14 Risk factors of Diabetes that Don Corleone never knew

Type 2 diabetes starts exhibiting its true colors usually over the age of 40. Until then, there may not be any signs at all or they may not be obvious. Often, it might take more than 10 years before you realize you had been suffering from Diabetes. Awareness of the risk factors and regular assessment to detect the disease early is critical for better prognosis. There are several online assessment tools such as Blue Circle Test by International Diabetes Federation (IDF) and FINDRISC assessment by Finnish Diabetes Association.

There are certain risk factors such as age or genetic predisposition that are beyond our control. Nonetheless, there are other risk factors such as obesity, large waist size, physical inactivity, unhealthy eating habits and smoking that can be actively be modified. If any of your family members has diabetes, keep a tab on your weight, especially the waist size, which is the single biggest portent for diabetes, in otherwise normal individuals. Active lifestyle preferences including regular moderate physical activity and healthy diet – fruits, vegetables and fiber-rich cereal products – can completely deter type 2 diabetes or at least defer its onset.

NON-MODIFIABLE RISK FACTORS (HANDICAPS) OF TYPE 2 DIABETES

There are some non-modifiable or non-actionable risk factors for developing pre-diabetes and, ultimately, Type 2 Diabetes. Nevertheless, knowing them is important in assessing the overall risk and the efforts required to tame the disease. These Risk factors that are beyond our control, include:

1. Age
Advancing age is a contributing factor as the general functionality of human bodies declines with age. Though Diabetes may occur at any age, proportionate to the body’s weight and to certain ethnicities, over 80% of cases occur after 49 years of age.

Women have an advantage though as until menopause, the high levels of estrogen, keeps insulin resistance at bay. Contrast these with women who have had hysterectomy early and you’d notice that they too would develop Diabetes, if at risk, earlier.

2. Family history
Risk of developing Type 2 diabetes has been associated with several gene mutations, multiple loci are associated, most commonly MHC class II. However, they cannot lead to diabetes on their own, but have to interact with environmental factors (toxins, viruses, and foods etc) and each other to compound the risk. According to ADA (American Diabetes Association), the risk of developing type 2 diabetes is:

  • one in seven, if either parent is diagnosed before the age of 50
  • one in 13, if either parent is diagnosed after the age of 50
  • one in two, if both your parents have diabetes

3. Ethnicity
Though disparities in Socio-Economic status and access to healthcare can explain the differences in incidence, several studies have proved that, with access and other factors being equal, the risk of developing diabetes is far higher in people of certain ethnicities.

  • In South Asian, Chinese, African-Caribbean, Black African, Diabetes can start as early as 25 years. In others, it is usually seen in people over age over 40.
  • Hispanic, African American, Native American, Asian, or Pacific Islander ethnicities are at almost double the risk of white Americans.
  • Odds of developing Diabetes are 6 times higher in people of South Asian descent and 3 times in African/Africa-Caribbean people.
  • Age-adjusted diabetes risk is more than
    • 120% for African Americans,
    • about 76% for Hispanics,
    • and 43% for Asians.

4. Gender (Women)

  • Delivering a baby who weighed more than 9 lbs or 4 kg
  • Diagnosis of Polycystic Ovarian Syndrome
  • Poor nutrition during pregnancy
  • History of Gestational Diabetes: Some women develop diabetes during the pregnancy, which gets resolved after the baby is born. However, these women have 20- 50% greater risk of developing diabetes in the subsequent 5-10 years.

5. Low birth weight
Chances of developing diabetes goes up by 23% for babies born under 2.5 kilograms and by 76% for babies under 2.25 kilograms.

CONTROLLABLE RISK FACTORS (LIBERATORS) OF TYPE 2 DIABETES

Apart from improving overall quality of life, consistent and sustained amendments in these modifiable risk areas such as healthy diet and lifestyle changes, can lead to substantial risk reduction or delay in the onset of diabetes.

6. Obesity:
A body mass index (BMI) higher than 25 is a ready trigger for Pre-Diabetes. BMI over 29 increases the odds of diabetes to one in four. A mere 5-7% loss of body weight can drastically reduce the risk of developing pre-diabetes by half. The more the weight loss, the higher the reduction of risk of developing Type 2 Diabetes.

Waist Circumference (excess abdominal fat) is an easy measure and proxy for BMI. Onset of Diabetes is assured If it is more than

  • 80cm/31.5 inches in women
  • 94 cm/37 inches in men
  • 90cm/35 inches in South Asian men.

7. Cardiovascular disease:
Existing cardiovascular disease or past history of a heart attack or a stroke is  a very high risk factor for Diabetes. Vascular disorders such as hypertension often co-exist with Diabetes. Unattended high blood pressure (140/90 or higher), apart from irreversible damage to the cardiovascular system, can trigger the development of diabetes. On the other hand, prolonged diabetes along with dyslipidemia can also lead to the onset of hypertension.

Dyslipidemic states such as low HDL and/or high triglycerides can also increase the risk of developing Type 2 diabetes and cardiovascular disease –

  • High level of triglycerides (250 mg/dL or higher)
  • Low HDL level (35 mg/dL or lower)
  • High LDL level (130 mg/dl or higher)

Strict dietary regimen, ample aerobic physical activity, coupled with robust weight management can help improve abnormal lipids and reduce the risk of developing hypertension and diabetes. In certain intractable cases, medications are necessary.

8. Eating a diet high in sugar, cholesterol, fat, and processed food
Appropriate diet is of paramount importance and occupies primary place in the prevention and control of diabetes. Refer to the detailed posts about diet hacks for more details.

9. Irregular or no exercise:
Physical activity on less than 3 occasions per week increases the risk for diabetes. Please ensure one of the following for overall cardiovascular health and preventing Diabetes.

  • Moderate-intensity aerobic physical activity for at least 150 minutes per week – 30 minute of walking daily * 5 days a week
  • Vigorous-intensity aerobic physical activity for at least 75 minutes per week – 25 minutes of Jogging daily * 3 alternate days in a week

A combination of the above two coupled with muscle-strengthening at least 2 days per week

10. Stress: Emotional stress
This has become an unavoidable ingredient in our modern day slavery stew, which is accelerating the onset of Diabetes in working adults. Apart from regular physical activity; Yoga, Meditation and Breathing techniques such as Pranayama help surmount the stress and also deftly safeguard our work-life balance.

11. Pre-diabetes is a Trigger and an alarming sign to kick-start the “preventabl” regime ASAP
Pre-Diabetes —an A1C level of 5.7 to 6.4 percent
Impaired fasting glucose: a fasting plasma glucose test result of 100–125 mg/dl
Impaired glucose tolerance: a 2-hour oral glucose tolerance test result of 140–199 mg/dl

12. Psychiatry Disorders
Patients suffering from schizophrenia, bipolar illness or depression, or are on anti-psychotic medication have been shown to be at increased risk of developing Diabetes.

13. Smoking and 14. Alcohol consumption accelerate the onset of Diabetes.

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