Type 2 diabetes operates differently across weight profiles

From healthcare-in-europe.com

Despite opposing biological mechanisms, medical professionals currently treat both groups with the exact same medications

Research published in Diabetologia by Amsterdam University Medical Center (Amsterdam UMC) and the University of Ghana reveals that type 2 diabetes manifests in two fundamentally different ways depending on a patient's body mass index (BMI). While type 2 diabetes in patients with a higher BMI is primarily driven by insulin resistance, the study demonstrates that in individuals within a lower BMI range, the condition is caused by the pancreas failing to produce sufficient insulin. Despite these opposing biological mechanisms, medical professionals currently treat both groups with the exact same medications. 

Type 2 diabetes is generally seen as a disease associated with being overweight. In wealthy countries that picture holds true: nine out of ten people with type 2 diabetes are overweight. In Africa the situation is different. Almost four in ten African adults with type 2 diabetes are lean, with a normal or even low body weight. In some rural areas, such as in Ghana, it is as many as six in ten. First Author Sabrina Esmail: "This means that there are an estimated ten million lean patients on the African continent who do not fit the standard picture. For them, the problem is therefore a shortage of insulin, not a reduced response to insulin." Project leader Charles Agyemang at Amsterdam UMC believes “this study shows that we need to look for better treatments for this large group of lean Africans."  

Yet in Africa both groups are almost always given the same treatment, based on international guidelines: oral tablets such as metformin or sulfonylureas. These medicines, however, are mainly effective against insulin resistance, not against a shortage of insulin. They are therefore probably receiving the wrong treatment, and until now the consequences of this had not been investigated. 

The researchers analysed data from more than 3,300 African adults with type 2 diabetes from Ghana, Nigeria, Kenya and Europe. "From this we concluded that lean patients more often develop eye damage, known as retinopathy, and strokes. People who are overweight, by contrast, more often have high blood pressure and an increased risk of cardiovascular disease. Chronic kidney disease occurred equally often in both groups," says senior author Felix Chilunga. The amount of body fat explained the greater part of these differences, which points to genuinely different disease processes. The risk factors differ as well: whereas being overweight is often linked to an unhealthy lifestyle, lean patients have more often experienced malnutrition or a low birth weight, which can disrupt the development of the pancreas. 

Type 2 diabetes in lean Africans is therefore, biologically and clinically, a different type of disease from the one seen in people who are overweight. But it is still being treated as though it were the same. As a result, millions of people may not be receiving the right care. Chilunga: "We are calling for targeted clinical trials to determine which treatment works best for this large and often overlooked group of patients." 

For Africans in Europe, too, it is very likely that a different treatment is needed. Another study with analysis from data from the UK Biobank showed that people of African descent with a BMI of 26 already have the same diabetes risk as Europeans with a BMI of 30. Studies of migrants in Europe consistently show that Africans are more likely to have type 2 diabetes, develop it around ten years earlier, and have poorer blood sugar control than the native population. Agyemang: "So a considerable proportion of African patients in Europe have a lower BMI but are treated according to guidelines written for the form of the disease found in people who are overweight, and their control is demonstrably worse. There is no reason to assume that the treatment mismatch we describe stops at the border." 

This study was carried out by Amsterdam UMC, University of Ghana, the national Institutes of Health (Center for Research on Genomics and Global Health) via de cohorts AADM and RODAM.  

https://healthcare-in-europe.com/en/news/type-2-diabetes-different-weight.html

Type 2 Diabetes timeline: What happens inside the body in the first 10 years after diagnosis

From indianexpress.com

Understand how the first decade of diabetes silently shapes your long-term cardiovascular and metabolic health

A diabetes diagnosis often feels like a single moment in time, but its impact unfolds gradually inside the body over the years. What makes this condition particularly complex is that much of the early damage is not immediately visible. While blood sugar levels may fluctuate day to day, the long-term effects build silently.

DISCLAIMER: This article is based on information from the public domain and/or the experts we spoke to. Always consult your health practitioner before starting any routine.

In the first decade after diagnosis, the body begins to adapt — and sometimes struggle — with persistently elevated glucose levels. Understanding this timeline is essential, not to alarm but to inform. From early metabolic changes to potential complications involving internal organs, the first ten years can set the tone for long-term health outcomes. With the right interventions, some of these effects can be delayed or even prevented, but it requires clarity on what is happening beneath the surface and when.

             Diabetes can quietly affect multiple organs over time (Source: AI Generated)

Key internal changes happening in the body

Kanikka Malhotra, Consultant Dietician & Diabetes Educator, tells indianexpress.com, “Most people assume diabetes is simply about managing sugar levels, but what is actually happening inside the body tells a far more complex story. In the first 5 to 10 years after diagnosis, chronically high blood glucose quietly begins damaging the body’s infrastructure from the inside out.”

She adds that one of the earliest changes happens in the blood vessels. Sugar molecules attach themselves to proteins and fats in a process called glycation, gradually making blood vessels stiffer and narrower. This affects both the large vessels supplying the heart and brain and the tiny capillaries serving the eyes, kidneys and nerves. “The nervous system begins taking hits too, particularly in the feet and hands, often without any obvious symptoms for years. The kidneys start showing early signs of stress. The eyes develop fragile, leaky blood vessels. And running beneath all of this is a steady current of systemic inflammation that silently accelerates the damage, while the pancreas continues losing its ability to produce insulin on its own.”

Which organs are most vulnerable to early damage?

What makes diabetes particularly unforgiving is how quietly it works. By the time most people feel something is wrong, significant internal damage may already have taken place over several years. Malhotra stresses, “The kidneys are often among the first to suffer. High blood sugar puts relentless pressure on their delicate filtering units, and without intervention, this progresses from early warning signs in urine tests to serious kidney disease over time.”

She adds that the eyes follow a similar silent path. Retinal blood vessels weaken, bleed or grow abnormally, and vision loss can set in well within the first decade if blood sugar remains uncontrolled. The heart and arteries age faster under diabetic conditions, sharply raising the risk of heart attacks and strokes. “The nerves in the feet deteriorate gradually, sometimes to the point where injuries go completely unnoticed, raising the risk of serious infections and amputations. The liver, too, tends to accumulate fat, which worsens insulin resistance and creates a damaging cycle. The sobering reality is that most of this damage builds up in complete silence.”

Lifestyle changes to slow down or prevent long-term complications

The first ten years after a diabetes diagnosis are not just a period of damage; they are genuinely the most powerful window of opportunity to change the trajectory of the disease. Malhotra notes, “Scientists call this the legacy effect, meaning the habits and choices made early on leave a lasting biological imprint on how the disease unfolds for decades to come. Food and nutrition are the most powerful tools available. A plan built around whole grains, vegetables, lean proteins and healthy fats helps stabilise blood sugar, calm inflammation and protect blood vessels.”

Even a modest weight loss of 5 to 10 percent of body weight can meaningfully improve how the body responds to insulin and reduce pressure on the kidneys, heart and liver. “Regular movement, both walking and strength-based exercise, helps muscles absorb glucose more effectively and brings down HbA1c levels. Managing blood sugar, blood pressure, and cholesterol together is critical, as all three compound the damage when left unchecked. From my perspective, the simplest daily habits, including consistent meal timings, cutting back on ultra-processed foods and staying well hydrated, are far from small. Done consistently, they are genuinely life-changing,” concludes Malhotra.

https://indianexpress.com/article/lifestyle/health/diabetes-timeline-first-10-years-after-diagnosis-body-effects-10691052/

Managing body weight is key driver out of all lifestyle factors in reducing type 2 diabetes risk

From diabetes.co.uk/news

New research has demonstrated that while a number of healthy lifestyle behaviours can cut the risk of type 2 diabetes, managing body weight remains a key driver, particularly when it comes to different ethnic groups.

The risk of developing type 2 diabetes can be influenced by both a person’s genetics and their lifestyle, which includes diet, alcohol intake, smoking and physical activity.

These behaviours can be combined into a lifestyle index to better predict diabetes risk.

However, previous studies only covered short follow-up periods so in this latest research, the team examined how combined lifestyle behaviours influence type 2 diabetes risk across different population groups over time, using a composite Lifestyle Risk Factor Index (LSRI).

A key finding was that participants in the study classed as obese – with a body mass index over 30 – were more than three times more likely to develop type 2 diabetes compared to those with a normal weight.

The international team of authors concluded that body mass index (BMI) had a stronger link with type 2 diabetes risk than LSRI, saying: “The LSRI’s significant association with type 2 diabetes risk persisted even after adjusting for BMI, indicating its independent significance.

“However, the influence of overweight and obesity on type 2 diabetes, when adjusted for LSRI, was notably stronger. This underscores that while LSRI captures key lifestyle factors affecting type 2 diabetes risk, BMI remains the strongest predictor.

“In summary, our study demonstrates significant ethnic differences in how lifestyle factors and BMI affect type 2 diabetes incidence.”

The research highlights how important it is to combine lifestyle habits through an index to assess diabetes risk.

The study group, which was made up of 165,383 participants, included European American, African American, Native Hawaiian, Japanese American, and Latino volunteers.

The research revealed that a higher LSRI score was associated with much lower type 2 diabetes incidence, particularly among the African American, Latino, and European American groups.

This suggests the need for public health programmes that are tailored to different ethnic groups.

https://www.diabetes.co.uk/news/2025/jun/managing-body-weight-is-key-driver-out-of-all-lifestyle-factors-in-reducing-type-2-diabetes-risk.html

Reverse your type 2 diabetes with these 7 proven lifestyle changes

From rollingout.com

Research-backed strategies that can help control blood sugar and potentially reverse diabetes 

The diagnosis of diabetes often feels overwhelming, but emerging research suggests this condition isn’t always a permanent sentence. Through dedicated lifestyle modifications, many individuals have successfully improved their blood glucose levels and reduced or eliminated medication dependence. These science-backed approaches create a comprehensive strategy for those looking to take control of their health journey.

Here are seven powerful interventions that work together to help manage and potentially reverse diabetes when implemented consistently.

Transform your eating approach for lasting results

Nutrition forms the cornerstone of effective diabetes management. Rather than thinking in terms of restrictive dieting, focus on creating balanced meal patterns that stabilize blood sugar while providing sustained energy throughout the day.

Blood sugar-friendly eating emphasizes nutrient-dense foods with minimal processing. Low-glycaemic carbohydrates such as quinoa, lentils, sweet potatoes, and non-starchy vegetables offer fibre-rich alternatives to refined options. These foods digest more slowly, preventing the blood sugar spikes that can damage the body over time.

Incorporate lean proteins such as poultry, fish, tofu, and legumes to maintain stable glucose levels while supporting muscle preservation. Healthy fats from sources like avocados, olive oil, nuts, and seeds improve insulin sensitivity while protecting cardiovascular health – a critical consideration for those with diabetes.

The most successful approach involves developing sustainable eating patterns rather than following overly restrictive regimens. Working with healthcare providers to create personalized nutrition plans helps ensure nutritional needs are met while optimizing blood sugar control. Small, consistent improvements typically yield better long-term results than dramatic overhauls that prove difficult to maintain.

Activate your body with strategic movement

Physical activity delivers powerful benefits for diabetes management through multiple mechanisms. Regular exercise improves insulin sensitivity, helping muscle cells absorb glucose more efficiently without requiring excessive insulin production. This effect can last for hours after activity concludes, contributing to better overall glucose control.

A comprehensive movement strategy includes both aerobic exercises and resistance training. Aim for at least 150 minutes of moderate-intensity aerobic activity weekly, such as brisk walking, swimming, or cycling. Additionally, incorporate resistance exercises two to three times weekly to build and preserve muscle mass, which serves as a primary site for glucose utilization.

Even light activity breaks throughout the day prove beneficial for those previously sedentary. Simply standing and moving briefly every 30 minutes can significantly improve glycaemic control compared to prolonged sitting. This approach makes exercise more accessible for those with mobility limitations or busy schedules.

The key to success lies in finding enjoyable activities that can become consistent habits. Whether through structured workouts, active hobbies, or integrated movement throughout daily routines, regular physical activity represents a non-negotiable component of diabetes management.

Achieve sustainable weight balance

Body weight significantly influences diabetes progression, particularly regarding abdominal fat that increases insulin resistance. Research consistently shows that even modest weight reduction of 5-10% can dramatically improve blood glucose levels in those with type 2 diabetes.

Effective weight management combines thoughtful nutrition with regular physical activity while addressing behavioural and emotional factors that influence eating patterns. Rather than pursuing rapid weight loss through extreme measures, focus on creating sustainable habits that support gradual, consistent progress.

Regular monitoring helps track changes while maintaining motivation, but avoid becoming fixated on daily fluctuations. Instead, look for overall trends while celebrating non-scale victories like improved energy, better-fitting clothes, and enhanced blood sugar readings.

For those struggling with significant weight challenges, medical supervision provides additional support and potentially appropriate interventions. The goal remains finding an individualized approach that creates lasting changes rather than temporary fixes.

Prioritise restorative sleep patterns

Sleep quality directly impacts glucose metabolism through multiple hormonal pathways. Poor sleep increases insulin resistance while elevating stress hormones and disrupting appetite regulation – a combination that significantly complicates diabetes management.

Adults should aim for 7-9 hours of quality sleep nightly, with consistent bedtimes and wake times that align with natural circadian rhythms. Creating an environment conducive to restful sleep involves limiting screen exposure before bed, maintaining comfortable room temperatures, minimizing noise disruptions, and ensuring appropriate darkness.

Those experiencing sleep disorders like sleep apnoea should seek medical evaluation, as these conditions disproportionately affect people with diabetes and further complicate glucose control when left untreated. Using overnight continuous glucose monitoring often reveals how sleep disruptions directly impact blood sugar levels, providing powerful motivation for sleep improvement.

Simple strategies like establishing pre-bed relaxation routines, limiting caffeine after midday, and creating technology-free periods before sleep can dramatically improve rest quality without medication. These approaches help optimize the body’s natural regulatory processes that maintain healthy glucose levels overnight.

Develop effective stress management techniques

Chronic stress significantly impacts diabetes control through elevated cortisol production, which increases blood glucose while promoting insulin resistance. This physiological response creates a challenging cycle where diabetes-related concerns create stress that further worsens the condition.

Identifying personal stress triggers allows for proactive management strategies. Regular mindfulness practices, deep breathing exercises, and progressive muscle relaxation techniques help activate the parasympathetic nervous system, countering the stress response that elevates blood sugar.

Physical activity serves as both stress management and direct glucose control, making movement particularly valuable during high-stress periods. Creative pursuits, time in nature, and maintaining social connections also provide powerful buffers against chronic stress.

For those facing significant stress challenges, professional support through counselling or therapy offers additional tools for emotional regulation. These resources help develop personalized coping strategies while addressing deeper issues that may influence both stress levels and diabetes management behaviours.

Implement consistent health monitoring systems

Regular monitoring provides essential feedback about how lifestyle changes affect glucose control. Beyond traditional finger-stick measurements, continuous glucose monitoring systems now offer detailed insights into how specific foods, activities, stress levels, and sleep patterns influence blood sugar throughout the day and night.

Tracking additional metrics like blood pressure, cholesterol levels, and kidney function helps create a comprehensive picture of overall health improvements. Working closely with healthcare providers ensures appropriate interpretation of these measurements while allowing for timely adjustments to management strategies.

Digital health tools can streamline data collection while identifying patterns that might otherwise remain unnoticed. However, the focus should remain on using this information to guide practical decisions rather than becoming overwhelmed by constant monitoring.

Regular healthcare appointments provide opportunities to discuss monitoring results, address concerns, and adjust approaches based on changing needs. This partnership between patient and provider creates accountability while ensuring appropriate medical support throughout the diabetes management journey.

Eliminate harmful substances for enhanced results

Tobacco use significantly worsens diabetes outcomes through multiple mechanisms. Nicotine increases insulin resistance while constricting blood vessels, accelerating complications like neuropathy, kidney damage, and cardiovascular disease. Smoking cessation represents one of the most impactful steps for improving both diabetes control and long-term health prospects.

Alcohol consumption requires careful consideration for those managing diabetes. Moderate drinking may be acceptable for some individuals, but excessive consumption disrupts liver function, interferes with medication effectiveness, and can cause dangerous blood sugar fluctuations. Those who choose to drink should follow medical guidance regarding appropriate limits and always consume alcohol with food to prevent hypoglycaemia.

Working with healthcare providers to develop personalized strategies for reducing or eliminating these substances improves success rates while ensuring safety during the transition process. Support groups, cessation programs, and sometimes medication can make these challenging lifestyle changes more manageable.

The combination of these seven approaches creates a powerful framework for diabetes management that addresses the condition’s complex nature. While each strategy offers individual benefits, their true potential emerges when implemented together as part of a comprehensive lifestyle approach.

Those beginning this journey should start with changes that feel most achievable, gradually incorporating additional strategies as initial steps become habits. With patience, consistency, and appropriate medical support, many individuals can significantly improve their diabetes management – and some may achieve remission, regaining normal blood glucose levels without medication.

The path to better health begins with taking action today on these evidence-based approaches that have helped countless others transform their relationship with diabetes.

https://rollingout.com/2025/03/09/reverse-your-diabetes-these-7-proven/

These 4 factors can predict if you’ll get diabetes within 10 years — most have nothing to do with weight

From nypost.com

Turns out, you can’t outrun diabetes with a low BMI. 

In a sweeping study of nearly 45,000 participants, researchers set out to determine what drives the progression from prediabetes to diabetes — and weight is only one facet.

They found that factors like age, sex and fasting plasma glucose levels, or the amount of sugar in your blood, all play a significant role as well.

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More than 38 million Americans have been diagnosed with Type 2 diabetes.        habrovich – stock.adobe.com

“The study highlights that the prevalence of diabetes is increasing in the world and that we need to highlight the importance of prevention, regardless of medical history, because we see that the risk is increased across all types of patients, including lower BMI patients,” Dr. Danielle Brooks, an endocrinologist at North Shore University Hospital who was not involved with the study, told The Post.

In the study, published Thursday in the journal JAMA Network Open, the average age of participants was 43.7 years, with an average BMI of 28.9, which is considered overweight. 

Their fasting plasma glucose levels ranged from normal (70-100 mg/dL) to impaired (100-125 mg/dL), placing the latter group in the prediabetes zone, where blood sugar is elevated but not yet in the diabetic range.

Over a median follow-up of 6.8 years, 8.6% of participants developed diabetes — and the researchers estimated that number would be 12.8% chance within 10 years.

A particularly eye-popping finding was that any FPG level outside of the narrow range of 80 to 94 mg/dL — even if still considered normal — was linked to a heightened risk of developing diabetes. 

Abnormal BMI categories, including those considered underweight, were also associated with increased risk.

“The authors postulate that there was an increased risk for this section of individuals based on potentially having a malnourished state as an individual increased risk factor for insulin resistance and development of diabetes, which is not something that we typically think about,” Brooks added. 

Researchers also found that men were more likely to develop diabetes than women, while older age was similarly linked to a higher risk.

Notably, the study revealed a significant additive relationship between key variables, especially between FPG levels and BMI.

For example, a woman aged 55 to 59 years with a BMI of 18.5 to 24.9 and an FPG level of 95 to 99 mg/dL had a 7% chance of developing diabetes within 10 years. 

But if her BMI increased to 30 to 34.9, her risk almost doubled to 13%. If her FPG level also rose to 205 to 209 mg/dL, her risk shot up to 28%.

One limitation of the study was that more than 87% of participants were Caucasian, leaving questions about how race and ethnicity might interact with other factors to either increase or decrease the risk of developing diabetes.

“We do know that there are increased risks of diabetes development in patients with particular ethnicities,” said Brooks. “I think further research is definitely needed in that area to further individualize patient care and patient prevention for diabetes development.

What you can do now

As the US grapples with an obesity epidemic, the number of people with diabetes continues to rise. According to the CDC, nearly 98 million Americans have prediabetes, and over 38 million have Type 2 diabetes.

Brooks says the study underscores the need for doctors to be hyperaware of increased diabetes risk in every patient — not just those who are overweight or have a history of the disease. 

“We need to be hyper aware of this trend in our health,” she said. 

Researchers believe the findings could help guide both doctors and patients in implementing lifestyle and pharmacologic interventions for those at the highest risk, ultimately aiming to reduce future morbidity and mortality from the disease. 

In 2022, 101,209 Americans died from diabetes, which was the eighth leading cause of death.

Currently, metformin is the primary option for delaying or preventing Type 2 diabetes with medication. But new research shows that next-generation weight-loss drugs, like tirzepatide, could also reduce the risk of developing the disease in overweight or obese individuals.

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Lifestyle factors like diet and exercise can lower your risk of developing diabetes.                                                  peopleimages.com – stock.adobe.com

If you’re not ready to reach for the medicine cabinet just yet, there are still plenty of everyday steps you can take to lower your diabetes risk.

“Leading a healthy lifestyle in terms of achieving the general recommended amount of exercise per week is one of the foundations of diabetes prevention,” said Brooks, who recommended aiming for 150 minutes of exercise per week.

Managing your food choices is just as crucial, especially at a time when 60% of the average U.S. diet consists of ultra-processed foods, like sugary cereals, frozen pizzas and potato chips.

Brooks advises focusing on a low-carb, high-protein diet to maintain a healthy weight over time and help prevent diabetes.

https://nypost.com/2025/01/23/health/weight-isnt-the-only-factor-driving-diabetes-risk-3-other-drivers/

The complex relationship between diabetes and weight

From parkview.com

In the realm of health and wellness, few conditions are as widely misunderstood as diabetes. From misconceptions about its causes to its supposed effects on weight, misinformation often clouds the understanding of this complex metabolic disorder. One belief is that diabetes inherently leads to weight gain or loss. However, the reality is much more nuanced.  

Understanding diabetes

Firstly, it is important to grasp the basics of diabetes, which typically manifests as type 1 and type 2. For more information on additional forms such as gestational diabetes, visit our website. 

Type 1 diabetes is an autoimmune disease that occurs when the pancreas fails to produce enough insulin, the hormone responsible for regulating blood sugar levels. Individuals with type 1 diabetes require insulin injections to manage their blood glucose, as insulin serves as their lifeline.

On the other hand, type 2 diabetes usually develops over time due to insulin resistance, in which the body’s cells become less responsive and cannot properly absorb the glucose required for energy production. This is often associated with lifestyle factors such as poor diet, lack of exercise and obesity.

 

Weight gain

While it's true that weight gain is often a risk factor for type 2 diabetes, the condition itself doesn't directly cause increased body mass. There are certain factors related to diabetes management which can contribute to weight gain, including:

• Insulin therapy, a universal treatment for type 1 diabetes and sometimes prescribed for type 2 diabetes can increase the storage of fat and glucose in cells.
• Hypoglycaemia prevention, or fear of low blood sugar levels, can lead individuals to consume extra calories.
• Medications such as sulfonylureas and thiazolidinediones, that are used to manage diabetes.

Weight loss

Conversely, some believe that diabetes causes weight loss. A reduction in weight can occur in those with uncontrolled diabetes, but it’s not a universal symptom. It may occur due to several factors such as:

• Insulin deficiency, caused by inadequate insulin production in type 1 diabetes, may cause the body to break down muscle and fat for energy leading to weight loss.
• High blood sugar levels can trigger the body to excrete excess glucose through urine, resulting in calorie loss and weight reduction.
• Frequent urination is a common symptom of diabetes and can contribute to dehydration and subsequent weight loss. 

Managing weight with diabetes

Regardless of whether you have diabetes or not, maintaining a healthy weight is essential for overall well-being. For individuals with diabetes, adopting a balanced diet, engaging in regular physical activity, and adhering to prescribed medications are vital for managing both blood sugar levels and weight.

Diabetes itself doesn't directly cause weight gain or loss. Instead, factors such as insulin therapy, medication side effects, and lifestyle choices play significant roles in weight changes. Understanding these nuances is essential for dispelling myths and promoting accurate knowledge about diabetes. By adopting healthy lifestyle habits and seeking appropriate medical care, individuals with diabetes can effectively control their condition while maintaining a healthy weight.

https://www.parkview.com/blog/the-complex-relationship-between-diabetes-and-weight 

Early type 2 diabetes risk skyrockets with low birthweight and overweight at age 20

From news-medical.net

New research being presented at this year's European Congress on Obesity (ECO) in Venice, Italy (12-15 May), and published in Diabetologia (the journal of the European Association for The Study of Diabetes [EASD]) suggests that having a low birthweight together with being overweight in young adulthood (but not childhood) contributes to the development of type 2 diabetes at an early age (59 years or younger) in men.

Notably, the study involving over 34,000 Swedish men, found that those born with a low birthweight (<2.5 kg/5 lbs 8oz) who were also overweight at aged 20 years (BMI >25kg/m²) were 10 times more likely to develop early type 2 diabetes than those with a birthweight in the normal range (2.5-4.5 kg) who were normal weight as young adults (BMI <25 kg/m²).

Importantly, the researchers from the University of Gothenburg and Sahlgrenska University Hospital also found that babies with a low birthweight who were overweight at age 20 years had a 27% absolute risk of developing early type 2 diabetes, compared with an absolute risk of 6% for those with a birthweight in the normal range who were also normal weight at aged 20 years. This suggests that preventing excess weight gain during young adulthood in boys born with low birthweight could reduce the absolute risk of early type 2 diabetes by 21%.

Type 2 diabetes is being diagnosed at progressively younger ages, suggesting that significant risk may begin to accumulate during the developmental period. The association between low birthweight and overweight in childhood and/or young adulthood and type 2 diabetes in adults is already known, but it has been unclear how much influence the combination of these two factors exerts.

To find out more, researchers analysed data from 34,231 men born between 1945 and 1961 involved in the BMI Epidemiology Study (BEST) Gothenburg-;a population-based cohort examining the associations between growth and BMI development in early life and the risk of disease in later life.

The researchers analysed birthweight and BMI of participants from school health care records (at the age of 8 years) and from medical examinations on enrolment in the military (at age 20), which was mandatory until 2010.

Participants were followed from 30 years of age until type 2 diabetes diagnosis, death, or emigration, or until 31st December 2019. Information on type 2 diabetes diagnoses was retrieved from Swedish national registers to estimate the risk of early (<59.4 years) and late (>59.4 years) type 2 diabetes. They also examined whether these associations were independent of, or modified by, socioeconomic factors such as level of education.

During an average 34 years follow up (after 30 years of age), a total of 2,733 cases of type 2 diabetes were diagnosed (1,367 cases of early diabetes and 1,366 cases of late diabetes). The analyses found that birthweight below the average (median; <3.6 kg/7lbs 9oz) and overweight at age 20 years (BMI >25 kg/m²), but not overweight at age 8 years (BMI >17.9 kg/m²), were associated with an increased risk of both early and late type 2 diabetes.

Furthermore, low birthweight and overweight in young adulthood were found to have an additive effect on the risk of type 2 diabetes. For example, having a below average birthweight (<3.6 kg/7lbs 9oz), followed by overweight at 20 years of age was associated with a six times greater risk of developing early type 2 diabetes. Whereas a lower birthweight (<2.5 kg/5 lbs 8oz) combined with later overweight at 20 years was linked with a 10 fold greater risk of developing early type 2 diabetes.

Adjusting for education, a known risk factor for type 2 diabetes, did little to change the results.

Our findings establish low birthweight and overweight in young adulthood as the main developmental determinants, whereas overweight in childhood is of lesser importance for type 2 diabetes in adult men. The combination of low birthweight followed by overweight at age 20 years is associated with a massive excess risk for early type 2 diabetes, which is substantially higher than the risk associated with low birthweight or being overweight as a young adult separately."

Dr Jimmy Celind, lead author, researcher at Sahlgrenska Academy's Institute of Medicine, University of Gothenburg

Co-author Dr Jenny Kindblom from Sahlgrenska University Hospital adds, "It's possible that the metabolic consequences of foetal growth restriction, which promotes resilience against starvation through fat storage and insulin resistance, when combined with a detrimental BMI trajectory during puberty when the insulin resistance is at a lifetime peak due to the surge of growth and sex hormones, result in an additive excess risk for later type 2 diabetes. Public health initiatives should target boys born with low birthweight to work on prevention of overweight as young adults, to reduce this huge excess risk for early type 2 diabetes."

The authors acknowledge that the findings are associations only and that the study wasn't designed to measure direct cause and effect, and point to several limitations, including that the participants were mainly white men which may limit the generalisability of the findings to other ethnicities and women. In addition, the analyses were unable to account for the influence of other known risk factors for type 2 diabetes such as smoking, dietary habits, and physical activity which could have influenced the results.

https://www.news-medical.net/news/20240304/Early-type-2-diabetes-risk-skyrockets-with-low-birthweight-and-overweight-at-age-20.aspx

How to Balance Body Positivity, Weight and Diabetes

From diatribe.org

By Alexandra Frost 

Struggling with body positivity, overweight, and diabetes can be overwhelming. But it's possible to balance all three and improve your overall well-being.

In high school, when Samantha Puff was working at an amusement park, she remembers telling a co-worker that she had diabetes. The guy stepped back, looked her up and down, and said, “Huh. But you’re not that fat.” In that moment, she realized that to some people, there’s a “look” to having diabetes, she explains.

Puff, now 34 and living in Cincinnati, said she continues to battle body image issues around having diabetes, especially in a culture that promotes mixed messages around bodies — embrace your body as it is (but don’t be too fat). Curves are beautiful (but not too curvy). 

These messages can be even more complicated with diabetes in a culture where even the medical field sometimes promotes weight loss as a way to improve diabetes management and overall health. 

For example, the American Diabetes Association writes on its webpage for people with diabetes who need to lose weight: “Break the cycle. By losing just a few pounds with healthy eating and exercise, you’ll start to feel better. You’ll have more energy. And it will get easier to manage your diabetes, all while reducing your risk of developing other related problems.”

Puff said that hearing messages like that felt discouraging. 

“I know I definitely struggled with body image throughout my life because I've never been skinny. As a teenager, I was extremely active and had more of an athletic build,” Puff says. “It was hard for me to feel good about myself when I was sick with something that had a stigma of being overweight, even though I was very active and fit.”

Mixed Messages

People with and without diabetes are exposed to messages such as singer Lizzo’s attempts to normalise bigger bodies, pushing against the norm that smaller frames and thighs are the only beautiful images, among her other messages. “I want to normalize my body,” she said in a 2020 Vogue cover story. But for people with diabetes, being above an ideal weight can be dangerous, increasing the odds of complications. 

“We definitely live in a culture where being ‘healthy’ is synonymous with ‘skinny.’” Puff said, adding that this message can be even more difficult to hear for people with diabetes. “We can't just cut everything out of our diet. If we're hungry, we have to eat or else put ourselves at risk of getting a bad low. We have to be careful with exercise because our bodies react differently to it.” 

She explains that she enjoys working out, but it can sometimes have adverse effects on her body. “It's never as easy as just grabbing my keys, heading to the gym, working out for an hour and calling it a day,” she said. “I have to make sure I test my sugar beforehand, lower my basal rate so I don't drop, and make sure I have snacks and juice on hand at all times.”

Diabetes educator Crystal Scott with Top Nutrition Coaching explains that social media contributes to this mixed messaging of telling people with diabetes, and others, that they should feel comfortable in their bodies, but at the same time they should lose weight to be healthier. 

“Social media can be great, and it can also be toxic and lead to very unhealthy relationships with food,” she said. Instead, she works with clients through transparent conversations about “being comfortable” in their bodies at each stage, but also focusing on goals that promote health. 

Getting real about the risks of excess weight with diabetes

Nobody needs a “friend” telling them about the latest weight loss fad while they navigate day-to-day life with diabetes. “My favourite part is when the non-diabetics tell us to ‘just do keto’ and the weight will ‘fall right off.’  For a ‘normal’ person, keto can be okay, but for a diabetic, the keto diet could put us in the hospital,” Puff said. She said she’s glad to see diabulimia finally recognized as an eating disorder. 

Weight loss can be a major struggle for people with diabetes, and body acceptance is still essential at any weight. Scott says she does counsel her clients with diabetes on the potential effects of carrying too much weight. “It can lead to other things,” she said, “such as high cholesterol, high blood pressure, cardiovascular disease, chronic kidney disease.” 

Your weight is a complex equation, of which diet and exercise only make up one part. You can be healthy at many different sizes. "Losing weight" alone can be hard (and impossible in some cases) but improving health by making small changes is the key. Things like sleep, stress, mental health, access to affordable healthcare are also part of the equation. A cohesive plan should focus on more than weight, Scott said: “How’s your sleep? How’s your energy? How do you feel? Where’s your mental and emotional space?” 

Janet Zappe, a certified diabetes educator with The Ohio State University Wexner Medical Centre, explained that it only takes a small reduction in weight to make an impact on diabetes health, and it might not even change your “look” that much anyway. 

“A healthy body is a beautiful body,” she said. “Bodies come in all shapes and sizes, and we want people to honour their bodies. If a person is overweight, losing 7% of their body weight yields tremendous health benefits with their pre-diabetes.” 

She added that in most cases, 7% is not going to take people down to a size six or some idealized version of thin, and that skinny does not equal healthy.

Taking active steps toward improved body image at any size

Even in the face of trying to improve your overall health with your diabetes care team, mixed messages might mean accepting two realities at once. 

Zappe’s colleague at Wexner Medical Centre, psychologist Sophie Lazarus, said, “Acknowledge that sometimes messages that seem oppositional can both be true; for instance, your body being beautiful and acceptable does not depend on its size, and losing weight or increasing exercise can improve your health outcomes.”

Lazarus and Zappe have a few tips for tackling this challenge of accepting your body and improving your health:

• Start by working on loving and accepting your body for its uniqueness right now

• Set boundaries around media or other sources telling you something different

• Prioritize friendships, which are important for weight management and activity levels, especially spending time with like-minded people who have similar goals and values

• Attend to emotional distress associated with diabetes, and the burden that can come with managing it by building coping skills

• Make time to learn about diabetes and your health to feel more in control

• Find new ways to address stress such as social support, prayer, meditation, and exercise

Finally, remember you are far from alone in struggling with body image issues with diabetes. 

https://diatribe.org/how-balance-body-positivity-weight-and-diabetes