us did not know about. So it is best to always consult your doctor, particularly if you are overweight and over 45 years old.Surely a lifestyle change will benefit you.