How do I assess my risk for Type 2 Diabetes Mellitus?
Author: Chhaya Makhija, MD (American Board certified Endocrinologist)
Diabetes mellitus occurs when the blood glucose, also called blood sugar, is too high. Type 2 Diabetes mellitus is the most common form of diabetes
As per the American Diabetes Association (ADA 2023), Type 2 Diabetes is due to a progressive loss of adequate B-cell insulin secretion. The most common root cause of this condition is insulin resistance and metabolic syndrome.
According to the Centers for Disease Control and Prevention (CDC), over 34 million Americans have diabetes and face its devastating consequences. In the State of California, approximately 3,209,418 people in California, or 10.5% of the adult population, have been diagnosed with diabetes.
With the rising incidence of Type 2 Diabetes mellitus worldwide, it has become more crucial to spread awareness about prevention and screening.
Risk factors for Type 2 Diabetes Mellitus can be categorized into modifiable and non-modifiable factors.
Non-modifiable risk factors are as follows:
Age: Age is a major risk factor for diabetes. As per the American Diabetes Association testing should begin at no later than age 35 years for all people and earlier if there are risk factors.
Family history of Type 2 Diabetes mellitus: in first or second-degree relatives.
Personal history of Gestational diabetes (in woman): In pregnant women, with no prior history of diabetes mellitus, abnormal glucose levels seen between the second and third trimester of pregnancy is called gestational diabetes
Ethnicity: e.g., African-American, Latino, Native American, Asian American, and Pacific Islanders are at a higher risk of developing Type 2 Diabetes mellitus.
Modifiable risk factors are as follows:
Personal history of prediabetes: Prediabetes is a condition where there is evidence of abnormal glucose levels and intolerance but levels are lower than the diabetes mellitus diagnostic values. A hemoglobin A1C of 5.7% to 6.4% or the presence of impaired fasting glucose or impaired fasting glucose intolerance. Prediabetes is a risk factor for progression to Type 2 Diabetes mellitus as well as cardiovascular diseases, hence patients should be screened and counseled for prevention.
Overweight: Weight is a sensitive risk factor and studies have shown that at least 5-10% weight loss helps reduce the risk for type 2 diabetes mellitus and improve glucose levels. Your healthcare professional will calculate your body mass index (BMI) to help determine if your weight is a risk factor. In General, a BMI of >= 25kg/m2 is a risk factor for diabetes. It is important to differentiate between weight contributed by visceral fat vs healthy muscle as both will increase the body mass index but one increases the risks for Type 2 Diabetes mellitus and healthy muscle helps reduce that risk.
Physical inactivity: This is a key modifiable risk factor. In the modern era of technology, screens, and video games, we as humans have more time spent sedentary which is a risk factor for several other chronic diseases, prediabetes and type 2 diabetes mellitus. Movement, daily walks, muscle-strengthing exercises, balance exercises, etc have been shown to improve insulin sensitivity. ADA guidelines recommend 150 mins of physical activity in a week which is 30 minutes for 5 days a week. One can make it fun and enjoyable by participating in various physical activities, group activities, yoga, taichi, and other exercise classes. Here is an article about benefits of physical activity in type 2 Diabetes mellitus.
Smoking: is truly injurious to health. It increases the risk of cardiovascular diseases in patients with prediabetes and diabetes mellitus. Seek care with your health care professional to help with smoking cessation.
Food choices/Diet: The American Heart Association recommends an eating plan that includes fruits and vegetables, whole grains, skinless poultry, fish, legumes, non-tropical vegetable oils, and unsalted nuts and seeds. A healthy diet should also replace saturated fats with monounsaturated and polyunsaturated fats, avoid trans fats, reduce cholesterol and sodium (salt) and limit red and processed meats, refined carbohydrates and sweetened beverages. The American Diabetes Association has similar recommendations and studies have shown that an emphasis on whole grains, legumes, nuts, fruits, and vegetables and minimal refined and processed foods, is also associated with a lower risk of type 2 diabetes.
Several Major Randomized Controlled Trials, including the Diabetes Prevention Program trial and the Finnish Diabetes Prevention Study have shown that lifestyle/behavioral intervention with an individualized reduced-calorie meal plan is highly effective in preventing or delaying type 2 diabetes and improving other cardiometabolic markers (such as blood pressure cholesterol panel, and inflammation)
In general, it is important for healthcare professionals to individualize recommendations for their patients. The macronutrient distribution (carbohydrates, fat, and protein) should be based on an individualized assessment of current eating patterns, preferences, and metabolic health goals.
The key is to stay consistent with small changes, avoid processed foods and sugars, and rely on a plate with 60-70% of vegetables for most of the meals as they are low in calories, low in fat, and filled with fiber and antioxidants.
High blood pressure: Untreated high blood pressure is a major risk factor for cardiovascular disease. Type 2 Diabetes mellitus is also a major contributor of cardiovascular diseases. Individuals with diabetes and high blood pressure should maintain a blood pressure of less than 130/80 mm Hg. Normal blood pressure is below 120/80 mm Hg.
High cholesterol: Diabetes mellitus is a risk factor for developing heart diseases, and vascular complications. It is imperative to get a screening lipid panel while assessing your risks. The usual picture in an individual with metabolic syndrome is low HDL cholesterol (good cholesterol), higher triglycerides, and/or high LDL (bad cholesterol). Lifestyle interventions and in individualized cases, the use of statins help reduce the risk of heart disease.
Sleep: Studies show that not getting enough sleep or getting poor quality sleep on a regular basis increases the risk of having high blood pressure, heart disease, high blood glucose, depression, and other medical conditions. Research from the National Institutes of Health shows that four key sleep factors are crucial to protect your health; 7-8 hours of sleep, regular bedtime and wake-up time, good quality uninterrupted sleep, and exposure to sunlight. If you are experiencing difficulties in sleep or have symptoms of snoring, or daytime fatigue, these should be discussed and evaluated by your healthcare team.
Stress: We cannot eliminate stressors in life but one can learn how to cope and respond to stress. This is crucial for mental health as well as overall well-being. In patients with type 2 diabetes mellitus, a stress response leads to higher or more pronounced blood glucose, evident on their continuous glucose monitors. Encourage positive healthy behaviors in your daily routine and seek medical care to address your symptoms and concerns.
Other medical conditions: related to insulin resistance like Polycystic ovarian disease.
Medications: like steroids and certain antipsychotic drugs can increase insulin resistance and cause high blood glucose.
To learn more about your risk assessment, American Diabetes Association has a risk calculator, click here
If you are looking for medical expertise to treat prediabetes or prevent Type 2 Diabetes mellitus, CALL NOW for an appointment with Dr. Makhija.