One in three adults will develop diabetes

Risk factors

18 Nov 2015

One in two 45 year-olds of European ancestry will develop pre-diabetes during their lifetime and a one in three will develop type 2 diabetes, data from the Rotterdam Study in The Netherlands suggest.

As expected, obesity increased the risk and was associated with 10 extra years of living with glucose impairment compared to people of healthy weight.

Once prediabetes developed, 74% would progress to diabetes.

“Impaired glucose metabolism is a substantial burden on population health, and our findings emphasise the need for more effective prevention strategies, which should be implemented as soon in a person’s life as possible,” the researchers wrote in Lancet Endocrinology. 

Although higher BMI and a larger waist circumference substantially increased the risk, people who were lean at the age of 45 were not immune. Even in those with a BMI <25 the cumulative lifetime risk of prediabetes was about 30%.

“The substantial lifetime risk of pre-diabetes and diabetes in lean individuals also supports risk factor control in non-obese individuals,” they said.

The analysis was based on 10,050 participants who were enrolled in 1990 and followed for up to 14.7 years. Their glucose status was determined from GPs’ records, hospital discharge letters and pharmacy dispensing data as well as tests conducted at the study centre.

Prediabetes was defined as any fasting glucose measurement from >6.0 to <7.0 mol/L, and diabetes by any measurement of 7.0 mmol/L or more.

The study report quoted the AusDiab study as one of the few existing population-based studies on the lifetime risk and projected prevalence of diabetes.

Published in 2008, it calculated that 38% of 25 year-old Australians would develop diabetes during their lives.

An editorial commenting on the Rotterdam findings emphasised that 97% of participants were white, so the risks might be different in other ethnic groups.

The study also identified a high risk of progressing to insulin treatment, projected to occur in about 9% of the population, but this figure would be very dependent on the local clinical practice given the very large variation in the timing of insulin initiation.

Projections of prediabetes and diabetes risk might also be influenced by whether fasting plasma glucose or HbA1c was used to define glucose status, the editorial said.

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