September 15, 2014

Should Current Way of Diagnosing Diabetes Be Changed?

Normally I avoid this topic when it deals with women that have had gestational diabetes. The healthcare system in the United States tried and failed properly to diagnose gestational diabetes because everyone argued against increasing the number of women with gestational diabetes.

Now the United Kingdom is taking another approach and studied recently pregnant women to discover biochemical markers that would indicate type 2 diabetes earlier.  The current way of diagnosing type-2 diabetes using blood glucose levels needs to be revised, research by scientists from The University of Manchester and King’s College London suggests. The findings, published in the journal PLOS ONE (full study can be read at this link), show the current method of diagnosis - using blood glucose levels - means patients are diagnosed too late so that their blood vessels may already be damaged.

The study focused on young, previously pregnant women followed up in Greater Manchester after being identified as at increased, intermediate, and low risk of developing type-2 diabetes. Researchers examined biochemical markers in the blood before glucose became elevated – so before the patients reached the pre-diabetes stage.

Their findings show that changes in types of blood fat metabolites - naturally occurring particles that come from and make up fats in the blood - appear to be good indicators of developing type-2 diabetes. The changes in these particles were detectable well before changes in blood glucose that now define type-2 diabetes or pre-diabetes. The team’s findings could be important for future diagnosis and, in turn, treatments.

They 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. Blood vessels become damaged as part of the condition, but problems in the vessels arise before high blood sugar sets in during a ‘pre-diabetes’ period.

I think this is the key - the authors argue that rather than concentrating purely on glucose-directed treatments, which do not improve blood vessel health, a new, quite different definition of type-2 diabetes is required, partly based on the distribution of fat metabolites in the blood in the pre-diabetes stage. Not only could this improve treatment before the full onset of type 2 diabetes, but possibly delay or prevent onset of type 2 diabetes for some, and with dietary changes possibly delay full onset of type 2 diabetes for years.

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