Empowering prevention* of T2D
When it comes to type 2 diabetes, knowing your risk factors is the first step to enabling effective prevention.
The incidence of T2D is rising rapidly throughout the industrialized world. The American Diabetes Association estimates there are more than 20 million diabetics in the United States alone. The vast majority have T2D, and perhaps a third of diabetics are undiagnosed.
In addition, more than 50 million Americans are prediabetic (impaired fasting glucose and impaired glucose tolerance). About a third of these patients will convert to T2D within three years, while another third will remain as prediabetics and the remaining third will return to normal glucose levels without intervention. The American Diabetes Association (ADA) has recently focused on prediabetes as the clinical tipping point for intervention to prevent or delay conversion to T2D. Its recommendation is yearly screening for prediabetes using fasting blood glucose in patients with higher risk for T2D and more aggressive strategies for prevention in obese prediabetics with other risk factors for conversion.
Many major lifestyle and environmental risk factors for type 2 diabetes are well known obesity, poor diet, and lack of exercise, among others and it is well established that addressing these risk factors can effectively reduce the risk of diabetes. Inherited risk factors also influence individual susceptibility to T2D. For those who are at increased risk due to lifestyle factors also understanding inherited risk factors such as that measured by deCODE T2 may be especially important, underscoring the real potential benefit of a prevention program that involves losing weight, eating right, and perhaps the use of certain medications, to help reduce the likelihood of becoming diabetic.
deCODE T2™ measures four of the strongest gene markers validated for elevated risk of developing T2D independent of other risk factors, and identifies as well those prediabetics most likely to progress to full-blown T2D. The DNA markers included in deCODE T2™ are located in or near the following genes: TCF7L2, PPARG, CDKAL1, and CDKN2A and have each been widely replicated in 10 to 40 independent populations.
Eating healthy foods, getting plenty of exercise and maintaining a healthy weight are all known to be components of an effective prevention plan. Both a US government supported study and a European study showed that an effective weight loss program worked as well if not better for patients at highest genetic risk for conversion, reducing conversion to T2D by over 60%. The U.S. study demonstrated that even in those who did not lose weight, drug treatment with metformin also reduced progression rates of prediabetics to T2D.
The deCODE T2™ may therefore provide a new means to help you and your physician to decide how aggressive preventive measurers you want to take either through lifestyle change or through drug treatment, especially if you already have prediabetes. Published studies have shown that certain medications do appear to effectively slow the rate of progression from prediabetes to T2D. The 2002 Diabetes Prevention Program study showed that metformin could decrease conversion by 31% overall and even higher in patients younger than 60 ( N Engl J Med 346, op. cit.). Recent ADA guidelines state: “In addition to lifestyle counseling, metformin may be considered in those who are at very high risk (combined IFG and IGT plus other risk factors) and who are obese and under 60 years of age”