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

In part 1 of this two-part article, we discussed some statistics about diabetes and reviewed some of the modifiable risk factors for Type 2 diabetes. Here we will continue to look at risk factors for diabetes and some tips to help you make lifestyle modifications to improve your health and lower your risk for Type 2 diabetes.


6. Physical Inactivity


Physical inactivity is another top modifiable risk factor for Type 2 diabetes and one which you most likely have the most control over. The less active you are, the greater your risk of Type 2 diabetes. Moreover, physical activity helps with weight loss, uses up glucose as energy, and makes the cells more sensitive to insulin.


A 2011 study published in Medicine & Science in Sports & Exercise found that significantly decreasing regular physical activity contributes to impaired glucose tolerance. This finding suggests that inactivity may be a factor in the development of type 2 diabetes (17).


Screen time (TV or computer) affects the risk for type 2 diabetes, along with high blood pressure, elevated cholesterol levels, and obesity, in both children and adults. Looking at data from 1999 to 2004, it was found that the odds for children developing metabolic syndrome were 3 times higher in those that spent at least 5 hours of screen time a day compared to those with 1 hour a day or less (18).


However, you can lower your risk. Just 30 minutes a day 5 days a week - that’s only 150 minutes of aerobic exercise each week - can significantly reduce your risk for type 2 diabetes, heart disease, and high cholesterol. Strength training 2-3 days a week can also help prevent diabetes and other chronic medical conditions (20).


7. High Blood Pressure (Hypertension)


High blood pressure can cause significant damage to the cardiovascular system, and untreated high blood pressure can even play a role in the development of diabetes.


Participants in a 2005 study, who had an established diagnosis of hypertension, were more likely to develop diabetes compared to those who were not previously diagnosed with hypertension (1).

Not only can hypertension increase your risk for diabetes, it can significantly impact your health if you have both diabetes and high blood pressure. The combination of hypertension and Type 2 diabetes significantly raises your risk of having a heart attack or stroke. In a study evaluating health-related quality of life (HRQoL) in people with diabetes and hypertension, it was shown that both diabetes and hypertension impair HRQoL. Further reduction of HRQoL was found in those with both hypertension and diabetes (5).


If you blood pressure is running high, take it seriously and follow your doctor’s advice to keep it in check.


8. Abnormal Cholesterol (Lipid) Levels


A low level of high-density lipoproteins (HDL or ‘good’ cholesterol) and high triglycerides can increase your risk for Type 2 diabetes as well as cardiovascular disease.


A study done in 2007 showed that excess cellular cholesterol has a direct role in pancreatic islet dysfunction, which can lead to type 2 diabetes (21).


Some studies have linked increased risk for type 2 diabetes with use of statins, a medication class used to treat high cholesterol. Other studies have disclaimed the role of statins in diabetes risk due to the known effects of cholesterol on insulin secretion. Researchers concluded that it’s likely that one’s LDL level is associated with diabetes risk, rather than an effect of the statins (21,22,23).


To maintain healthy cholesterol levels, a healthy eating plan, consistent aerobic physical activity and a healthy weight can help a lot. Not smoking can also help maintain healthy cholesterol levels (24).


9. Prediabetes


Prediabetes, a milder form of the condition, is an obvious risk factor for developing Type 2 diabetes. Prediabetes is defined as blood glucose levels above normal but below diabetes thresholds (26).


A 2012 study published in Lancet reports that not people with prediabetes are at increased risk for development of diabetes. There is mounting evidence suggesting that damage to kidneys and nerves is present even at the prediabetes stage (26). Lifestyle modification, with a goal of at least 7% weight reduction and 150 minutes of moderate intensity physical activity, is the cornerstone of diabetes prevention with evidence of a 40 to 70 percent relative risk reduction (20,26).


Prediabetes can be easily diagnosed with a simple blood test. If you are diagnosed with prediabetes, you should increase your activity lose any extra weight. Also, opt for a healthy diet and follow the suggestions given by your doctor.


10. Polycystic Ovary Syndrome (PCOS)


Polycystic ovary syndrome (PCOS) has been identified as a risk factor associated with type 2 diabetes. PCOS is associated with insulin resistance, which is the main cause for this risk (25,27). For women, having polycystic ovary syndrome (PCOS) that causes irregular menstrual periods, excess hair growth and obesity is another risk factor for diabetes.


A 2004 study published in Minerva Ginecologica reports that women with PCOS have a 5- to 10-fold risk for developing type 2 diabetes compared to women who do not have PCOS. This same study found evidence of not only insulin resistance but beta-cell dysfunction resulting from PCOS (27).


A 2012 study published in Diabetes also confirms that the risk of Type 2 diabetes is markedly elevated in women with PCOS in middle-age, and therefore reinforces the need for routine screening of PCOS patients for diabetes over time (25).


Tips to Prevent Type 2 Diabetes:

  • Eat healthy by choosing foods lower in fat and calories and higher in fiber.

  • Include more fruits, vegetables and whole grains in your diet.

  • Replace full-fat dairy products with low-fat versions.

  • Choose healthy unsaturated fats, limit saturated fats, and limit or avoid trans fats.

  • When eating, always watch your food portions and try to eat small meals 4 or 5 times a day.

  • Aim for a minimum of 30 minutes of moderate physical activity a day.

  • If you’re overweight, take the necessary steps to lose the extra pounds.

  • Replace juice and soda with water infused with fresh fruit.

  • Quit smoking and excess drinking.

  • Watch your blood pressure level and take steps to keep in under control.

  • Reduce your risk of cardiovascular disease.

  • See your doctor for regular checkups. It is highly recommended to regularly check your blood glucose, blood pressure and blood cholesterol levels.

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. (2018). [online] Available at: https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf [Accessed 15 Oct. 2018].

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.

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

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