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New research suggests that some patients might receive a type 2 diabetes diagnosis earlier. These findings were presented at the European Association for the Study of Diabetes (EASD) Annual Meeting in Hamburg this year (2-6 October). The study reveals that several common disorders significantly increased in the years leading up to a type 2 diabetes diagnosis.
Senior author Dr. Adrian Heald from Manchester University, UK, stated, “These novel insights into the onset and natural progression of type 2 diabetes suggest an early phase of inflammation-related disease activity long before any clinical diagnosis of type 2 diabetes is made. These findings hint at the potential for type 2 diabetes to be diagnosed earlier, and we hope that the distinct clinical trajectory could become a predictive tool for people at risk of the disease.”
Type 2 diabetes is often associated with a growing complexity of various diseases and related treatments. While there has been progress in identifying the genetic and non-genetic risk factors for type 2 diabetes, understanding a person’s long-term clinical history before and after diagnosis could offer new insights into the disease’s causes and the complex paths of numerous other health issues.
To delve deeper, UK researchers from Manchester Metropolitan University, Manchester University, and Salford Royal Hospital analyzed longitudinal data from the Diabetes Alliance for Research in England (DARE) Study. They examined the accumulation of the most common clinical conditions in 1,932 adults, both with and without type 2 diabetes, matched by age and gender.
Data from 1,196 individuals eventually diagnosed with type 2 diabetes and 736 without diabetes were analyzed over a period of up to 50 years (25 years pre-diagnosis and 25 years post-diagnosis). The average age at type 2 diabetes diagnosis was 53 years.
The trajectory analysis showed that for individuals eventually diagnosed with type 2 diabetes, several common conditions consistently increased in the years leading up to diagnosis, including high blood pressure, respiratory tract infections, heart conditions, asthma, and eye, nose, and throat infections.
Additionally, researchers found that just before type 2 diabetes diagnosis, over 1 in 3 individuals experienced high blood pressure and respiratory tract infections, while around 1 in 5 had a heart condition or eye, nose, and throat infection, and 1 in 10 developed asthma.
This trajectory over time was much less pronounced in those without type 2 diabetes, with fewer than 1 in 20 individuals being diagnosed with any of these conditions, apart from respiratory tract infections, which were experienced by around 1 in 10.
After a type 2 diabetes diagnosis, the proportion of individuals experiencing high blood pressure, chronic obstructive pulmonary disease (COPD), retinopathy (a complication of diabetes when the retina is damaged), and infections, rose rapidly for around 15 years before leveling off. Similarly, both heart conditions and asthma continued to increase in those diagnosed with type 2 diabetes.
Co-author Dr. Adrian Heald from Salford Royal Hospital, UK, emphasized, “Understanding the long-term clinical history of type 2 diabetes years before diagnosis means that, in the future, people could have the time to make lifestyle changes to prevent this life-changing disease from arising.”
He continued, “This study demonstrates that subacute inflammation which manifests as the onset of hypertension, asthma, or an acute infection, regardless of whether it is caused by the genome, demography, or comorbidities, may serve as a precursor to the later onset of type 2 diabetes.”
Heald concluded, “These observations offer a fascinating and fresh perspective on the beginning and normal development from pre-type 2 diabetes to type 2 diabetes diagnosis and beyond, implying a possible early stage of disease activity that is linked to, but not yet clinically diagnosed as diabetes. The matter of metabolic control and how this relates to a broad range of treatment factors (pharmacological and non-pharmacological) will be addressed in future work.”
Despite the important findings, it’s important to note that this is a small, retrospective observational study and cannot prove causation. The authors acknowledge that they cannot rule out the possibility that other unmeasured factors may have influenced the results. Additionally, the authors mention several other limitations, including the accuracy of the coding at the GP level and the potential for bias through misclassification or missing data. They also note that type 2 diabetes is a diverse disorder and the study did not examine all its possible subgroups. Finally, some multimorbidity may be related to socio-economic deprivation.
