Type 2 Diabetes - Part 1 (The 10 Leading Risk Factors)

1 out of 11 people in the world currently live with diabetes. This is approximately 463 million adults between the ages of 20 and 79 and does not take into consideration the more than 1.1 million children with Type 1 diabetes or the 374 million people who are at increased risk of developing Type 2 diabetes. By 2045, the number of adults affected is expected to reach 700 million adults.

There are three major Types of diabetes:

• Type 1 Diabetes

• Type 2 Diabetes

• Gestational Diabetes

Of these, Type 2 Diabetes is the most common. The Centers for Disease Control and Prevention estimates that 90 percent of people around the world diagnosed with diabetes have Type 2. The 2020 National Diabetes Research Report offers the following statistics for the U.S. population:

DIABETES

• Diagnosed: 26.9 million people, including 26.8 million adults

• Undiagnosed: 7.3 million people (21.4% are undiagnosed)

• Total: 34.2 million people have diabetes (10.5% of the US population)

PREDIABETES

• 65 years or older: 24.2 million people aged 65 years or older have prediabetes.

• Total: 88 million people aged 18 years or older have prediabetes (34.5% of the adult US population).

In Type 2 diabetes, the pancreas produces insulin, but the cells are not able to utilize it as well as they should. This is what experts call “insulin resistance”. Initially, the pancreas delivers more insulin to move glucose into the cells; but eventually, it is unable to continue, resulting in sugar build up in the bloodstream. This leads to a high blood sugar level.

Many people with Type 2 diabetes are unaware they have the disease, which further contributes to the various health complications associated with it. According to the American Diabetes Association, 4 out of 10 at-risk adults do not believe they run the risk for diabetes (6). This makes it even more important to be aware of the risk factors.

There are both non-modifiable and modifiable risk factors for Type 2 diabetes. While little can be done about non-modifiable risk factors, there is much you can control to prevent development of this disease.

Allow us to share the initial set of Type 2 diabetes risk factors:

1. Family History

Family history of diabetes is a known predictor of diabetes prevalence in the adult U.S. population (7). The risk for developing Type 2 diabetes is elevated if one of your parents or a sibling has it.

According to the American Diabetes Association, your risk is:

• 1 in 13 if one of your parents was diagnosed with diabetes after age 50.

• 1 in 2 if both your parents have diabetes.

When combined with diabetes triggers, such as diet and viruses (#10,11,19), one’s risk increases

for developing diabetes. Though family history or genetic predisposition cannot be altered, the risk of developing diabetes may be lowered by avoiding the triggers.

2. Race or Ethnic Background

Apart from family history, research has shown that certain races or ethnicities are more prone to developing Type 2 diabetes. Hispanics, African Americans, Hawaiians, Native Americans, and Asians are at an increased risk of developing diabetes (8).

A 2016 study published in ‘Diabetes Care’ reports a significantly higher risk of developing diabetes among Asians, Hispanics, and African Americans than among white people, before and after considering differences in body mass index.

So, if you are of African American, Asian, Latino/Hispanic, Native American or Pacific Islander descent, it is time to make lifestyle changes to reduce your risk.

3. Age

Your risk of Type 2 diabetes increases as you age. Most often, it occurs in middle-aged adults, say after age 45. This may be due to the fact people tend to exercise less, lose muscle mass, and gain weight with increased age. In a 2010 retrospective study, looking at data from 1988 to 2006, the authors found the prevalence of diabetes in people 65 years and older to be 17.7%, compared to 7.8% in those aged 20-64, and 6.8% in 12–19-year-olds (9).

Even though age increases risk for Type 2 diabetes, more and more children, adolescents, and younger adults are developing Type 2 diabetes, mainly due to unhealthy lifestyle choices. Since the mid-1990s, there has been an increased incidence of Type 2 diabetes in children and adolescents worldwide. Childhood obesity is the most common risk factor for developing Type 2 diabetes at an early age (15,16).

Health experts recommend all adults, beginning at age 40, to have their blood sugar level checked every few months. If your risk factors for diabetes are higher due to race, family history, weight, and other factors, it is recommended to start screening earlier (14). Early diagnosis is key to preventing or managing Type 2 diabetes.

4. History of Gestational Diabetes

Women diagnosed with gestational diabetes during pregnancy face a significantly higher risk of developing Type 2 diabetes in the future (3). In fact, a study completed in 2008 revealed that 18.9% of women with a history of gestational diabetes were diagnosed with Type 2 diabetes within nine years after the original diagnosis of gestational diabetes. By contrast, only 2.0% of women without gestational diabetes were diagnosed with Type 2 diabetes in the same timeframe (2).

This is a modifiable risk factor that can be addressed by leading an active lifestyle and maintaining a healthy body weight. A 2016 study revealed that lifestyle and nutrition counselling during pregnancy significantly reduced the incidence of gestational diabetes (4).

5. Overweight or Obesity

Being overweight or obese increases the likelihood of developing Type 2 diabetes. It has been found that the prevalence of diabetes increases with increasing weight classes. In fact, nearly half of adults with diabetes in the United States are considered obese (11).

There are certain proteins and hormones generated by adipose, or fat, tissue which have been shown to contribute to insulin resistance. These bioactive molecules can also cause an inflammatory response, which further leads to increased risk for diabetes (12,13). This inflammatory response stresses the inner part of individual cells called endoplasmic reticulum (ER). When the ER has more nutrients to process than it can handle, it causes the cells to dampen down the insulin receptors on the cell surface. This leads to persistently high concentrations of glucose in the blood.

Moreover, if your body stores fat primarily in your abdomen, your risk of Type 2 diabetes is greater than if your body stores fat elsewhere, such as your hips and thighs.

An important point to remember regarding this risk factor is that by losing five to seven percent of body weight, the risk of developing Type 2 diabetes can be decreased.

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This article is one of a series of articles for diabetes education. Part 2 will follow next week.

References:

1. Wong TY. Retinal Arteriolar Narrowing, Hypertension, and Subsequent Risk of Diabetes Mellitus. Archives of Internal Medicine. 2005;165(9):1060. doi:10.1001/archinte.165.9.1060.

2. Feig DS, Zinman B, Wang X, Hux JE. Risk of development of diabetes mellitus after diagnosis of gestational diabetes. Canadian Medical Association Journal. 2008;179(3):229-234. doi:10.1503/cmaj.080012.

3. Kwak SH, Choi SH, Jung HS, et al. Clinical and Genetic Risk Factors for Type 2 Diabetes at Early or Late Post-Partum After Gestational Diabetes Mellitus. The Journal of Clinical Endocrinology & Metabolism. 2013;98(4). doi:10.1210/jc.2012-3324.

4. Koivusalo SB, Rönö K, Klemetti MM, et al. Gestational Diabetes Mellitus Can Be Prevented by Lifestyle Intervention: The Finnish Gestational Diabetes Prevention Study (RADIEL). Diabetes Care. 2015;39(1):24-30. doi:10.2337/dc15-0511.

5. Poljičanin T, Ajduković D, Šekerija M, Pibernik-Okanović M, Metelko Ž, Mavrinac GV. Diabetes mellitus and hypertension have comparable adverse effects on health-related quality of life. BMC Public Health. 2010;10(1). doi:10.1186/1471-2458-10-12.

6. Many People at Risk for Type 2 Diabetes Don't Think They Are at Risk. American Diabetes Association. http://www.diabetes.org/newsroom/press-releases/2013/many-people-at-risk-for-Type-2-dont-think-they-are-at-risk.html. Accessed October 15, 2018.

7. Annis, A., Caulder, M., Cook, M. and Duquette, D. (2005). Family History, Diabetes, and Other Demographic and Risk Factors Among Participants of the National Health and Nutrition Examination Survey 1999–2002. Preventing Chronic Disease Public Health Research, Practice, and Policy, 2(2), pp.1-9.

8. Cdc.gov. (2020). [online] Available at: https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf

9. Cowie CC, Rust KF, Byrd-Holt DD, et al. Prevalence of Diabetes and High Risk for Diabetes Using A1C Criteria in the U.S. Population in 1988-2006. Diabetes Care. 2010;33(3):562-568. doi:10.2337/dc09-1524.

10. Yoon J-W, Austin M, Onodera T, Notkins AL. Virus-Induced Diabetes Mellitus. New England Journal of Medicine. 1979;300(21):1173-1179. doi:10.1056/nejm197905243002102.

11. Nguyen NT, Nguyen X-MT, Lane J, Wang P. Relationship Between Obesity and Diabetes in a US Adult Population: Findings from the National Health and Nutrition Examination Survey, 1999–2006. Obesity Surgery. 2010;21(3):351-355. doi:10.1007/s11695-010-0335-4.

12. Lazar MA. How Obesity Causes Diabetes: Not a Tall Tale. Science. 2005;307(5708):373-375. doi:10.1126/science.1104342.

13. Iacobellis G, Leonetti F. Epicardial Adipose Tissue and Insulin Resistance in Obese Subjects. The Journal of Clinical Endocrinology & Metabolism. 2005;90(11):6300-6302. doi:10.1210/jc.2005-1087.

14. Dall TM, Narayan KMV, Gillespie KB, et al. Detecting Type 2 diabetes and prediabetes among asymptomatic adults in the United States: modeling American Diabetes Association versus US Preventive Services Task Force diabetes screening guidelines. Population Health Metrics. 2014;12(1). doi:10.1186/1478-7954-12-12.

15. Reinehr T. Type 2 diabetes mellitus in children and adolescents. World Journal of Diabetes. 2013;4(6):270. doi:10.4239/wjd.v4.i6.270.

16. May AL, Kuklina EV, Yoon PW. Prevalence of cardiovascular disease risk factors among US adolescents, 1999-2008. Pediatrics. 2012;129(6):1035–1041. doi:10.1542/peds.2011-1082d.

17. Mikus CR, Oberlin DJ, Libla JL, Taylor AM, Booth FW, Thyfault JP. Lowering Physical Activity Impairs Glycemic Control in Healthy Volunteers. Medicine & Science in Sports & Exercise. 2012;44(2):225-231. doi:10.1249/mss.0b013e31822ac0c0.

18. Mark AE, Janssen I. Relationship between screen time and metabolic syndrome in adolescents. Journal of Public Health. 2008;30(2):153-160. doi:10.1093/pubmed/fdn022.

19. Diagnosis and Classification of diabetes mellitus. Diapedia. 2014. doi:10.14496/dia..20.

20. Physical Activity. American Diabetes Association. http://www.diabetes.org/are-you-at-risk/lower-your-risk/activity.html. Accessed October 16, 2018.

21. Hao M, Head WS, Gunawardana SC, Hasty AH, Piston DW. Direct Effect of Cholesterol on Insulin Secretion. Diabetes. http://diabetes.diabetesjournals.org/content/56/9/2328. Published September 1, 2007. Accessed October 16, 2018.

22. Statins linked to increased risk of Type 2 diabetes. The Telegraph. https://www.telegraph.co.uk/news/2016/08/03/statins-linked-to-increased-risk-of-Type-2-diabetes/. Published August 3, 2016. Accessed October 16, 2018.

23. Smith AG, Singleton JR. Obesity and hyperlipidemia are risk factors for early diabetic neuropathy. Journal of Diabetes and its Complications. 2013;27(5):436-442. doi:10.1016/j.jdiacomp.2013.04.003.

24. Forey BA, Fry JS, Lee PN, Thornton AJ, Coombs KJ. The effect of quitting smoking on HDL-cholesterol - a review based on within-subject changes. Biomarker Research. 2013;1(1):26. doi:10.1186/2050-7771-1-26.

25. Gambineri A, Patton L, Altieri P, et al. Polycystic Ovary Syndrome Is a Risk Factor for Type 2 Diabetes: Results From a Long-Term Prospective Study. Diabetes. 2012;61(9):2369-2374. doi:10.2337/db11-1360.

26. Tabák AG, Herder C, Rathmann W, Brunner EJ, Kivimäki M. Prediabetes: a high-risk state for diabetes development. The Lancet. 2012;379(9833):2279-2290. doi:10.1016/s0140-6736(12)60283-9.

Pelusi, B., Gambineri, A. and Pasqual, R. (2004). Type 2 diabetes and the polycystic ovary syndrome. Minerva Ginecol, 56(1), pp.41-51.