On the threshold of diabetes mellitus
Six conditions and risks of the disease
The incidence of type 2 diabetes mellitus in recent years has acquired the character of a non-infectious pandemic: over the past 40 years, the number of people suffering from this disease has increased fourfold! But there is also encouraging news: scientists have recently found out that the stage of "prediabetes" has clearly defined subtypes that differ in concomitant pathology and the degree of risk of developing the disease. This discovery can become the basis of targeted prevention.
The mechanism of development of type 2 diabetes mellitus is associated with impaired sensitivity of cells to the hormone insulin and poor functioning of beta cells of the pancreas that produce this hormone. According to the International Diabetes Federation, today every eleventh adult in the world suffers from this disease.
However, type 2 diabetes does not develop immediately - it is preceded by a long preliminary stage (prediabetes), when the body no longer responds to insulin properly. Accordingly, the blood sugar level rises, but not so much that it is possible to diagnose diabetes. At the same time, until recently, it was impossible for people with prediabetes to predict whether they would develop full-fledged diabetes and how seriously it would proceed, since the causes of the formation of metabolic disorders and manifestations of the disease are very variable.
Now a research group working under the guidance of scientists from the University of Tübingen (Germany) analyzed the data of 900 people with prediabetes participating in a 25-year German medical study. They took into account a number of parameters at once: the level of glucose in the blood and the degree of tolerance to it; sensitivity to insulin and the level of its secretion; the level of lipids in the blood and the amount of adipose tissue in the body measured by MRI, as well as genetic factors determining hereditary predisposition to diabetes.
As a result, the researchers identified six subtypes of prediabetes, and then confirmed their findings based on the analysis of data from almost 7 thousand people who participated in the British study of the prevalence of cardiovascular diseases and the associated mortality rate.
Among all the identified subtypes, three are characterized by a low risk of developing diabetes. People from these two groups are practically healthy, while one group consisted of lean individuals with the lowest risk of complications. Another group includes overweight people, but with a relatively healthy metabolism: their fat mainly accumulates under the skin, and not on the internal organs, which corresponds to the concept of metabolically healthy obesity.
The remaining subtypes are associated with an increased risk of diabetes and concomitant diseases of the kidneys and cardiovascular system. One of the groups consisted of people with a high genetic risk of developing diabetes and impaired insulin secretion, possibly due to the large amount of fat in the pancreatic tissue.
But in another group, excess fat accumulated in the kidneys, which accompanies general obesity: such people have a moderate risk of developing type 2 diabetes, but a high risk of developing renal pathology. People with high insulin resistance and pronounced liver obesity have the highest risk of developing a "full-fledged" disease. It was in these two groups that the highest mortality was recorded: for the group with the risk of developing renal pathology, it is about 40% higher than for less "dangerous" subtypes of prediabetes.
The results of this study have so far been published as a preprint, i.e. without prior review, on the medRxiv website (Wagner et al., Pathophysiology-based subphenotyping of individuals at elevated risk for type 2 diabetes). But if they are confirmed, then such an approach to prediabetes can provide guidelines for developing prevention and treatment strategies at the early stages of the development of this disease, as well as cardiovascular and renal diseases.
So, people with the highest risk of developing diabetes can be recommended a diet and lifestyle changes aimed at weight loss and reducing fat in the liver, or a calorie-restricted diet and aerobic exercise. But it is easy to "miss" people with a genetic predisposition to renal pathology, since high blood sugar levels are uncharacteristic for them – in this case, you need to pay special attention to the development of insulin resistance in order to have time to take measures to protect the kidneys.
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