The American Diabetes Association reports that nearly 8% of the U.S. population is afflicted with diabetes, translating to approximately 17.9 million diagnosed cases. This prevalent health condition raises an important question: what leads to the development of diabetes? Understanding the various risk factors is crucial for assessing personal vulnerability to this disease. Armed with this knowledge, individuals can make informed lifestyle choices aimed at reducing their risk and safeguarding their health.

What is diabetes?

Diabetes is a chronic health disorder that impacts your body’s ability to regulate its blood sugar levels. Typically, the body converts food into sugars, which enter the bloodstream. Your blood sugar levels rise, activating the pancreas to create insulin. Insulin is a hormone that controls how and where blood sugar is stored and used as energy.

Diabetes impacts your ability to make or use insulin correctly. For example, you may not have sufficient amounts of insulin or your body does not respond appropriately to insulin. This causes your blood sugar levels to remain high, which can cause several downstream health complications. These can include conditions like kidney disease, heart disease, eye problems, hearing issues, and nerve damage.

What are the different types of diabetes?

To fully understand your risk for diabetes, we must first look at the different kinds of diabetes. There are three types of diabetes: type 1 diabetes, type 2 diabetes, and gestational diabetes. Let’s review what each of these are.

  • Type 1 Diabetes. Type 1 diabetes is underlined by an autoimmune reaction, meaning the body fights against itself. In this case, the autoimmunity prevents the body from making insulin. People are usually born with type 1 diabetes and can be diagnosed at any age, but it cannot be prevented. It affects roughly five to ten percent of diabetes cases.
  • Type 2 Diabetes. Type 2 diabetes happens when the body cannot properly utilize insulin. It typically affects adults but has been increasing in incidence in children over the years. Type 2 diabetes is the most common, affecting between 90 to 95 percent of individuals with diabetes. Diabetes can be prevented with certain lifestyle changes.
  • Gestational diabetes. Gestational diabetes can occur in women who are pregnant and do not have pre-existing diabetes. Gestational diabetes usually resolves after the birth of the baby, but it increases the mother and baby’s risk for type 2 diabetes later in life.

Prediabetes is a condition marked by elevated blood sugar levels that are not high enough to warrant a diabetes diagnosis. Despite not meeting the criteria for full-blown diabetes, prediabetes significantly raises the risk of developing type 2 diabetes, as well as other serious health issues like stroke and heart disease. This condition is surprisingly prevalent, impacting one out of every three people in the United States.

Prevalence of diabetes

Despite being a potentially dangerous condition, many individuals have diabetes throughout the United States. It is incredibly common, affecting almost 30 million individuals in the US, which accounts for about 8.9 percent of the population. That means almost one in every ten people will have some form of diabetes.

Diabetes can affect all ages, including children, adolescents, adults, and the elderly. There are several types of diabetes, including type 1 diabetes, type 2 diabetes, and gestational diabetes. These different types of diabetes, and associated risk factors, will be discussed later on.

As mentioned, children can even get diabetes. In the US alone, roughly 352,000 people younger than 20 years old have a diabetes diagnosis. Most of these cases (~304,000) included pediatrics and adolescents with type 1 diabetes.

Aside from just knowing the general numbers, it’s important to recognize trends in diabetes to understand who may be at higher risk. Let’s take a look at some of the statistics from 2019 to 2021:

  • The incidence of diabetes was highest in the following adult populations: Alaska Native and American Indian (13.6%), non-Hispanic Black (12.1%), Hispanic (11.7%), non-Hispanic Asian (9.1%), and non-Hispanic White (6.9%). Diabetes disproportionately affects minorities.
  • Individuals with a family income exceeding 500 percent of the federal poverty level had the lowest incidence of diabetes, with men being 6.3 percent and women being 3.9 percent. Thus, income level can also impact one’s susceptibility to diabetes.
  • There is also an increased prevalence of diabetes in those with a lower education level (e.g., less than a high school degree, high school degree) versus those with a higher education degree (e.g., college).
  • Finally, there was a lower incidence of diabetes in those living in cities versus those living in other types of areas.

What is my risk for diabetes?

Knowing how diabetes can disrupt your health and contribute to long-term complications, you may be wondering what your risk of diabetes is. Knowing your risk level can inform you on what lifestyle changes you may need to implement to lower this risk and prevent diabetes down the line.

Type 1 Diabetes

Someone’s risk for type 1 diabetes is primarily dictated by genetics. Usually, one would need to get genetic risk factors from both parents to develop type 1. The incidence of type 1 diabetes is higher in Caucasian individuals. This genetic predisposition is a significant type 1 diabetes risk factor.

In addition to genetics, environmental factors also play a role in the development of type 1 diabetes. Experts have identified certain viruses that may trigger the autoimmune response leading to type 1 diabetes. These include the Coxsackie B virus and other enteroviruses. The presence of these viruses can initiate an immune response that mistakenly attacks the insulin-producing cells in the pancreas.

Another type 1 diabetes risk factor is early dietary factors. For instance, the timing of introduction to certain foods in infancy has been linked to the development of type 1 diabetes. Some studies suggest that both early (before 4 months) and late (after 7 months) introduction of gluten may increase the risk of type 1 diabetes in children with a genetic predisposition.

Furthermore, geographical location and climate appear to influence the risk of developing type 1 diabetes. Higher rates of type 1 diabetes are observed in countries farther from the equator, suggesting that Vitamin D, which is synthesized in the skin in response to sunlight, might play a role in modulating immune function and preventing autoimmune diseases like type 1 diabetes.

It’s also important to note that while family history is a strong risk factor, the majority of people diagnosed with type 1 diabetes do not have a family history of the disease, indicating that other factors are also at play. Understanding these risk factors is crucial for early detection and management of type 1 diabetes. However, the mechanisms underlying type 1 are not fully understood, so it is nearly impossible to mitigate the risk completely. Regular monitoring and consultation with healthcare providers are essential for those at risk.

Type 2 Diabetes

Type 2 diabetes, being the only preventable type of diabetes, has several identifiable type 2 risk factors. Understanding and managing these factors can significantly reduce the likelihood of developing type 2 diabetes. These risk factors range from genetic predispositions to lifestyle choices, and recognizing them is the first step in prevention.

Genetics plays a crucial role in type 2 diabetes risk. Studies have shown that individuals with a family history of type 2 diabetes are at a higher risk. This genetic link is stronger in type 2 diabetes than in type 1. Twin studies have particularly highlighted this connection, showing a significant concordance rate for type 2 diabetes in identical twins. Furthermore, genomic studies have identified specific genes that increase susceptibility to type 2 diabetes. For instance, variations in genes related to insulin production, beta-cell function, or insulin resistance can elevate the risk. While genetic testing is not commonly done for type 2 diabetes, being aware of family history can be a critical factor in early detection and prevention.

Diet is another significant type 2 diabetes risk factor. Consuming foods high in sugar, fats, and calories can lead to obesity, which is a major risk factor for type 2 diabetes. Processed foods, high in glycemic index, contribute to the development of insulin resistance, a precursor to type 2 diabetes. Conversely, a diet rich in fiber, such as whole grains, and one that includes a variety of fruits and vegetables, can reduce the risk. Studies have consistently shown that diets high in processed foods and low in nutrients and fiber are linked to an increased risk of type 2 diabetes.

Physical activity levels. Physical inactivity is a well-established type 2 risk factor. Sedentary lifestyles lead to decreased insulin sensitivity and increased insulin resistance, both of which are precursors to type 2 diabetes. Regular physical activity not only helps in maintaining a healthy weight but also improves the body’s ability to use insulin effectively. Engaging in regular exercise, such as brisk walking, cycling, or swimming, can significantly reduce the risk of developing type 2 diabetes. It is recommended that individuals engage in at least 150 minutes of moderate-intensity exercise per week to mitigate this risk.

While genetics play a non-modifiable role in the risk of type 2 diabetes, lifestyle factors such as diet and physical activity levels are modifiable type 2 diabetes risk factors. By making informed choices about diet and physical activity, individuals can significantly reduce their risk of developing type 2 diabetes. Regular health check-ups, especially for those with a family history of diabetes, are also crucial in early detection and management of the condition.

Gestational Diabetes

Gestational diabetes is a condition that can develop during pregnancy and is characterized by high blood sugar levels. Understanding the risk factors for gestational diabetes is crucial for early detection and management, which is vital for the health of both the mother and the baby. The risk factors for gestational diabetes are diverse and include both genetic and lifestyle components. These risk factors are:

  • Being overweight: Women who are overweight or obese before pregnancy have a higher risk of developing gestational diabetes. Excess body weight, particularly around the abdomen, is associated with insulin resistance, which can lead to gestational diabetes.
  • Being over the age of 25 years old: The risk of developing gestational diabetes increases with age. Women over the age of 25 are at a higher risk compared to younger women. This increased risk is thought to be due to the combined effects of age-related insulin resistance and changes in hormonal balance during pregnancy.
  • Previous history of gestational diabetes: If a woman has had gestational diabetes during a previous pregnancy, her risk of developing it in subsequent pregnancies is higher. This recurrence indicates a pre-existing vulnerability to glucose intolerance during pregnancy.
  • Family history of type 2 diabetes: A family history of type 2 diabetes suggests a genetic predisposition to insulin resistance, which can be a contributing factor for developing gestational diabetes.
  • Having given birth to a prior baby that was more than nine pounds: Delivering a large baby (weighing more than nine pounds) in a previous pregnancy is a risk factor for gestational diabetes. This may be indicative of undiagnosed gestational diabetes during that pregnancy or a predisposition to glucose intolerance.
  • Having polycystic ovary syndrome (PCOS): PCOS is a condition characterized by hormonal imbalance and insulin resistance. Women with PCOS are at a higher risk of developing gestational diabetes due to their underlying insulin resistance.
  • Racial/Ethnic Groups: Certain ethnic groups, including African American, American Indian, Native Hawaiian, Hispanic/Latino, and Pacific Islanders, are at a higher risk of developing gestational diabetes. This increased risk is partly attributed to genetic factors, higher prevalence of obesity, and other metabolic conditions in these populations.

Understanding these risk factors is essential for pregnant women and their healthcare providers to implement appropriate screening and management strategies. Early detection and management of gestational diabetes are crucial to ensure the health and well-being of both the mother and the baby. Regular prenatal care, including glucose screening tests, is recommended for all pregnant women, especially those with these risk factors.

Prediabetes

Prediabetes is a critical health condition where blood sugar levels are higher than normal but not high enough yet to be diagnosed as type 2 diabetes. It serves as a warning sign, indicating a high risk of developing type 2 diabetes in the future. Understanding the risk factors for prediabetes is essential for early intervention and prevention of progression to type 2 diabetes. The risk factors for prediabetes are varied and encompass both lifestyle and genetic factors. These include:

  • Being overweight: Carrying excess weight, especially in the abdominal area, is a significant risk factor for prediabetes. Excess fat in this area can cause insulin resistance, where the body’s cells do not respond effectively to insulin, leading to elevated blood sugar levels.
  • Having an immediate family member with type 2 diabetes: Genetics play a crucial role in the development of prediabetes. If you have a parent, sibling, or child with type 2 diabetes, your risk of developing prediabetes is higher due to shared genetic factors that can affect insulin resistance and blood sugar regulation.
  • History of gestational diabetes: Women who have had gestational diabetes during pregnancy are at a higher risk of developing prediabetes and eventually type 2 diabetes. Gestational diabetes indicates an existing vulnerability to insulin resistance, which can persist or re-emerge later in life.
  • Having had a child who weighed more than nine pounds at birth: Giving birth to a large baby is often linked to gestational diabetes, which is a risk factor for prediabetes. This association suggests a history of impaired glucose tolerance during pregnancy.
  • Being 45 years of age or older: The risk of prediabetes increases with age. This is due to various factors, including the natural decline in insulin sensitivity and changes in body composition as one ages.
  • Exercising less than three times weekly: Physical inactivity is a significant risk factor for prediabetes. Regular physical activity helps maintain a healthy weight, improves insulin sensitivity, and helps regulate blood sugar levels.
  • Racial/Ethnic Groups: Certain ethnic groups are at a higher risk for prediabetes. This increased risk can be attributed to genetic factors, lifestyle factors, and higher rates of obesity and other metabolic conditions in these populations.

Awareness of these risk factors is crucial for taking proactive steps to prevent the development of prediabetes and its progression to type 2 diabetes. Lifestyle modifications, such as maintaining a healthy weight, engaging in regular physical activity, and eating a balanced diet, are key strategies for managing these risk factors. Regular health check-ups and blood sugar screenings are also important, especially for those with multiple risk factors for prediabetes.

If I’m high-risk, how do I prevent diabetes?

While some types of diabetes, such as type 1, are not preventable due to their genetic and autoimmune nature, there are effective strategies to reduce the risk of developing prediabetes and type 2 diabetes. These strategies primarily focus on modifying lifestyle factors that are within your control. Unhealthy dietary habits and a sedentary lifestyle are two significant risk factors for type 2 diabetes. By addressing these areas, you can significantly impact your health and reduce your risk.

Engaging in regular physical activity is a cornerstone of diabetes prevention. Experts recommend at least 150 minutes of moderate aerobic activity per week, which can include brisk walking, swimming, or cycling. This level of exercise helps improve insulin sensitivity and regulate blood sugar levels. Additionally, incorporating strength training exercises a couple of times a week can further enhance these benefits.

Dietary changes are equally important. A balanced diet rich in vegetables, fruits, whole grains, lean proteins, and healthy fats provides essential nutrients while helping to maintain healthy blood sugar levels. High-fiber foods, in particular, play a crucial role in blood sugar regulation. It’s also crucial to minimize the intake of highly processed foods, sugary snacks, and beverages, as well as foods high in sodium and unhealthy fats. These dietary adjustments not only aid in maintaining a healthy weight but also contribute to overall metabolic health.

If you’re concerned about your risk of diabetes, it’s advisable to consult with a licensed healthcare provider. They can assess your individual risk factors and provide personalized advice. They may also refer you to specialists, such as dietitians or nutritionists, who can help you develop a tailored plan to improve your eating habits and lifestyle. Remember, making small, consistent changes in your daily routine can lead to significant long-term health benefits and reduce your risk of developing diabetes.