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Diabetes Type 2 May Start More than 20 Years Before Diagnosis

The first signs of type 2 diabetes mellitus can be identified more than 20 years before diagnosis, according to a research study presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD) in Berlin, Germany, published in 2018 by Japanese researcher Hiroyuki Sagesaka.

The study tracked more than 27,000 adults, who did not have diabetes, with an average age of 49 years, from 2005 to 2016, where body mass, blood glucose, and insulin sensitivity indexes were analyzed. They found that increased fasting glucose, higher body mass index (BMI), and insulin sensitivity were detected up to 10 years before the diagnosis of diabetes, as well as pre-diabetes.

As the vast majority of people with T2D (type 2 diabetes) go through pre-diabetes stage, our findings suggest that the elevated metabolic markers for the disease are detectable more than 20 years before diagnosis. This was the researcher’s explanation in the study.

The period known as pre-diabetes means that your blood sugars are higher than usual, but not high enough for you to be diagnosed with type 2 diabetes.

Endocrinologist Andressa Heimbecher  agrees with the results of the study, because type 2 diabetes is a progressive disease, that is, it starts with insulin resistance, a start of insulin producing-cell dysfunction which lead to increased fasting blood glucose levels and pre-diabetes and finally, to diabetes. People rarely have symptoms in pre-diabetes. They report vague complaints of tiredness, malaise and fatigue.

The significance of this study to you and your doctor

The health professional needs to act preventively, through a comprehensive approach; understanding the patient’s life habits - if he/she drinks alcohol, smokes, is sedentary or eats ultra-processed industrialized foods. Knowing this allows them to help the patient make changes in lifestyle, encouraging regular practice of activity, and suggesting the adoption of a balanced diet consisting of whole grains, vegetables, fruit, lean meats, and omega 3-rich fish. The physician shall also guide them to avoid the consumption of simple carbohydrates, such as white refined foods, and the consumption of fatty foods.

“We have to take into account that not only habits trigger the development of the disease, but there must also be fertile ground for it to occur, that is, the individual’s genetics and susceptibility; people of Eastern descent have a chance of developing glycemic changes with much less weight gain than Afro-descendants and Hispanic descendants. Families with a history of type 2 diabetes have a fundamental risk factor; bearing this in mind, changes in habits are essential”, warns Dr. Andressa.

For our readers’ further clarification on the subject in question, the endocrinologist asked us to add an explanatory text on how the habit of waking up late can increase the risk of having diabetes, as follows: “Do you get up late? This could be disrupting your metabolism!”

Each individual has their own sleep rhythm. Some like to wake up very early, others not so much. This defines what we call a chronotype, an individual characteristic related to the person’s sleep behavior. Research suggests that individuals who tend to have the afternoon chronotype, that is, they sleep until later, tend to develop diabetes, metabolic syndrome, and muscle wasting. When compared to early risers, the owls are more likely to gain weight. The explanation for this is the release of the hormone cortisol. It is known that it is available as soon as we wake up and, for those who wake up early, this hormonal is released more harmoniously throughout the day, which helps control blood sugar levels and regulate metabolism. For those who wake up later, the production and release of cortisol take place in the middle of the day, causing its level to be higher for longer. This hormone imbalance, added to melatonin, may explain the increased risk of diseases such as diabetes and metabolic syndrome.


Hiroyuki Sagesaka, Yuka Sato, Yuki Someya, Yoshifumi Tamura, Masanori Shimodaira, Takahiro Miyakoshi, Kazuko Hirabayashi, Hideo Koike, Koh Yamashita, Hirotaka Watada, Toru Aizawa; Type 2 Diabetes: When Does It Start?, Journal of the Endocrine Society, Volume 2, Issue 5, 1 May 2018, Pages 476–484,




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