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    Insulin Changes Occur Years Before Diabetes

    Study Reveals Timeline of Prediabetes

    Timeline to Type 2 Diabetes continued...

    “This is the time when relatively straightforward lifestyle changes, like increasing physical activity, changing diet, and reducing obesity, could have the biggest impact,” he says.

    The second phase of progression to disease is characterized by increased beta-cell activity as the pancreas produces more insulin to compensate for insulin resistance.

    Witte says prevention efforts during this period may require more aggressive lifestyle intervention along with blood-sugar regulating medications like metformin.

    During the final phase toward progression, which Witte refers to as the unstable phase, insulin production drops and blood glucose levels rise dramatically and rapidly.

    The study suggests that people who are generally considered to have prediabetes are in this final phase or close to it.

    “We hypothesize that prevention would be more effective before this unstable period, but more research is needed to identify people at this stage of disease development.”

    Early Intervention Is Key

    Diabetes specialist Sue Kirkman, MD, tells WebMD that the research confirms that the progression to diabetes occurs over many years and not just a few.

    Kirkman serves as vice president of clinical affairs for the American Diabetes Association.

    “The earlier we can identify people at risk and intervene, the better off they are likely to be,” she says.

    But the new study may not help find at-risk patients any earlier, an accompanying editorial in The Lancet suggests.

    David Matthews, MD, and Jonathan Levy, MD, of the U.K.’s Oxford Center for Diabetes write that the prediction model is not specific or sensitive enough to identify patients years before they have clinically recognized disease.

    “Does this mean that we can find those who are about to get diabetes -- perhaps even 3 or 4 years ahead?” We fear not,” they write. "... However, we might at last begin to use insulin concentrations interpreted into beta-cell function and insulin resistance as another marker of risk -- and we know that we have proven advice and therapies that we can give.”

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