Four indicators can predict the risk of diabetes, even if blood sugar is measured | Weekly News

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206, age, BMI, waist-to-height ratio and the use of omeprazole, four indicators can predict the risk of diabetes? This article summarizes that hyperinsulinemia occurs earlier than obesity.
Health is not only dependent on weight.
Childbirth and miscarriage are prone to diabetes.
Feeding more milk reduces the risk of four problems predicting the risk of diabetes.
Even if blood sugar is measured, four indicators can predict the risk of diabetes.
Blood glucose is also quite accurate DOI: 10.
1007/s00125-021-05419-1.
2 The risk of type diabetes is related to many factors, but current studies often only analyze a small set of possible risk factors at a time, leading to scattered evidence and large heterogeneity between studies False positive results.

Therefore, the recent study published in "Diabetologia" assessed 134 types of risk factors that are potentially related to the development of type 2 diabetes at a time, trying to find out the risk factors that really have an impact on type 2 diabetes.

 Figure 1.
1 Study published in "Diabetologia" This study from Harvard Medical School and the University of Groningen used data from the Dutch Lifeline Research Group, including 96,534 participants who had no diabetes at the beginning of the study.
The cumulative follow-up data was up to 372007 person-years, screening and verifying a large number of risk factors.

The study used a wide-ranging association study (RV-WAS) design to independently screen and verify the risk factors associated with the 5-year incidence risk of type 2 diabetes.

The study found 63 risk factors for type 2 diabetes, including quality of life indicators and new risk factors such as proton pump inhibitors and anti-asthma drugs.

Although a series of blood test indicators such as blood glucose, HbA1c, and blood lipids are included, the predictive ability of the model will be better, but in order to obtain these data, blood drawing is inevitably required, which is not convenient in clinical application.

For ordinary people, it may be more convenient to choose non-invasive inspection methods such as measuring height, weight, waist circumference and other indicators.

Although the study found that the electrocardiogram has a certain predictive value, the average person will certainly not have an electrocardiograph at home, so the study excluded the electrocardiograph from the model.

The study finally selected four indicators to predict the risk of type 2 diabetes, including age, BMI, waist-to-height ratio and the use of omeprazole.
The predictive performance of the model is still good (c-index 0.
802).

 Figure 1.
2 The applicability of risk factors in predicting type 2 diabetes.
Researchers pointed out that the newly discovered risk factors for type 2 diabetes in the model established this time have almost nothing to do with currently known factors, and can simplify existing prediction models, even for everyone.
These data can be obtained at home.

For precision medicine, a systematic and data-driven method is needed to identify risk factors for predicting type 2 diabetes, and this study is a good attempt.

 REF: van der Meer TP, Wolffenbuttel BHR, Patel CJ.
Data-driven assessment, contextualisation and implementation of 134 variables in the risk for type 2 diabetes: an analysis of Lifelines, a prospective cohort study in the Netherlands.
Diabetologia.
2021 Mar 12 .
doi: 10.
1007/s00125-021-05419-1.
2 Hyperinsulinemia occurs earlier than obesity, health is more than just weight DOI: 10.
1001/jamanetworkopen.
2021.
1263.
Obesity is related to many non-communicable chronic diseases, including type 2 diabetes and coronary heart disease , Chronic kidney disease and asthma, etc.
, and even increase people’s risk of death.

However, people still have different views on the mechanism of high body mass index (BMI) causing the increased risk of chronic non-communicable diseases, mainly including chronic inflammation and hyperinsulinemia.

A recent study published in "JAMA Netw Open" summarized the relevant content, trying to analyze the relationship between obesity and the increased risk of other chronic non-communicable diseases.

 Figure 2.
1 Research published in "JAMA Netw Open" This meta-analysis from the University of Alberta in Canada included data from 5,603 participants in 112 cohorts in 60 studies.
Longitudinal studies and randomized clinical trials were included in at least 3 Fasting insulin levels and/or inflammation markers and BMI were measured at each corresponding time point.

The study analyzed the relationship between fasting insulin levels, inflammatory markers and BMI.

 Figure 2.
2 The meta-analysis included 60 studies.
It was found that in most studies, participants' BMI, fasting insulin levels, and C-reactive protein levels decreased on average, and the normalized slope was negative.

 There was a positive correlation between fasting insulin levels at the first time point and BMI at the second time point (β = 0.
26, 95% CI 0.
13～0.
38).

When the insulin level at the first time point increased by 1 standard deviation, the BMI at the second time point increased by 0.
26 standard deviation.

 Simultaneous analysis of insulin levels and C-reactive protein found that the correlation between fasting insulin levels at the first time point and BMI at the second time point was still significant (β = 0.
57, 95% CI 0.
27～0.
86), but at the first time point C There was no relationship between the level of reactive protein and BMI at the second time point (β= -0.
07, 95% CI -0.
42～0.
29).

 Figure 2.
3 The increase in insulin levels precedes the occurrence of obesity.
Researchers believe that changes in fasting insulin levels precede changes in body weight.
This is inconsistent with the view that obesity causes an increase in fasting insulin levels, leading to chronic non-communicable diseases.

It is generally believed that obesity causes hyperinsulinemia, but this study found that hyperinsulinemia actually causes obesity.

If people lose weight without a drop in insulin levels, these adverse health consequences may not improve.

 The study also found that thinner people may also develop insulin resistance.
Insulin resistance in men and Asians may increase the risk of type 2 diabetes and cardiovascular disease.

This phenomenon further indicates that hyperinsulinemia may be a sign of obesity and its related adverse health consequences, and insulin resistance may be the root cause of this series of health problems.

If someone has an increase in insulin levels, treatments that reduce insulin levels, such as reducing the proportion of simple carbohydrates in the diet and using metformin, may improve the health of these people.

 REF: Wiebe N, Ye F, Crumley ET, Bello A, Stenvinkel P, Tonelli M.
Temporal Associations Among Body Mass Index, Fasting Insulin, and Systemic Inflammation: A Systematic Review and Meta-analysis.
JAMA Netw Open.
2021 Mar 1; 4(3):e211263.
doi: 10.
1001/jamanetworkopen.
2021.
1263.
3 Childbirth and miscarriage are prone to diabetes.
Feeding more milk reduces the risk DOI: 10.
1111/1753-0407.
13176.
The global diabetes map in 2019 shows that there are currently 463 million diabetes in the world.
Of the patients, a quarter of them are in China, and the number is about 129.
8 million.

It is estimated that the number of diabetes patients worldwide will reach 700.
2 million by 2045.
It is urgent to reduce the risk of diabetes and the huge social and economic burden.

Pregnancy, miscarriage, and duration of breastfeeding are related to diabetes, but the relationship between these fertility status and diabetes is not completely determined.

A recent study published in "J Diabetes" analyzed the relationship between fertility, miscarriage, breastfeeding and diabetes risk among middle-aged and elderly women in China.

 Figure 3.
1 Study published in "J Diabetes" The study led by Jiangxi Provincial People's Hospital used data from the REACTION study and included more than 259,000 women aged ≥40 years from 25 communities across China.

These participants come from regions with different levels of urbanization and economic development.

A total of 131,174 women were included in the study after excluding men, participants who lacked diabetes diagnosis information, lack of parity or miscarriage data, or participants who had more than 10 miscarriages.

 Figure 3.
2 The study included more than 131,000 Chinese women.
Among the study participants, 22.
89% were diagnosed with diabetes.

 Compared with diabetic patients, women without diabetes are generally younger, thinner, better educated, eat healthier, exercise more, and rarely have a family history of diabetes.

 The results showed that compared with women who had only given birth to one child, non-partum women (OR 1.
27, 95% CI 1.
10-1.
48), 2 births (OR 1.
17, 95% CI 1.
12-1.
22) or ≥ 3 births (OR 1.
28, Women with 95% CI 1.
21-1.
35) have a significantly increased risk of diabetes.

Compared with women who have not had a miscarriage, women with 2 miscarriages (OR 1.
09, 95% CI 1.
04-1.
14) or ≥ 3 times (OR 1.
11, 95% CI 1.
04-1.
18) also have an increased risk of diabetes.

In addition, women who breastfeed for 0-6 months (OR 0.
82, 95% CI 0.
75-0.
90) and 6-12 months (OR 0.
94, 95% CI 0.
89-0.
99) have a significantly lower risk of developing diabetes.

 Figure 3.
3 BMI, menstrual status, and age affect the relationship between fertility and diabetes risk.
Researchers pointed out that women with infertility, multiple births, and multiple miscarriages have an increased risk of type 2 diabetes, and breastfeeding can reduce the risk of diabetes. Blood sugar during pregnancy is more difficult to control.
With multiple pregnancies, women's insulin resistance exposure time also accumulates, which makes pregnant women more likely to cause insulin resistance and even gestational diabetes.

The stimulation of placental hormones during pregnancy can also cause β-cells to proliferate and produce more insulin, thereby inducing insulin resistance.

The systemic inflammatory response associated with pregnancy can also promote the occurrence of insulin resistance and type 2 diabetes.

At the same time, miscarriage may increase anxiety and psychological stress, thereby changing blood sugar levels.

However, breastfeeding seems to increase the sensitivity of the female body to insulin and improve the risk of diabetes.

 REF: Huo Y, Cheng L, Wang C, et al; REACTION Group.
Associations between parity, pregnancy loss, breastfeeding duration and risk of maternal type 2 diabetes:An observational cohort study.
J Diabetes.
2021 Mar 12.
doi: 10.
1111/ 1753-0407.
13176.