Familial age of onset of type 2 diabetes forecasts your risk

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Does Age at Diagnosis in Familial Diabetes Affect Type 2 Risk?

Mar 27, 2021 Editor: David L. Joffe, BSPharm, CDE, FACA
Author: Mit Suthar, PharmD. Candidate, LECOM School of Pharmacy 

Study of the Danish national register suggests that family members’ age at onset of diabetes could be an essential factor that is overlooked in determining type 2 risk. 

A family history of diabetes is a risk factor that is widely used in screening and predicting which patients are at increased risk of developing diabetes. Family history is a practical and conveniently identifiable risk factor that provides insight into the genetic and social/behavioral contributing factors of diabetes. The familial risk depends on the number of family members affected with diabetes and the type of family relationship. However, the strongest determinants of developing type 2 diabetes are the social and behavioral elements: “obesity, physical inactivity, diet, and low socioeconomic status.”  

There has been progress in understanding the connection between the etiology of type 2 diabetes and family history. Still, there is a lack of information about the effect of family members’ age at diabetes diagnosis and its relation to a patient’s risk of diabetes and their likely age of onset. The study hypothesized that “in addition to the type of family relationship and the number of family members affected with diabetes, their age at diagnosis would be associated with overall familial diabetes risk.” In a nutshell, they were trying to ascertain the effect that family members’ age at diabetes diagnosis had on an individual’s risk of developing diabetes and developing diabetes. This hypothesis was studied by using a national register that covered the total Danish population.  

A national register-based open cohort study of patients living in Denmark between 1995 and 2012 was performed. The study population consisted of individuals 30 years old or older without a diabetes diagnosis but who had access to their parent’s identity and information. The open cohort design allowed the addition of patients who turned 30 years old during the observation period. These specific criteria meant that most individuals included in the study were born between 1960 and 1982. This population was followed from January 1, 1995 (or the date of cohort entry) until they emigrated, or death, or until December 31, 2012.

After the inclusion and exclusion criteria were implemented, the study population comprised 2,000,552 individuals in 1,107,915 families, with the median age at entry into the study being 30 years old. These individuals were followed for a median of 14 years, and 76,633 new cases of type 2 diabetes were observed. They found that men and women had similar sociodemographic backgrounds and familial diabetes indicators. Still, a more significant proportion of women (42%) had completed more than 15 years of education than men (31%).  

Furthermore, and more importantly, they found that: “Compared with individuals of the same age and sex who did not have a parent or full sibling with diabetes, the highest risk of developing type 2 diabetes was observed in individuals with family members diagnosed at an early age.“ The IRR was also increasingly lower when family members had diabetes diagnosed at a later age. “3.9 vs. 1.4 for those with a parental age at diagnosis of 50 or 80 years, respectively; and 3.3 vs. 2.0 for those with a full sibling‘s age at diagnosis of 30 or 60 years, respectively.“  

The data collected from the national registers of Denmark illuminated how different combinations of exposure to familial diabetes can increase an individual’s risk of developing type 2 diabetes.  The researchers found that individuals with a family member who was diagnosed with diabetes at an earlier age are more likely to develop diabetes and unfortunately also develop it at an earlier age, compared to individuals with family members who developed diabetes at a later age.  

These findings are significant as they highlight the importance of understanding the complex interactions between “genetic diabetes determinants and the social, behavioral and environmental diabetes determinants,” which follow families across generations. There is a strong argument for the inclusion of recording an age of onset of diabetes for those family members we include in the family history when trying to screen for and predict the risk of developing type 2 diabetes in patients. The relative ease with which such data can be obtained and the highly relevant nature of the findings can significantly improve individuals’ identification, especially those at a higher risk of developing diabetes at a younger age vs. those who are more likely to develop diabetes later in life. This information can benefit many family members and not just the patient who is being screened.  

Practice Pearls: 

  • Family history is a vital independent risk factor for developing type 2 diabetes. Right now, the familial risk depends on the number of family members affected by the disease and the nature of the family relationship, but the age of onset of diabetes could be an essential factor that is overlooked. 
  • The nationwide open cohort found that patients with a family member who was diagnosed with diabetes earlier in life are more likely to develop diabetes, and also at an earlier age, than those patients whose family members developed diabetes at a later age. 
  • The benefits of obtaining the age of diagnosis of family members mean that it should become part of recording the diabetes family history. These individuals with family members who developed diagnosis at an earlier age could benefit from a more detailed risk factor assessment as well as individualized prevention strategies. 

Schwarz, et al. Effect of Familial Diabetes Status and Age at Diagnosis on Type 2 Diabetes Risk: a Nationwide Register-Based Study from Denmark.Diabetologia, 19 Feb. 2020, link.springer.com/article/10.1007/s00125-020-05113-8.  

Mit Suthar, PharmD. Candidate, LECOM School of Pharmacy  

My comment: Although it seems common sense that the younger age at diagnosis and the number of relatives affected with type 2 diabetes, the higher a persons individual risk seems, this is the study that nails it.

American Diabetes Association Endorses Low-Carb for Type 2s

eggs and asparagus

eggs and asparagusA landmark decision this week—the American Diabetes Association (ADA) has decided to back low-carb diets for type 2 diabetics.

Diabetes.co.uk reported the announcement this week. The charity has produced a report, ‘Nutrition Therapy for Adults with Diabetes or Prediabetes: A Consensus Report (Consensus Report)‘, published in the journal Diabetes Care.

Last year, the ADA acknowledged the low-carb approached as beneficial for treating type 2 diabetes. The new report goes further, stating that diabetes-focused nutrition therapy is a crucial part of overall diabetes management.

Previous high-carb recommendations

Previous dietary guidelines have focused on high-carb diets for people with or without diabetes.

The report says: “Reducing overall carbohydrate intake for individuals with diabetes has demonstrated the most evidence for improving glycemia and may be applied In a variety of eating patterns that meet individual needs and requirements.

“For select adults with type 2 diabetes not meeting glycemic targets or where reducing antiglycemic mediations is a priority, reducing overall carbohydrate intake with low- or very low-carbohydrate eating plans is a viable approach.”

Non-starchy vegetables

The report also says it is important to eat non-starchy vegetables, minimise the intake of added sugars and refined grains, and choosing whole foods instead of highly-processed foods.

As one of the authors of the paper, Dr Laura Saslow from the University of Michigan was also the author of a research paper published last year which revealed that 26 percent of users of Diabetes Digital Media’s Low Carb Programme put their type 2 diabetes into remission after a year. Remission was defined as reducing HbA1c to normal levels while taking no glucose-lowering medications or just metformin.

If you’re a low-carb enthusiast (type 2 diabetes or not), you’ll find lots of recipe ideas on this website and you can also buy our book, The Diabetes Diet as a paperback or e-book on Amazon. The book has recipes, meal plans and suggestions for how to adjust insulin when starting on a low-carb eating plan.

Paperback Copy of the Diabetes Diet

If you’d like a paperback copy of The Diabetes Diet, you can now buy one via CreateSpace on Amazon. The e-book version has been there since 2014, but we know many people prefer to hold something solid when they are reading. It’s a lot easier to work from a book when you’re making recipes, for example.

diabetes diet
The Diabetes Diet is now available in paperback and e-book.

The Diabetes Diet by Dr Katharine Morrison and Emma Baird explores what people affected with type one diabetes and type two diabetes, pre-diabetes and obesity need to do to get mastery over their blood sugar control, metabolism and weight.

The scientific reasoning behind the low carbohydrate dietary approach is fully referenced and made easy by menu plans and low-carb recipes. You will be introduced to information and case studies that help you decide what level of blood sugar control, carbohydrate restriction and monitoring is most appropriate for your individual needs.

Children, adolescents, women needing contraception or planning a pregnancy, drivers, keep fit enthusiasts, and those with emotional problems or co-morbidities will find advice in this book for them. We also help those new to exercise fit it into their lives.

In the Diabetes Diet, doctors, nurses and dieticians will learn about the dietary approach endorsed by the American Association of Clinical Endocrinologists and the Nutrition and Metabolism Society but which is not yet taught in most NHS diabetes clinics or by the American Diabetes Association.

The complexities of insulin management for optimal insulin to meal matching is covered in depth and other medications used in diabetes are discussed. Many people think that a sensible and scientifically accurate approach to blood sugar management is long overdue for diabetics including Ron Raab, ex vice president of the International Diabetes Federation, who has contributed his story about how this way of eating and low-carb recipes have helped him manage diabetes in this book.

This book can help those with type 1 diabetes AND type 2 diabetes. It won’t cure diabetes, but it will make living with the condition so much easier.

Diabetes Diet Book – Updated & Given a Make-over

We’ve been doing a little work in the background here at the Diabetes Diet. We decided to go for a print version via CreateSpace, and we’ve updated our book and uploaded it onto Kindle.

This is the new cover. What do you think?

diabetes diet
The Diabetes Diet is now on Amazon.

The Diabetes Diet explores what people affected with type one diabetes and type two diabetes, pre-diabetes and obesity need to do to get mastery over their blood sugars, metabolism and weight.

The scientific reasoning behind the low carbohydrate dietary approach is fully referenced and made easy by menu plans and low-carb recipes. You will be introduced to information and case studies that help you decide what level of blood sugar control, carbohydrate restriction and monitoring is most appropriate for your individual needs.

This book can help those with type 1 diabetes AND type 2 diabetes. It won’t cure diabetes, but it will make living with the condition so much easier.

The print version is going though some final checks, but should be ready in a few weeks’ time and we’ll update you.

You can buy the Diabetes Diet on Amazon.com here, and Amazon.co.uk here.

“Chocolate Staves Off Diabetes” – not so fast…

Low-carb chocolate fudge

Chocolate could help stave off diabetes… Another day, another sensationalist headline of the kind favoured by the Daily Express/Mail as it acts as perfect click bait.

What’s the story behind this one? Researchers have found that certain compounds found in cocoa can help the body release more insulin and respond better to increases in blood glucose levels. Therefore, this is of benefit to type 2 diabetics.

Beyond the headline is this qualifier. Study leader Professor Jeffrey Tessem from Brigham Young University said you would probably need to eat a lot of cocoa, and that you wouldn’t want the accompanying sugar that usually comes with it.

And the study did centre on cocoa and its compounds, rather than actual chocolate.

If you are looking for a healthy chocolate fix, we can help. We have plenty of chocolate recipes on our website that use cocoa powder or high-quality plain chocolate. Feel free to try them out…

Low carb chocolate fudge

Low carb chocolate chip cookies

Low-carb chocolate

Good quality plain chocolate (70 percent cocoa solids and above) doesn’t have that many carbohydrates in it – generally, about 10g per 40-50g, which is a decent portion. Don’t eat it late at night though, if you’re sensitive to caffeine, as you might find it hard to get to sleep.




Diabetes in the News

What’s new in the world of diabetes? We’ve rounded up the news for you…

The BBC reported that a pioneering therapy is safe for type 1 diabetics. The therapy retrains the immune system, and it was tested on 27 people in the UK. It showed signs of slowing the disease. Like many of these kinds of treatments, though, it only works on people who have been diagnosed recently – it’s unlikely to help those who’ve had the condition for years.

Another BBC report focused on the rise of Type 2 diabetes in children. More than 600 children and teenagers in England and Wales are being treated for the condition. A report from child health experts found 110 more cases among the under-19s in 2015-16 than two years before. Local councils have warned this is a “hugely disturbing trend” – and that urgent action to tackle childhood obesity is needed.

Bedfordshire News reported on a new approach to type 2 diabetes treatment the University of Bedfordshire and the local branch of Diabetes UK is trying out. The university is hosting weekly exercise sessions so people can take advantage of regular exercise sessions and support to help them make changes to their lifestyle. One 70-year-old told the newspaper the clinic had made a huge difference to his strength and energy levels.

How do you feel about your diabetes? Amy Mercer thought she’d come to terms with her condition a long time ago, but a chakra reading revealed pent-up anger and frustration. Amy wrote an interesting post on what she learned from the reading on Diabetes Self-Management.

Finally, it’s not a week if there isn’t at least one article purporting a ‘cure’ for diabetes… Clinical trials have begun for ViaCyte’s PEC-Direct – an implant that grows insulin-producing cells from stem cells, according to futurism.com. ViaCyte’s president, Paul Laikind, said he thought the PEC-Direct product had the potential to transform the lives of people with type 1 diabetes.



Buy Our Book!

diabetes diet
The Diabetes Diet is now available in paperback and e-book.

Forgive our wee plug – but if you’re looking for a comprehensive explanation of how you can use low-carb eating to help with diabetes (type 1 and type 2), we’ve got the answer with our book, The Diabetes Diet. 

How can it help you? If you’re a type 2, we give you detailed menu plans for different levels of carb intakes and lots of recipes, including plenty of baking and treats so you don’t feel as if you’re missing out on anything.

The missing link with many low carb diet plans is that they don’t tell you what happens if you take insulin or any other blood glucose lowering medication. (Hypos!) Our book explains how you manage your medication to prevent or minimise that and how you work out how much medication you need to take for protein. Yes, that needs taking care of too.

We also include some case studies of people who’ve used a low-carb diet to manage their diabetes and how it has helped them, including one from a vegan…

It doesn’t cost much and it might help you a lot.

Thanks in advance! Emma and Katharine.


World Diabetes Day

world_diabetes_day_logo-svgToday is World Diabetes Day. We send fond greetings to all those with diabetes all over the world.

No doubt, innovations in healthcare continue to offer improvements for we diabetics. When I was diagnosed in the 80s, blood testing wasn’t routine, there were few insulins on the market and logging your results meant writing them down in a little book. [As a teenager, I used to sit in the doctor’s waiting room, filling in the results using different-coloured pens to fool the doctor that I’d been doing tests regularly – did anyone else do this?!]

And now – there’s continuous glucose management, FDA approval of a so-called artificial pancreas and access to tonnes of information about diabetes thanks to the internet. There’s never been a better time to be a diabetic.

On the other hand, levels of type 2 diabetes are soaring. Our healthcare systems will not have the funds to cope with this epidemic. What will happen in the future when there are so many people suffering from diabetes-related complications? What will happen to families, watching people suffer from this condition?

Take time to think about diabetes today. If you have diabetes yourself, we wish you long and continued good health. And if there’s a diabetic in your life, give them an extra hug today.

Dr Lois Jovanovic:Everything you need to know about diabetes in pregancy

Dr Lois Jovanovic from Santa Barbara is an expert in getting great results with diabetic women in pregnancy. This video series from Diabetes in Control covers in depth interviews with Lois. Even if you are not pregnant or intending to be you can pick up information on how to get excellent blood sugar control in these videos.