According to data released in 2021, the number of diabetic patients worldwide has exceeded the 500 million mark, and the number of patients will even increase by more than 200 million by 2045. In the face of such a grim situation, many people will choose to undergo relevant examinations to detect or prevent diabetes as soon as possible, and blood tests are one of them. It includes blood lipids, blood sugar, liver function, blood routine tests, etc.
Most people think that blood tests can only look at whether there is a current risk of diabetes, but a study in Nature sub-journal sub-article subverts the public perception: through blood tests, it is possible to predict an individual's risk of developing diabetes in 10 years. If it does, it may be possible to more precisely identify signals that reduce or delay the onset of disease as we age. Let's take a closer look at this study in combination with the cognition of diabetes.
First, type 2 diabetes is not scary? Nature Reviews Endocrinology study: The consequences are more serious than expected
Most people used to think that type 2 diabetes was only caused by the elderly, but now with the improvement of quality of life, many unhealthy lifestyles of young people (such as lack of exercise, preference for sweets, etc.) have made the disease younger people. And a growing body of data shows that in young people under the age of 40 with type 2 diabetes, β cell function deteriorates faster than late-onset type 2 diabetes.
In fact, with the increase in the number of young people with type 2 diabetes, relevant studies predict that this type of disease may become a common feature of the wider diabetic population in developed and developing countries, especially for certain ethnic groups. But some aspects remain less well understood, such as the extent of the excessive risk of premature death and complications of events.
The review, published in Nature Reviews Endocrinology, is a further study on this issue. They highlight the association between the incidence of type 2 diabetes and premature death in younger populations, and review the evidence on the prevalence and incidence of type 2 diabetes in developing and developed countries and young onset, as well as the current and future burden of the disease. I believe that through the careful reading of this study, we can have a clearer understanding of the harm of type 2 diabetes.
Type 2 diabetes is a serious condition caused by insulin not working properly or the pancreas not producing enough insulin, which can force blood sugar levels to rise, causing a series of strokes, foot and nerve damage. In terms of the harm of type 2 diabetes in young people, the study mainly focuses on the rapid development of the disease and the increased risk of multiple complications.
Compared with late-onset type 2 diabetes, the disease progresses more rapidly in young people, which means that the pathophysiology of the two is different. Although there are certain similarities between the causes of young onset and late-onset type 2 diabetes, such as other obesity-driven mechanisms, β cell dysfunction, insulin resistance, etc., it is undeniable that young onset β faster cell failure.
Specifically, the decline rate of β cell function in late-onset type 2 diabetes is about 7% per year, while the annual decline rate of β cell function of adolescents with an average age of 14 years old is 20%~35%, which shows that the β cell function of mild type 2 diabetes will decline much faster with the progress of time than that of late-onset type 2 diabetes.
From another perspective, the impact of obesity in young people with type 2 diabetes is greater, with far more than half of young patients being obese at the time of onset, but this proportion has decreased by 30% in patients with late-onset diabetes. And according to relevant studies, the fat in the muscles and liver of young patients with mild type 2 diabetes is about 3 times higher than that of patients with late-onset.
Although the researchers are comparing the harm caused by young and late-onset type 2 diabetes, we can clearly see that no matter what kind of population suffers from the disease, it may have problems such as β cell failure and obesity, but there is a certain difference in the severity of the two.
In terms of the increased risk of a number of complications, mainly including cardiovascular disease and mortality, nephropathy, microvascular complications, neuropathy, and retinopathy, the researchers also compared mild and late-onset type 2 diabetes. In the case of kidney disease, for example, the prevalence of microproteinuria in patients with mild type 2 diabetes will be relatively high, and the rate of progression to massive proteinuria in the future will also be higher.
According to relevant studies, the prevalence of microalbuminuria in such patients was 6% at the time of medical diagnosis, but it increased significantly after 4 years. In addition, Canadian studies have also shown that compared with late-onset type 2 diabetes, young patients with type 2 diabetes are 4 times more likely to have kidney failure, and adolescent patients can develop kidney failure as early as 15 years after diagnosis of the disease, and the survival rate is relatively low.
What is the risk of cardiovascular disease and death in mild type 2 diabetes?
In fact, the mortality and mortality risk of cardiovascular disease in patients with mild type 2 diabetes show an increasing trend, if the age of diagnosis is advanced by 10 years, the risk of cardiovascular disease death will increase by 60%, and the risk of all-cause death will increase by 20%~30%.
The risk of macrovascular complications differs between young and late-onset patients, with the former having a 1-fold increased risk compared with the latter. More seriously, in terms of myocardial infarction, the risk of developing this condition in young type 2 diabetes is more than ten times higher than that of late-onset! However, it should be noted that even late-onset type 2 diabetes has a 4-fold increased risk of myocardial infarction, and the harm to the body and health cannot be ignored.
All in all, in any of these ways, the harm of type 2 diabetes is not as simple as we think. In the case of young patients with mild type 2 diabetes, because of the rapid deterioration of metabolic function, the disease is similar to invasive diseases, and progression often leads to early macrovascular and microvascular complications, accompanied by the risk of premature death. Therefore, we should do a good job of prevention as early as possible in life, observe the changes in blood sugar in time, and reduce the risk of diabetes as much as possible.
Second, can blood test predict the risk of diabetes after 10 years? This study in the Nature sub-journal sub-journal sub-journal sub-journal sub-journal
Diabetes disease progresses rapidly, and complications may occur that have many adverse effects on the health and life of patients, so many people will wonder if there is any way to predict the risk of diabetes as early as possible, so that targeted prevention and treatment measures will be more effective.
Type 2 diabetes, as one of the main economic and health burdens, can reduce pressure by improving early prediction and intervention. The University of Edinburgh researchers published a study in Nature showing that although standard risk factors showed good predictive performance, they published the study and found that the use of blood DNA methylation information can significantly improve the prediction of the risk of type 2 glycosuria in the next 10 years.
Specifically, the researchers predicted the risk of developing type 2 diabetes in the next 10 years by detecting DNA changes in the blood, and said that the synthesis of DNA methylation data and common type 2 diabetes risk factors could show more accurate risk prediction results.
But what is DNA methylation? Why is it so important in this study?
In fact, studying DNA methylation models is helpful for tracking the aging process and disease progression, because when methyl groups bind to DNA, DNA methylation may change the function of the gene by blocking the transcription process of the gene, so that it cannot produce RNA copies that build new proteins.
In terms of experimental methods, researchers at the University of Edinburgh have also shown innovation. Previous studies have had a limitation: they have been largely limited by the use of cytosine-guanine pairs at a time and the binary outcome, linear hypothesis. The researchers offer an updated approach to this, based on a series of linear and tree-ensemble models that combine time-to-time data to make predictions.
The researchers then created several potential models by combining the two data, and trained the algorithm model in a cohort of nearly 10,000 people, and found that a total of 374 people developed type 2 diabetes. For further research and analysis, the researchers applied these models to another group of subjects and found that the area under the curve of the model that performed best among all the models was 0.872.
Based on this value, the researchers believe that the model shows a significant improvement in 10-year risk prediction ability compared to standard non-methylation assessment methods, because the area under the model curve of the non-methylation assessment method is 0.839. After repeated analysis and extrapolating the predictive performance of the relevant model, the researchers concluded that if applied to a population of 10,000 people with nearly one-third of the population who will develop diabetes in the next 10 years, the model's current risk assessment capabilities can correctly identify relatively many high-risk individuals than the standard assessment method without methylation.
And the researchers say the model can not only predict the risk of type 2 diabetes, but eventually serve as a tool to assess risk scores for other diseases. When we are faced with other common diseases, we may be able to use a similar approach to generate a wide range of health predictors based on a single saliva or blood sample
It can be said that this research is of great significance, not only to give high-risk groups the opportunity to develop corresponding preventive measures before the onset of diabetes, but also to capture the early "alarm" of the disease in order to improve the treatment outcomes of high-risk people with diabetes on a broader scale. At the same time, this research is possible, and it can also help us more accurately identify the signals sent by diseases that reduce and delay aging.
Bibliography:
[1] Danni A. Gadd, Christian Gieger.Development and validation of DNA methylation scores in two European cohorts augment 10-year risk prediction of type 2 diabetes.2023.04.06.
[2] Harding, Edward W. Gregg.Young-onset type 2 diabetes mellitus — implications for morbidity and mortality.2020.03.20.