From kcl.ac.uk
Preventing type 2 diabetes could require action much earlier in life, according to experts calling for a new approach to protecting metabolic health
A new perspective article in Nature Medicine, led by Andreas Birkenfeld, Medical Director of the Department of Internal Medicine IV at University Hospital Tübingen and Transcampus Professor of Diabetes at King’s College London, argues that preventing type 2 diabetes (T2D) should move beyond waiting until people develop abnormal blood glucose levels and instead focus on maintaining healthy metabolism throughout life.
Around 90–95% of people living with diabetes have type 2 diabetes, which develops through a complex combination of genetic, biological, environmental and lifestyle factors. While current prevention approaches often focus on people who have already developed prediabetes, the authors argue that this may miss opportunities to intervene earlier.
The researchers propose a life-course approach that recognises T2D as a gradual process, with metabolic changes accumulating over many years before the disease develops. They suggest that prevention should focus on identifying periods when people are more metabolically vulnerable and providing targeted support to preserve or restore metabolic health.
The paper brings together an international group of experts who identified ten priorities for improving diabetes prevention. These include redesigning screening approaches across the life course, recognising differences between individuals, developing clearer stages of disease progression and ensuring prevention strategies are accessible across different socioeconomic settings.
The authors argue that, rather than focusing only on preventing progression to diabetes, a key goal should be prediabetes remission, which means restoring and maintaining normal blood glucose levels (normoglycaemia).
The researchers also highlight that diabetes risk is not constant throughout life. Instead, there are periods when people may be more susceptible to metabolic changes. The first opportunity for prevention may begin before conception. Evidence suggests that the metabolic health of both parents, including factors such as obesity, may influence a child’s future metabolic health.
Pregnancy is another important window. During pregnancy, the body naturally becomes more resistant to insulin to support the developing baby. Some women are unable to compensate for this increased demand and develop gestational diabetes. Women who experience gestational diabetes have a substantially increased risk of developing type 2 diabetes later in life, making the period after pregnancy an important opportunity to monitor metabolic health.
The authors also highlight childhood and adolescence as important stages for protecting metabolic health. Increasing sedentary behaviours, including prolonged screen time, alongside changes in diet and activity levels, may contribute to future diabetes risk.
Later life stages, including midlife and menopause, represent further periods of increased vulnerability. For women, changes in hormone levels during menopause can contribute to changes in body composition and metabolism, which may increase diabetes risk.
We think it is no longer sufficient to wait until someone has prediabetes or diabetes before taking action. We need to recognise the stages of life when people are more metabolically vulnerable and use these as opportunities to tailor prevention and protect metabolic health.
Professor Andreas Birkenfeld, Medical Director at University Hospital Tübingen and Transcampus Professor of Diabetes at King’s College London
The article suggests that prevention should become more personalised, using information such as family history, changes in weight over time, pregnancy-related diabetes and emerging biomarkers to better understand an individual’s risk. The authors also call for future prevention research to look beyond blood glucose measurements alone and consider wider health outcomes, including cardiovascular and kidney health.
https://www.kcl.ac.uk/news/diabetes-prevention-starts-as-early-as-conception-experts-say
