Pre-stages of diabetes - not every risk of cardiovascular disease

People with a disturbed blood glucose metabolism that have a pre-stage of diabetes( = prediabetes) have an increased risk of type 2 diabetes, cardiovascular disease, dementia and cancer. But their individual risk for these diseases differs significantly. New analyzes show that screening for fatty liver, increased abdominal fat, and disruption of the production and effect of insulin can help to predict and prevent the risk of cardiovascular disease and type 2 diabetes. These results were reported by DZD scientists in the prestigious Journal The Lancet Diabetes &Endocrinology.

Diabetes and its precursors have reached epidemic proportions worldwide. A concern is the fact that an increased blood glucose is associated with an increased risk of type 2 diabetes, cardiovascular disease, dementia and cancer in prediabetes. But even in the stage of prediabetes the risk for these diseases differs significantly between humans. This finding was taken by scientists from the Department of Internal Medicine IV of the University Hospital of Tübingen and the Institute for Diabetes Research and Metabolic Diseases( IDM) of the Helmholtz Zentrum München, a partner of the German Center for Diabetes Research( DZD), to investigate the factors influencing these differences in disease riskcould explain.

Precursors of diabetes. Image: Syda Productions - fotolia precursors of diabetes. Image: Syda Productions - fotolia

Type 2 diabetes is not the same type 2 diabetes
Several mechanisms play a role in the development of type 2 diabetes. But in clinical practice it is difficult to keep these mechanisms apart - which would be very helpful for the personalized prevention and therapy of diabetes. For example, only the sober blood sugar can be increased or the sugar metabolism may derail within a few hours after food intake. In other patients, both phenomena can be observed. Various "risk phenotypes" can be distinguished from the appearance images.

Phenotypes determine the cardiovascular risk
In an analysis of the data from 1,003 participants of the Tübingen diabetes family study, in which 405 people had prediabetes, the four risk phenotypes were fatty liver, Tomography( MRI) - and a disruption of the production and effect of insulin is crucial for the risk of diabetes. The three risk phenotypes of fatty liver disease and a disorder of the production and effect of insulin also predicted how successful a lifestyle intervention was to normalize elevated blood glucose levels in people with prediabetes. In addition, patients with fatty liver and increased abdominal fat content showed a thickening of the throat lines and thus an increased risk for cardiovascular diseases.

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Phenotypes of prediabetes
Based on the increasing knowledge of the presence of different phenotypes of metabolism that are metabolicobese people and metabolic-diseased normal-weight individuals, the researchers have examined the frequency of the four risk phenotypes among the different BMI categories( normal weight, overweight, obesity) in people with normal blood glucose levels and in people with prediabetes. They showed that a different distribution of these phenotypes exists between the BMI categories( Figure).While e.g.an insulin production defect is by far the most frequent risk phenotype in normal-weight prednisone, the frequency of fatty liver disease and the increased abdominal fat content in overweight and obese people is increasing significantly.
Norbert Stefan, first author of the work, suggests that "according to the classification of the categories normal sugar metabolism and prediabetes, the fatty liver, the increased abdominal fat content and a disturbance of the production and effect of insulin in the assessment of the risk forcardiovascular diseases and type 2 diabetes. If this approach proves to be promising, it could enter the medical guidelines for the prevention and treatment of diabetes and related diseases. "Hans-Ulrich Häring, last author of the study, adds that" the application of precise phenotyping strategieswill improve the understanding of cardiovascular disease and type 2 diabetes in clinical trials. "

Original Publication:
Norbert Stefan, Andreas Fritsche, Fritz Schick, Hans-Ulrich Häring. Phenotypes of prediabetes and stratification of cardiometabolic risk. Lancet Diabetes &Endocrinology 2016 [epub ahead of print] DOI: http: //dx.doi.org/10.1016/ S2213-8587( 16) 00082-6

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