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The Transition from Pre-Diabetes to Diabetes Comes into Better Focus

Posted Jul 08 2009 11:43am

More sophisticated use of medical diagnostics will enable the identification of diseases in earlier and earlier stages. For example, there are various types of pre-clinical manifestations of diabetes. One of them that is now well-recognized is the metabolic syndrome. A state of apparent wellness can co-exist with a predisposition to disease which can transition to a pre-disease and then to clinically overt disease (see: Predisposition to Disease and Pre-Disease on the Health Continuum ). Pre-disease is frequently recognized by abnormal lab test results. A recent article provides some additional clues about the transition from pre-diabetes to diabetes (see: The trajectory of pre-diabetes comes into focus ). Below is an excerpt from it with boldface emphasis mine:

[T]the Lancet [recently] published a study of 6,538 British civil servants who were followed for over 13 years....Five hundred and five of these subjects eventually developed diabetes (7.7% of the study population). Interestingly, when the measures of blood glucose and insulin resistance were examined for the people who developed diabetes and for the people who did not, they behaved quite differently. The people who did not develop diabetes during that 13 year period did not experience any increase in fasting blood glucose levels but they did experience a slow increase in their non-fasting glucose levels. Meanwhile, the people who did develop diabetes had higher values both for fasting blood glucose as well as the non-fasting glucose level....What this study shows is that the onset of type 2 diabetes can be divided into 2 stages. There is a long period of reasonably successful compensation where blood sugar levels are slowly rising but things are pretty much under control. During this period the pancreas is compensating for the metabolic problem by increasing insulin production. Then the patient enters into an unstable metabolic state which lasts from 3 – 5 years before diabetes onset. During this time, insulin secretion can no longer handle the metabolic deficit and blood glucose levels rise rapidly. The importance of this observation is that most people with pre-diabetes are identified after they have entered this unstable period of rapid deterioration. It is likely that if lifestyle changes were initiated during the more stable portion of the process, the results would have been vastly more successful.... We need a study that looks at the costs of early identification and lifestyle modification in these people who are likely to develop type 2 diabetes a decade hence. Since the rate of increase in blood glucose levels was vastly different for people who develop diabetes from those who do not, it should not require a decade to figure out the answer.

On the basis of clinical studies such as this one, we are now beginning to better understand the transition from pre-diabetes to clinically overt disease. We are also getting clues about when intervention such as lifestyle changes can alter or prevent the onset of frank disease. This value of such studies is so obvious, one wonders why a number of them have not been performed prior to this time. I suspect the reason is that most medical researchers have had little interest in the past in studying pre-disease such as pre-diabetes. This may have been because there were few good therapeutic options available for pre-diabetes (see: Few Good Treatment Options for Pre-Diabetes and Metabolic Syndrome ) or lifestyle interventions were not as well understood. At nay rate, my hope is that studies such as this one will peak the interest of younger physicians who will then begin to delve deeper into predictive/preventive medicine.

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