Type 2 diabetes usually does not appear suddenly. Changes in the way the body handles blood sugar can develop slowly over many years before a person receives a diagnosis.
An international group of experts now says diabetes prevention should begin much earlier than it usually does.
Researchers led by University Hospital Tübingen and the German Center for Diabetes Research, known as DZD, are calling for a “life-course” approach to prevention. This means looking at diabetes risk from before pregnancy through childhood, adulthood and later life, rather than waiting until blood sugar has already started to rise.
Their recommendations were published in the journal Nature Medicine. The international panel reviewed existing research and developed a 10-point framework aimed at improving the prevention of type 2 diabetes and the health problems that can come with it.
Type 2 diabetes is a condition in which the body has trouble keeping blood sugar within a healthy range. The hormone insulin normally helps move sugar from the blood into cells, where it can be used for energy. In type 2 diabetes, the body may become less responsive to insulin and, over time, may also struggle to produce enough of it.
Persistently high blood sugar can gradually damage blood vessels and organs. This can increase the risk of heart disease, stroke, kidney disease, nerve damage and vision problems. Preventing diabetes before these problems develop could therefore have major benefits for long-term health.
The researchers argue that prevention often starts too late. Many programs focus on adults who already have prediabetes, which means their blood sugar is higher than normal but not yet high enough for a diabetes diagnosis. The new framework says important influences on future diabetes risk can begin decades earlier.
For example, the health of both parents before pregnancy may affect the future metabolic health of their children. During pregnancy, a mother’s blood sugar, weight and general health can also influence a child’s development. Breastfeeding and nutrition during early childhood may provide further opportunities to support healthy development.
Childhood, adolescence and young adulthood are also important periods. Eating habits, physical activity, sleep, body weight and social conditions can change during these years. These patterns may continue into adulthood and influence the likelihood of developing diabetes later in life.
The researchers say prevention should continue through middle and older age rather than being treated as a one-time intervention. Risk can change as people gain or lose weight, become more or less physically active, develop other medical conditions or experience changes in their living and working environments.
Another major part of the new framework is the idea of remission. Instead of simply trying to delay the progression from prediabetes to diabetes, the experts argue that prevention should aim to help people return their blood sugar to the normal range whenever possible.
Research has shown that some people with prediabetes can achieve normal blood sugar levels through targeted lifestyle changes.
These can include changes in diet, increased physical activity and weight loss when appropriate. People who return to normal blood sugar appear to have a substantially lower risk of developing type 2 diabetes later.
The experts therefore want prediabetes remission to become a major goal of preventive care. This represents an important change in thinking because prediabetes would not simply be viewed as an unavoidable step on the road to diabetes.
Instead, it could be treated as a warning period in which there is still an opportunity to restore healthier blood sugar control.
The 10-point framework also calls for prevention to become more personalized. Two people with similar blood sugar readings may not have the same underlying risks, so their most effective prevention strategies may differ. Genetics, body fat distribution, age, lifestyle and social circumstances can all influence risk.
Digital technology and artificial intelligence may eventually help doctors identify risk earlier and choose more individualized approaches. The researchers also stress that prevention programs need to address health inequalities because access to nutritious food, safe places to exercise and medical care differs greatly between communities.
The article is important because it brings together experts from several areas and proposes a broader way to think about diabetes prevention.
However, it is an expert framework based on existing evidence rather than a clinical trial proving that all 10 recommendations will reduce diabetes rates in every population. Health systems will need further research to determine which approaches are practical, affordable and most effective.
Still, the central idea is compelling. If type 2 diabetes develops over decades, waiting until blood sugar becomes abnormal may mean missing years of opportunities to reduce risk. Prevention that begins earlier, responds to changing risks and aims to restore normal metabolic health could eventually help more people avoid diabetes altogether.
Source: University Hospital Tübingen and German Center for Diabetes Research (DZD).
