New research presented at this year’s European Association for the Study of Diabetes (EASD) annual meeting in Hamburg (October 2-6) shows that several common conditions are significantly more likely to occur before and in the years leading up to the type of diabetes. The increase in type 2 diabetes diagnoses suggests that some patients may be diagnosed earlier.
These new insights into the onset and natural progression of type 2 diabetes indicate early stages of inflammation-related disease activity long before any clinical diagnosis of type 2 diabetes is made. “
Dr. Adrian Heald, Senior Writer, University of Manchester, UK
“These findings hint at the potential for type 2 diabetes to be diagnosed earlier, and we hope that unique clinical trajectories can serve as a predictive tool for people at risk for the disease.”
Type 2 diabetes is often associated with multiple diseases and increasingly complex associated treatments. While some progress has been made in identifying genetic and non-genetic risk factors for type 2 diabetes, understanding an individual’s long-term clinical history before and after diagnosis may provide additional insights into its causes and the complex trajectory of multiple health conditions.
To find out more, UK researchers from Manchester Metropolitan University, the University of Manchester and Salford Royal Infirmary analyzed longitudinal data from the Diabetes Research Alliance in England (DARE) study to examine 1,932 people with and without diabetes. Cumulative profiles of the most common clinical condition in adults type 2 diabetes matched for age and sex.
Data from 1,196 patients ultimately diagnosed with type 2 diabetes and 736 patients without diabetes were analyzed over a 50-year period (25 years before and 25 years after diagnosis). The average age at diagnosis of type 2 diabetes is 53 years.
Trajectory analysis revealed that for individuals ultimately diagnosed with type 2 diabetes, many common conditions continued to increase in the years before diagnosis, specifically: hypertension, respiratory infections, heart disease (i.e., heart failure, heart attack, angina) , coronary angioplasty, coronary artery bypass grafting, and heart disease), asthma, and eye, nose, and throat infections (eg, pharyngitis, sinusitis, and conjunctivitis; see Figure 1a in Editor’s Note).
Additionally, the researchers found that before being diagnosed with type 2 diabetes, more than one-third of people had high blood pressure and respiratory infections, about one-fifth had heart disease or eye, nose and throat infections, and 10 in 10 had heart disease or eye, nose and throat infections. One suffers from high blood pressure and respiratory infections. Develop asthma.
For those without type 2 diabetes, the corresponding trajectories over time were much smaller, with less than 1 in 20 people diagnosed with any of these conditions, except for about 1 in 10 of people experienced a respiratory infection (see Figure 1b in Notes to the Editor).
After type 2 diabetes is diagnosed, the proportion of individuals with hypertension, chronic obstructive pulmonary disease (COPD), retinopathy (a complication of diabetes when the retina is damaged), and infections rises rapidly for about 15 years and then levels off. Likewise, rates of heart disease and asthma continue to increase in patients with type 2 diabetes (see Figure 1a in the Editor’s Note).
“Understanding the long-term clinical history of type 2 diabetes years before diagnosis means that, in the future, people can have time to make lifestyle changes to prevent the onset of this life-changing disease,” said co-author Dr. Adrian Heald. Salford Royal Hospital, UK. “This study suggests that subacute inflammation manifesting as episodes of hypertension, asthma, or acute infection, whether caused by genomic, demographic, or comorbid conditions, may be a precursor to later development of type 2 diabetes.”
He continued: “These observations provide a fascinating, fresh perspective on the onset and normal progression from pre-type 2 diabetes to type 2 diabetes diagnosis and beyond, meaning that early stages of disease activity may be associated with diabetes but are not yet Obtain a clinical diagnosis. …as diabetes. Issues of metabolic control and its relationship to a broad range of therapeutic factors (pharmacological and non-pharmacological) will be addressed in future work.
Despite the important findings, this was only a small retrospective observational study and cannot prove cause and effect, and the authors acknowledge that they cannot rule out the possibility that other unmeasured factors may have affected the results. In addition, the authors noted a number of other limitations that may have affected the results, including the accuracy of GP level coding and the potential for bias due to misclassification/missing data; Type 2 diabetes is a diverse disease that this study has not examined all its possible subgroups; some multimorbidity may be associated with socioeconomic deprivation.