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Type 2 Diabetes Diagnosis Needs to Be Changed: Prediabetes=Diabetes

A long-term UK study revealed that in order to prevent poorer health outcomes, changes need to be made to the current way of diagnosing patients with type 2 diabetes…. 

New research showed that blood vessels may already have been damaged by the time patients are currently diagnosed with type 2 diabetes using their blood glucose level. Blood vessel damage can cause organs, such as the heart, nerves, eyes, and kidneys, to stop functioning efficiently, and this leads to the development of many serious long-term diabetes complications.

Scientists from The University of Manchester and King’s College London, UK, conducted a study on young women with different risks of developing type 2 diabetes. The scientists analyzed biochemical markers in the blood of these patients before their glucose level became elevated to the point of reaching the prediabetes stage.

The scientists discovered that long before changes began to occur in blood glucose, which is currently used to define prediabetes and type 2 diabetes, they could detect changes in types of blood fat metabolites, which are particles used to make up fats in the body. The lead author of the study, Professor Kennedy Cruickshank, explained, "We found that several groups of fat metabolites, also linked to body fat, were changed in the blood, as were others including some amino acids and to some extent vitamin D, before glucose levels increased."

Professor Cruickshank said that the findings from this study revealed that the definition and diagnosis of type 2 diabetes need to be modified to become partially based on the distribution of blood fat metabolites in the prediabetes stage, instead of being based on blood glucose alone. He went on to say, "Blood vessels become damaged as part of the condition, but problems in the vessels arise before high blood sugar sets in during a ‘prediabetes’ period. The current method of categorizing type 2 diabetes solely by a patient’s glucose level means that many will already have suffered blood vessel damage and will experience poorer outcomes."

The scientists said that the results of their research indicated that blood fat metabolites seem to be good indicators of when patients are first beginning to develop the metabolic disorder. Dr. Simon Anderson, a co-author of the study, commented, "In the long term, we aim to identify a biomarker or a disorder in a chemical pathway that is linked to blood vessel health and subsequent diabetes. Ultimately this might translate into a specific blood test to identify people at risk of type 2 diabetes early on but most importantly, it may allow advice on lifestyle modification at an earlier stage to reduce the long-term impact of diabetes." However, Dr. Anderson said that further evaluation of the metabolome, or the total chemicals in the blood, will be required in order to better understand the metabolic conditions that cause patients to develop type 2 diabetes.

Practice Pearls:
  • When using the blood glucose level alone to define prediabetes and type 2 diabetes, blood vessel damage may have already occurred by the time a patient is diagnosed with type 2 diabetes.
  • Changes in types of blood fat metabolites can be detected long before changes in blood glucose began to occur.
  • The findings suggest that the definition of type 2 diabetes needs to become partially based on the distribution of blood fat metabolites in the prediabetes stage, instead of being solely based on blood glucose, which would identify those with diabetes much sooner.

Published online in PLOS ONE 04 Sept 2014.