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Early Metabolic Features In Relation to Type 2 Diabetes Susceptibility

Nov 14, 2020
Editor: David L. Joffe, BSPharm, CDE, FACA

Author: Bernice Ford, 2021 PharmD Candidate, Florida Agricultural & Mechanical University, College of Pharmacy and Pharmaceutical Sciences

The likelihood of developing type 2 diabetes can be detected at an early age through assessment of certain metabolic features. 

Insulin is a pancreatic hormone released upon rising serum glucose levels, occurring after the ingestion of food. Once insulin is secreted, it binds to the insulin receptors on our cells’ surface and allows glucose to enter the cell and be used for energy throughout the body. Suppose an inadequate amount of insulin is produced, or the body becomes resistant to this insulin production; in that case, glucose cannot enter the cells and accumulate in the bloodstream, leading to T2D.  

The diagnosis of type 2 diabetes is predominant amongst middle-aged and older individuals. This is not a condition that maturates overnight; it takes time to evolve. There is compelling evidence that disease susceptibility indications can be seen approximately fifty years before a clinical diagnosis of type 2 diabetes. Being knowledgeable of early signs and symptoms increases patients’ and healthcare providers’ opportunity to intervene before the disease progresses and inflicts harm. Diabetes Care, an American Diabetes Association journal, has recently published a study that illuminates primitive signs that can manifest years before a diagnosis of diabetes is made.  

A research team from the University of Bristol conducted a study in the United Kingdom. Blood samples were drawn from over 4,760 study participants at ages 16, 18, and 25. Researchers assessed the effects of being more genetically prone to developing type 2 diabetes in adulthood on metabolism measures taken from blood samples across early life. An approach called “metabolomics” was used for combining information on genetics. Metabolomics involved the measurement of numerous small molecules in a serum sample to identify early-onset type 2 diabetes characteristics. This study was performed in a young population with the absence of type 2 diabetes or any other chronic condition to thoroughly analyze how early the susceptibilities to adult diabetes onset became distinguishable. The effects of subtle distinctions in metabolism refer to the inclination of these young patients developing type 2 diabetes later in life, without implying that they already have adult diabetes. 

The association of type 2 diabetes culpability was most distinct at the age of eight years, with lower lipids in high-density lipoprotein (HDL) subtypes. Citrate, glycoprotein acetyls, and preglycemic attributes were more pronounced at sixteen years of age. Amino acids with branched chains were predominant at eighteen years of age. Associations were enhanced with verylowdensity lipoproteins (VLDL) lipids, while previously modified traits (including HDL lipids) remained constant in serum samples drawn at 25 years. 

The researchers of this cohort study intended to unveil premature metabolic features that constitute type 2 diabetes liability. The results obtained from this study revealed that disconcerted HDL lipid metabolism is one of the earliest markers of susceptibility to adulthood type 2 diabetes, along with more significant branched-chain amino acids and levels of inflammation.  

Practice Pearls: 

  • A clinical diagnosis of type 2 diabetes is most frequently made in middle-aged adults. 
  • Abnormal HDL lipid metabolism, higher amino acids with branched chains, and inflammatory levels are metabolic measurements associated with adulthood type 2 diabetes susceptibility. 
  • These early signs of type 2 diabetes susceptibility can be seen in patients as young as eight. 


Bell JA, Bull CJ, Gunter MJ, et al. Early Metabolic Features of Genetic Liability to Type 2 Diabetes:  

Cohort Study With Repeated Metabolomics Across Early Life. Diabetes Care. April 2020:dc192348.  doi:10.2337/dc19-2348 


Bernice Ford, 2021 PharmD Candidate, Florida Agricultural & Mechanical University, College of Pharmacy and Pharmaceutical Sciences