“Prediabetes is much more dangerous than we think”

“Prediabetes is much more dangerous than we think”

Plea to screen people for diabetes sooner

04-11-2022 · Background

Many doctors don’t think much about the idea: screening people for diabetes, even before they are sick. Yet this is what we need to do, says Coen Stehouwer, UM professor of Internal Medicine. The damage to organs is considerable, as appears time and again from the results of the Maastricht Study.

In the past, people were only sick if they had symptoms, now you can be a patient if specific values in the blood are too high, says professor Coen Stehouwer, head of Internal Medicine at MUMC. "You are diabetic if your blood glucose values are above a critical level. And that level, nothing more than a number, is not set in stone, but it is an agreement among doctors. Everyone under that level, we refer to as healthy and anyone above that level, is sick.”

It appears to be a lot more complicated than that, says Stehouwer, who explains things using colours. Between healthy (white) and sick (black), there is a grey area in diabetes, where the blood glucose values are raised but remain under the critical level. ‘Let’s not complicate matters,’ many doctors say. We only treat those who are in the black zone. But what if people in the grey zone have already suffered considerable organ damage, as recent research reveals? What if they are, with regard to health, on average seven years older than their actual age? 

Objectors

The grey area is called prediabetes. A quarter of the population between the ages of 40 and 75 ‘suffers’ from it. “They are not sick and don’t notice anything, but those raised glucose values are much more dangerous than we think,” says Stehouwer. “You can see damage to the heart, the nerves and the brain, with an increased risk of depression and dementia. This is clearly and consistently revealed in the analyses of the Maastricht Study, the extensive screening project in Zuid-Limburg.”

Doing nothing is no longer an option, says Stehouwer, who is arguing for the screening of those who are over forty and overweight. But, say the objectors: if you publicise that and examine everyone over forty, you will also see a lot of people from the white zone. So, not effective and expensive.

Stehouwer would like a more targeted approach: focus on people over forty who are too fat and who for whatever reason have a GP appointment. “This already occurs in the US. Partly also because diabetes and obesity are bigger problems there. In the Netherlands, one in five people is overweight, in the US it is one in three.”

Hunger pangs

There is also something else going on, says Stehouwer. “If you have diabetes and you are overweight and you lose 10 to 15 kilos, you can recover completely. As if you never had the disease, so going from black back to white. But this will be more successful if you are in the grey zone.”

In addition to lifestyle advice, there are now also medicines, the so-called GPL1 agonists, which help with losing weight. “With this, you can lose between 3 to 5 kg. But the stronger version of this medicine, which is already on the market in some countries, enables people to lose twice as much weight. It is very sought-after and sometimes even sold out.”

The next generation of slimming medication is already in the making, says Stehouwer: this allows you to lose fifteen to twenty kilos. “They are still in the research phase, but in a couple of years’ time, everyone will be using them.” 

These new medicines are a game changer, says Stehouwer. “We have been tinkering at these types of medicines for thirty years, but it was a total failure. With one medicine, people used up more energy, which turned out to be bad for their hearts. Other medication brought on depressions. The present medicines delay the emptying of the stomach and influences the hunger pangs, but not the mood. We expect that this medication will also be safe in the long term, although this still has to be proven.”

Power training

In short, Stehouwer expects there to be a new era of slimming on the horizon. “We seem to have hit gold. Of the 1.2 million diabetics in the Netherlands, 800 thousand will, in theory, disappear, if they lose that much weight.”

In theory, because intensive supervision continues to be important. “You don’t want your patients to suddenly start eating more fast food, just because they can lose the kilos easily anyway. Or that they stop exercising when they reach their target weight. Power training is important too, because losing weight goes hand in hand with the loss of muscle tissue.”

So, what about his plea to screen prediabetic people? Does that not lose its urgency? “No, you have to see the new medicines as an extra instrument to be able to intervene at an early stage. To ensure that people don’t end up in the black zone, but go from grey back to white.”

Huge difference: fat in the belly or in the buttocks

For a long time, it was the man who formed the golden standard in medical research, and doctors assumed that illnesses manifested themselves the same way in both sexes. By now, we know that the differences in the clinical picture are huge, also with type 2 diabetes. This is shown in Rianneke de Ritter’s thesis, with which she recently obtained her PhD.  

It is a known fact that chances of diabetes are greater in people who are overweight. That is when the insulin hormone works less well and the blood sugar level in the blood rises. But it makes a difference to the course of the illness where the extra kilos are. 

In men, they end up in and around the belly. Hence, diabetes will occur sooner, but the risk of cardiovascular diseases also increases. This is because belly fat causes a higher fat percentage in the blood, high blood pressure and higher inflammation values in the blood – the so-called metabolic syndrome.”

In women, the extra kilos largely end up in the buttocks and around the hips. That is less dangerous, says De Ritter, and diabetes takes longer to manifest itself and the chances of cardiovascular disease are considerably smaller. 

What is remarkable, however, is the fact that this medical advantage immediately disappears as soon as women develop diabetes. “After the buttocks and hips, the extra fat then ends up in the belly and the risk of cardiovascular disease quickly rises. Ultimately it is just as high as in men."

Photo: Pixabay

Categories: news_top, Science
Tags: diabetes, stehouwer

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