The findings of this research suggest that ‘diabetes prevention efforts’ that focus on people with prediabetes (phase between normal and diabetes stage or an alarm for upcoming diabetes) may come too late to make a big difference.
Insulin is a hormone that has extensive effects on metabolism and other body functions. When control of insulin
levels in the body fails, it results in diabetes mellitus.
Patients with Type-2 diabetes mellitus are insulin resistant, and may suffer from a relative insulin deficiency.
The study
The researchers tracked around 6,500 British people without diabetes for up to 13 years, and during that time they repeatedly measured their insulin sensitivity with fasting and non-fasting glucose levels.
All through an average follow-up of 10 years of the study participants, 505 of them developed Type-2 diabetes.
The study results showed a steady upward course in metabolic changes among participants who did not develop diabetes at all. In contrast, such changes had a propensity to occur at different periods among those who did develop diabetes.
The findings of the research
• There is a steady increase in glucose, almost 13 years prior to the diagnosis (of Type-2 diabetes), with glucose levels rising rapidly three years before diagnosis.
• Glucose levels after eating meals begin to increase rapidly, starting three years prior to the diagnosis.
• Insulin sensitivity begins to decline sharply five years before diagnosis.
• Beta-cell function (a measure of insulin production) begins to increase three to four years prior to diagnosis, Insulin production drops precipitously in the three years prior to a diagnosis of Type-2 diabetes.
Daniel R. Witte, study co-author and MD of University College London, said, “The main addition of this study is that it shows for the first time a clear picture of the timeline to diabetes.”
Witte continued, “There are three distinct phases in the progression of diabetes, which may also require different disease prevention strategies at different time”.
Three phases of diabetes progression
The first phase occurs six or more years before the diagnosis, where glucose levels remain quite stable but insulin resistance increases along with the insulin secretion.
“This is the time when relatively straightforward lifestyle changes, like increasing physical activity, changing diet, and reducing obesity, could have the biggest impact,” he said.
The second phase of development is characterized by increased beta-cell activity where the pancreases produce more insulin to recompense for insulin resistance.
In final phase towards progression, referred to as ‘the unstable phase’ by Witte, production of insulin drops and blood glucose levels rise significantly.
The study implies that people who are considered to have prediabetes are generally in this final phase or nearing it.
“We hypothesize that prevention would be more effective before this unstable period, but more research is needed to identify people at this stage of disease development.”
The study was presented June 9 at the 69th Scientific Sessions of the American Diabetes Association in New Orleans, U.S. and also appears in the latest online issue of the journal The Lancet.
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