Progression of Type 2 Diabetes Begins Years Before Diagnosis—But So Can Diabetes Intervention

We see it every day: exam rooms filled with patients with diabetes. We know the potential prognosis for many.

A Growing Problem

According to the most recent report from the Centers for Disease Control (CDC), the United States adult diabetes population tops 30 million.1 But diabetes is not just affecting older generations. The CDC released statistics that revealed type 2 diabetes is on the rise in people under the age of 20.2 These statistics alone are frightening, especially considering that this ‘early-age exposure’ may increase the risk for future kidney disease, heart disease, stroke, and other complications.3

Most diabetic patients do not realize that they have been insulin resistant, prediabetic, or even diabetic for years before they receive their official diagnosis. Often by the time most are diagnosed with type 2 diabetes, up to 80% of their insulin-producing pancreatic beta cells have already become damaged or dysfunctional.4 The good news is that clinicians and their patients can take steps to prevent diabetes.

Using the Right Biomarkers at the Right Time

The key to prevention is earlier-in-life detection of any predisposing risk factors/markers, and then recommending individualized nutritional and lifestyle therapies known to alter pathophysiological adversity.

The standard glucose and/or hemoglobin A1c (HbA1c) diagnostic criteria for prediabetes/diabetes are limited in their ability to provide even earlier presence of insulin resistance. Biomarkers that help detect the presence of preglycemic insulin resistance (IR) fall into the following groups:

Insulin Resistance:

  • Leptin: satiety/obesity influencing adipokine
  • Adiponectin: adipokine inversely related to diabetes and heart disease risk
  • Alpha-hydroxybutyrate, oleic acid, and Linoleoyl-GPC:  metabolomic signatures of insulin resistance
  • Ferritin: iron storage/transport protein correlated with insulin resistance-inducing iron overload

Beta-Cell Function:

  • Insulin: various levels of which are reflective of beta-cell function/dysfunction
  • Proinsulin: the precursor peptide for insulin increases of which are potentially indicative of delayed conversion to insulin typical of beta-cell dysfunction and insulin resistance
  • C-Peptide: a beta-cell produced protein that has a longer serum presence than insulin

Lipids and Lipoproteins:

  • Low density lipoprotein particle concentration (LDL-P) / small LDL particle concentration (sLDL-P): lipoprotein markers often associated with insulin resistance
  • Small, dense LDL cholesterol (sdLDL-C): the cholesterol content of insulin resistant-related small LDL particles
  • High density lipoprotein particle concentration (HDL-P): lipoprotein marker decreases of which may be associated with insulin resistance
  • HDL2 cholesterol: the cholesterol content of the larger HDL particles, which when decreased may be associated with insulin resistance
  • Triglycerides: increases may be associated with insulin resistance

When necessary, by investigating earlier presence of non-glycemic indicators of insulin resistance, clinicians can help patients initiate healthier outcome-influencing behaviors with the hope of avoiding type 2 diabetes.

For more information about diabetes testing, connect with True Health’s experts: 1.877.443.5227.

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References

[1] https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

[2] https://www.cdc.gov/media/releases/2017/p0412-diabtes-rates.html

[3] https://www.nhs.uk/conditions/type-2-diabetes/complications/

[4] DeFronzo RA and Abdul-Ghani M. J Clin Endocrinol Metab. 2011; 96(8):2354-2366.