Risk Factors for Developing Type 2 Diabetes

Type 2 Diabetes is a chronic progressive disease characterized by consistent abnormally elevated blood glucose, eventually leading to complications due to damage of every organ in the body. 

Diabetes is a modern public health epidemic affecting 422 million people world wide, and is considered one of the leading causes of death. (1) 

In America alone, 52.3 percent of adults have been diagnosed with diabetes or pre-diabetes.  This means that due to strictly diabetes related conditions, less than half of the american population is considered healthy. (1) 

The prevalence of this disease has dramatically increased since the 1980s, by 1160 percent to be exact. (1) 

There are many factors associated with an increased risk of developing diabetes, of which some are modifiable and some are not. 

In this article I will review the leading risk factors of diabetes and which contribute to the dramatic rise in prevalence over the last 40 years.

Understanding the risk factors associated with diabetes is essential to properly evaluate personal and family chances of developing the disease.

For detailed information about type 2 diabetes read my article Type 2 Diabetes: A Major Public Health Epidemic, What it is and Why it Develops

Types of Risk Factors

The risk factors of diabetes are often divided into two categories:

o   Modifiable risk factors

o   Non-modifiable risk factors.

Things like your genetics, heredity, and age are non-modifiable risk factors.

Yet, one of the extremely important risk factors is modifiable..  Lifestyle.

Below, we have explained each one for you to understand it better:

Obesity

Obesity is the leading risk factor for diabetes, increasing the chances of development by a whopping 80%. (2) More specifically, having a Body Mass Index (BMI) of more than 25 puts you 80 times more at risk for developing the disease (normal BMI is at 18.5 to 24.9).  

Although insulin resistance is a cause of weight gain, obesity is multifactorial in causality.

Genetics alone can increase the chances of developing obesity by 40-70%.(3)

So how does obesity contribute to the development of insulin resistance and diabetes?

In obesity large amounts of adipose (fat) tissue lead to chronic low-grade inflammation. These pro-inflammatory components such as CRP, TNF-a, IL-6, and other cytokines interfere with the insulin signaling pathway, primarily in adipose (fat) tissue, and hepatocytes (liver cell). This leads to insulin resistance and a further increase in fat deposition or weight gain, creating a vicious cycle. (3) 

If you are thinking “this sounds like me”, don’t fret, weight can be lost and risk decreased! I have helped many patients lose weight utilizing a combination or 

Genetics and Heredity

If both of your parents have type 2 diabetes, it does not necessarily mean that you are doomed for the same diagnosis, but rather that your risk of developing diabetes is 50% higher than people with non-diabetic parents.

On the other hand, if you have a sibling diagnosed with type 2 diabetes, your risk is approximately 3 times greater in  comparison to the general population. (4)

The genes that are commonly associated with an increased risk of diabetes are your peroxisome proliferator-activated receptor gamma (PPARG), insulin receptor substrate 1 (IRS1) and IRS-2, potassium inwardly-rectifying channel, subfamily J, member 11 (KCNJ11), Wolfram syndrome 1 (wolframin) (WFS1), HNF1 homeobox A (HNF1A), HNF1 homeobox B (HNF1B) and HNF4A. (4)

The genetic factor of type 2 diabetes is clearly seen in the Pima Indians of Arizona, being documented by an epidemiologic study from the World Health Organization,as having the highest rates of Type 2 diabetes. 

Age 

risk factors for dm

In general, with age activity level and sleep decrease, while stress and weight increase. All of which are risk factors themselves for developing diabetes. 

Diabetes slowly develops as a result of years of progressing insulin resistance, meaning more years of life are more likely to turn insulin resistance into full blown diabetes. 

Although, diabetes type 2 is being seen in young adults and children the average age of diagnosis is 45.

Gestational Diabetes  

Risk Factors for type 2 DM

Gestational diabetes occurs when blood glucose levels are consistently abnormally elevated during pregnancy. This type of diabetes affects 2% to 10 % of pregnancies and often develops as a result of weight gain, elevated insulin resistance, and reduced insulin production during gestation.  

Excess body fat, previously existing insulin resistance, a family history of type 2 diabetes, and PCOS will all increase the risk of developing gestational diabetes. 

Although, blood glucose levels often return to normal after pregnancy, the risk of developing type 2 diabetes within the next ten years is 10 times greater than those who have healthy pregnancies.  (5,6)

Cholesterol Imbalance 

Cholesterol, although often demonized as the cause of cardiovascular disease, is essential for things like the structure of cell membranes, and the proper production of hormones.  Cholesterol is neither good nor bad, it just must be balanced.

Standard cholesterol tests measure triglycerides, High density lipoprotein (HDL), low density lipoprotein (LDL), and very low density lipoprotein (VLDL). 

LDLs and VLDLs are considered the “bad” cholesterol. This is because at high levels it is associated with an increased risk of developing atherosclerotic plaques and cardiovascular disease. It is recommended to keep LDL levels under 100 mg/dL, and VLDL levels under 40 mg/dL.

Excess calories that the body can not use are converted into triglycerides to then be stored as fat and may be used as energy at a later time. This type of cholesterol is commonly elevated in diabetic patients due to consistently elevated blood glucose. Just like LDL, and VLDL cholesterol elevated triglycerides are also associated with and increased risk of cardiovascular disease.  It is recommended to keep triglyceride levels below 150 mg/dL. 

HDLs are considered the “good” cholesterol because they help to clean up the “bad” cholesterol and take it back to the liver for clearance. Low levels of HDL cholesterol are associated with an increased risk of developing type 2 diabetes.  

Although more research is needed, it is speculated that this is due to HDL cholesterol’s involvement in blood glucose control.  HDL cholesterol has been shown to stimulate insulin production from beta cells, and therefore low levels may lead to inadequate production and therefore hyperglycemia and even diabetes. (7)

Hypertension

Elevated blood pressure, or hypertension shares many of the same risk factors as diabetes, obesity, hyperglycemia, physical inactivity, ect. 

More recently hypertension and even prehypertension have been shown to be separate yet significant risk factors for developing diabetes, increasing risk by 1.5 to 2 times.  

A consistent blood pressure as low as 130/85 is linked to an increased risk of developing diabetes. 

Although more research is needed to determine exactly how elevated blood pressure increases risk, it is speculated to cause dysfunctional blood flow contributing to the development of type 2 diabetes.  (8)

Endocrine disorders

Endocrine disorders affect hormone signaling pathways in the body, which oftentimes indirectly or directly influences the functioning of other organs and hormone pathways. Many endocrine disorders and imbalances have been linked to an increased risk of developing diabetes. 

PCOS has recently been determined to be a non-modifiable risk factor, resulting in a 6.8-fold increase in chance of development of type two diabetes by middle age (9). Despite the high prevalence of obesity associated with PCOS the increase in risk is completely independent of BMI, although risk will further increase with elevation in BMI. (10)  

For a better understanding of PCOS and diagnosis and treatments, read my comprehensive article Polycystic Ovarian Syndrome (PCOS): Diagnosis, Treatment, & Medication.

Thyroid hormones, T3 and T4,  function to control blood glucose and lipid metabolism.  Insufficient levels of these hormones are linked to higher insulin levels and the development of insulin resistance, increasing risk of diabetes. To be exact, studies show a 40% increased risk of developing diabetes in overt hypothyroidism.(11)

Not only is this effect on insulin seen in over hypothyroidism but also subclinical hypothyroidism, supporting the need to adjust “healthy” laboratory ranges for these hormones. (12) See your naturopathic physician to optimize your thyroid function and avoid these negative effects.

If you are interested in optimizing your thyroid function and would like more detailed information on this topic read my articles: 

HPA axis dysfunction, or more specifically flattening of the diurnal cortisol curve due to chronic stress has been shown in many studies to increase risk of developing insulin resistance, and type 2 diabetes. In addition, Diabetics display higher than average cortisol production with less variability due to stress.

Cortisol, the primary stress hormone, signals the release of glucose into the blood from glycogen stores in the muscles and liver in times of stress. This in turn stimulates a higher blood glucose level, which is why chronic stress will increase risk of developing insulin resistance and diabetes. (13)

Be sure to optimize your cortisol production! For a comprehensive review of cortisol and adrenal function read my article What is Cortisol? Why Does it Matter? Everything You Need to Know.

Low Testosterone in men is said to be predictive for the development of diabetes, with strong links to insulin resistance, obesity, and adverse cholesterol levels.(14,15,16) Up to 50% of men already diagnosed with diabetes are estimated to have overtly low testosterone levels. (15) Early detection and treatment using testosterone replacement therapy has been shown to have beneficial effects. (15,16)

Hormone imbalances not only contribute to the development of diabetes, and obesity but may also be associated with low mood, anxiety, fatigue, irregular menstrual cycles and more. For more information read my article What is Hormone Replacement Therapy? How Does it Help?

Lifestyle

Since lifestyle is easily modifiable it is arguably the most important risk factor for diabetes. This means by making simple changes to diet, sleep, and activity level you are able to decrease risk of development. 

Consistent exercise (both aerobic and resistance training) and modest weight loss can effectively decrease risk of developing type 2 diabetes by up to %58. This benefit is highly associated with resulting long term improvements in insulin activity. (17)

Despite exercising, many still live a sedentary lifestyle, with the majority of hours spent sitting, driving, watching TV, ect.  A sedentary lifestyle may increase risk of developing diabetes by up to %112, this increases chances by over double!  This risk is not decreased with exercise or BMI. (18)

Sleep is a fundamental need of all living organisms, and if made to go without results in many health dysfunctions.  For optimal health, human adults require 7 to 9 hours of natural sleep per night. This being said, more than 30% of American adults between 30 to 64 years old report sleeping less than 6 hours per night, making chronic sleep insufficiency a public health epidemic. (19)

Chronic Sleep deprivation is  a significant risk factor for the development of type 2 diabetes. Short sleep of less than 7 hours per night increases morning fasting insulin, fasting glucose, and insulin resistance. These effects of sleep deprivation are seen quickly, even after one night of short sleep. (19)

Sleep deprivation negatively affects every function of the body, yet is rarely discussed.  To understand why we sleep and how to optimize yours, read my article The Science of Sleep. Why Sleep is Important.

The standard American diet, high in fast food, processed packaged foods, refined carbohydrates, high fructose corn syrup, desserts, red meat, fried food and low in fiber, vegetables, and micronutrients, is highly linked to the development of type 2 diabetes. (20)

In the United States about ⅔ of the food purchased from grocery stores and other retailers is packaged highly processed food that often contains large amounts of added sugar and high fructose corn syrup. (21)   The process of refining carbohydrates removes the plant fiber, fat, and protein, making the carbohydrate very quickly and easily absorbed, causing significantly higher spikes in blood glucose and insulin levels than unrefined food.

In addition, the lack of fiber, protein, and fat makes these foods much less filling, promoting over consumption, leading to both obesity and diabetes. To top it off these refined food often include added high fructose corn syrup which while keeping blood glucose comparably lower, spikes insulin levels and stimulates the development of fatty liver disease, and insulin resistance.

Nutritional guidelines for diabetes recommends eating foods with low glycemic load, primarily excluding the highly processed and high sugar containing foods. Ironically, the foods used to make these refined products such as corn, soy, and wheat are highly subsidized by the government, while unprocessed carbohydrates such as fresh fruits and vegetables receive nearly no financial aid.

This is why fresh fruit and vegetables are much more costly than refined carbohydrates, making them less attainable for low income individuals. (22)

Our government is subsidizing the food that is making us sick. 

Conclusion

Although type 2 diabetes is becoming increasingly more prevalent, remember that it is not a predetermined conditioned fated to happen to anyone that holds the risk factors listed above. 

The good news is that despite living in a modern society that promotes sickness rather than health, there are many easily modifiable risk factors.

You can take control of your health, prevent and even reverse diabetes.  

My goal is to provide information to help you understand your personal risk and motivate you to make the necessary changes to heal and obtain optimal health. 

In this article we discussed the following:

For more detailed information on type 2 diabetes please read my comprehensive articles on this topic: 

Type 2 Diabetes: A Major Public Health Epidemic | What it is and Why it Develops

Conventional Treatments for Type 2 Diabetes

If you think you have any of the above risk factors and want to know more, you can contact us here!  

References:

1.     Scibilia R. (2019). The Diabetes Code: Prevent and Reverse Type 2 Diabetes Naturally. Clinical diabetes : a publication of the American Diabetes Association,  37(3), 302–303. https://doi.org/10.2337/cd19-0025 

2.     Anonymous (Ed.). (2019, January 15). DIAGNOSIS Diabetes and Obesity. Retrieved August 6, 2020, from https://www.diabetes.co.uk/diabetes-and-obesity

3.     Ye J. (2013). Mechanisms of insulin resistance in obesity. Frontiers of medicine, 7(1), 14–24. https://doi.org/10.1007/s11684-013-0262-6

4.     Gaulton, K. J., Willer, C. J., Li, Y., Scott, L. J., Conneely, K. N., Jackson, A. U., Duren, W. L., Chines, P. S., Narisu, N., Bonnycastle, L. L., Luo, J., Tong, M., Sprau, A. G., Pugh, E. W., Doheny, K. F., Valle, T. T., Abecasis, G. R., Tuomilehto, J., Bergman, R. N., Collins, F. S., … Mohlke, K. L. (2008). Comprehensive association study of type 2 diabetes and related quantitative traits with 222 candidate genes. Diabetes, 57(11), 3136–3144. https://doi.org/10.2337/db07-1731

5.     Gestational Diabetes. (2019, May 30). Retrieved from https://www.cdc.gov/diabetes/basics/gestational.html

6. Herath, H., Herath, R., & Wickremasinghe, R. (2017). Gestational diabetes mellitus and risk of type 2 diabetes 10 years after the index pregnancy in Sri Lankan women-A community based retrospective cohort study. PloS one, 12(6), e0179647. https://doi.org/10.1371/journal.pone.0179647

7. Haase, C. L., Tybjærg-Hansen, A., Nordestgaard, B. G., & Frikke-Schmidt, R. (2015). HDL Cholesterol and Risk of Type 2 Diabetes: A Mendelian Randomization Study. Diabetes, 64(9), 3328–3333. https://doi.org/10.2337/db14-1603

8. Kim, M. J., Lim, N. K., Choi, S. J., & Park, H. Y. (2015). Hypertension is an independent risk factor for type 2 diabetes: the Korean genome and epidemiology study. Hypertension research : official journal of the Japanese Society of Hypertension, 38(11), 783–789. https://doi.org/10.1038/hr.2015.72

9.     Gambineri, A., Patton, L., Altieri, P., Pagotto, U., Pizzi, C., Manzoli, L., & Pasquali, R. (2012). Polycystic ovary syndrome is a risk factor for type 2 diabetes: results from a long-term prospective study. Diabetes, 61(9), 2369–2374. https://doi.org/10.2337/db11-1360

10.  Wang, E. T., Calderon-Margalit, R., Cedars, M. I., Daviglus, M. L., Merkin, S. S., Schreiner, P. J., Sternfeld, B., Wellons, M., Schwartz, S. M., Lewis, C. E., Williams, O. D., Siscovick, D. S., & Bibbins-Domingo, K. (2011). Polycystic ovary syndrome and risk for long-term diabetes and dyslipidemia. Obstetrics and gynecology, 117(1), 6–13. https://doi.org/10.1097/AOG.0b013e31820209bbhttps://doi.org/10.1097/AOG.0b013e31820209bb

11.  Johnson, J. L. (2006, July 01). Diabetes Control in Thyroid Disease. Retrieved from https://spectrum.diabetesjournals.org/content/19/3/148

12.   Hage, M., Zantout, M. S., & Azar, S. T. (2011). Thyroid disorders and diabetes mellitus. Journal of thyroid research, 2011,439463. https://doi.org/10.4061/2011/439463

13.  Harris, M. L., Oldmeadow, C., Hure, A., Luu, J., Loxton, D., & Attia, J. (2017). Stress increases the risk of type 2 diabetes onset in women: A 12-year longitudinal study using causal modelling. PloS one, 12(2), e0172126. https://doi.org/10.1371/journal.pone.0172126

14.  Nelly Pitteloud, Vamsi K. Mootha, Andrew A. Dwyer, Megan Hardin, Hang Lee, Karl-Fredrik Eriksson, Devjit Tripathy, Maria Yialamas, Leif Groop, Dariush Elahi, Frances J. Hayes. (2005). Relationship Between Testosterone Levels, Insulin Sensitivity, and Mitochondrial Function in Men. Diabetes Care Jul 2005, 28 (7) 1636-1642; https://doi.org/10.2337/diacare.28.7.1636

15.  Muraleedharan, V., & Jones, T. H. (2010). Testosterone and the metabolic syndrome. Therapeutic advances in endocrinology and metabolism, 1(5), 207–223. https://doi.org/10.1177/2042018810390258

16.  Hackett G. (2019). Type 2 Diabetes and Testosterone Therapy. The world journal of men’s health, 37(1), 31–44.https://doi.org/10.5534/wjmh.180027

17.  Colberg, S. R., Sigal, R. J., Fernhall, B., Regensteiner, J. G., Blissmer, B. J., Rubin, R. R., Chasan-Taber, L., Albright, A. L., Braun, B., American College of Sports Medicine, & American Diabetes Association (2010). Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement. Diabetes care, 33(12), e147–e167. https://doi.org/10.2337/dc10-9990

18.  Hamilton, M. T., Hamilton, D. G., & Zderic, T. W. (2014). Sedentary behavior as a mediator of type 2 diabetes. Medicine and sport science, 60, 11–26. https://doi.org/10.1159/000357332

19.  Knutson, K. L., & Van Cauter, E. (2008). Associations between sleep loss and increased risk of obesity and diabetes. Annals of the New York Academy of Sciences, 1129, 287–304. https://doi.org/10.1196/annals.1417.033

20.  Sami, W., Ansari, T., Butt, N. S., & Hamid, M. (2017). Effect of diet on type 2 diabetes mellitus: A review. International journal of health sciences, 11(2), 65–71.

21.  Popkin, B. M., & Kenan, W. R., Jr (2016). Preventing type 2 diabetes: Changing the food industry. Best practice & research. Clinical endocrinology & metabolism, 30(3), 373–383. https://doi.org/10.1016/j.beem.2016.05.001

22.  Fung, J. (2016). The obesity code: Unlocking the secrets of weight loss. Brunswick, Vic.: Scribe Publications.

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Hello, my name is Dr. Sarah Bennett, NMD! I am a naturopathic physician licensed in the state of Arizona currently practicing at my office in Scottsdale, AZ. I received my degree from Southwest College of Naturopathic Medicine, did a year residency at Keystone Natural Family medicine, and received additional training for aesthetics & anti-aging at National Laser Institute. My passion and fascination for natural medicine began during my undergraduate studies at Indiana University where I got a dual degree in neuroscience & psychology. I saw how a preventative approach could help you live a long and youthful life. Since then I have dedicated my life to serving others to understand the latest medical trends. I spend my spare time running, hiking, rock climbing, camping, testing out new diets, and reading books on latest medical trends / listening to podcasts to find the latest nuggets of knowledge to improve the quality of life for my patients. I look forward to serving you!

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