Answer: Up to 10 years before diagnosis…

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Signs of Diabetes, Prediabetes Present Up to At Least a Decade Before Diagnosis

By Jeff Craven, /alert Contributor

Elevated fasting plasma glucose and glucose dysregulation were seen at least a decade before individuals eventually developed type 2 diabetes mellitus and 10 years prior to developing prediabetes, according to recent research published in the Journal of the Endocrine Society.

“As the vast majority of people with type 2 diabetes go through the stage of prediabetes, our findings suggest that elevated metabolic markers for diabetes are detectable more than 20 years before its diagnosis,” Hiroyuki Sagesaka, from Aizawa Hospital in Matsumoto, Japan, stated in a press release.

Dr. Sagesaka and colleagues performed an analysis of 27,392 non-diabetic participants’ fasting plasma glucose (FPG) trajectories, single point insulin sensitivity (Si) estimator (SPISE) and body mass index (BMI) over a period of 10 years (mean 5.3 years) or until they received a diagnosis of prediabetes or type 2 diabetes. The researchers defined diabetes as FPG ≥ 126 mg/dL or HbA1c ≥ 6.5%, while prediabetes was defined as FPG between 100 mg/dL and 125 mg/dL as well as HbA1c between 5.7% and 6.4%. They found 4,781 new cases of prediabetes (PDM) and 1,061 new cases of type 2 diabetes during the study period.

“We noticed that the trajectories of FPG, before both PDM and diabetes, fitted nicely to the cubic regression, which suggested a time-dependent pathophysiology,” the researchers noted in their study.

Specifically, among participants who developed type 2 diabetes, there were significantly higher mean FPG levels (101.5 mg/dL) and BMI (24.0 kg/m2) at 10 years prior to diagnosis compared with FPG levels (94.5 mg/dL) and BMI (22.7 kg/m2) in non-diabetic participants (P < 0.01). There was also single point insulin sensitivity in participants 10 years prior to developing diabetes (7.32) compared with participants who did not develop diabetes (8.34; P < 0.01).

For participants who developed prediabetes, there were slightly higher FPG levels at 10 years before diagnosis compared with non-diabetic participants (91.8 mg/dL vs 89.6 mg/dL; P < 0.01) as well as slightly higher BMI (22.6 kg/m2 vs 22.1 kg/m2; P < 0.01). The researchers noted the finding of dysglycemia leading to prediabetes was “highly important” but had a smaller degree of abnormality when compared with participants who progressed to diabetes compared with non-diabetic participants.

“Because trials of prevention in people with prediabetes seem to be less successful over long term follow up, we may need to intervene much earlier than the prediabetes stage to prevent progression to full blown diabetes,” Dr. Sagesaka stated in the release. “A much earlier intervention trail, either drug or lifestyle related, is warranted.”