The Top 7 Risk Factors for Prediabetes and Type 2 Diabetes
When you know what to watch out for, you can take better control of your health.
February 17, 2021
How to Prevent Diabetes
The numbers tell a dramatic public health story: According to the Centers for Disease Control and Prevention (CDC), an estimated 88 million Americans are living with prediabetes and 34 million more with full-blown type 2 diabetes. “In fact, diabetes is a global epidemic, and the seventh leading cause of death worldwide,” says Maziyar Saberi, PhD, systems physiologist and Chief Scientific Officer of January AI. “Of the tens of millions of Americans living with a diabetes diagnosis, a more alarming 8 million may be undiagnosed and unaware of this preventable condition.” Let’s focus on the words “preventable condition” for a more positive take: Yes, you can get ahead of diabetes if you understand the risk factors and take the necessary and basic steps to protect your metabolic health, which starts with controlling blood sugar. Here are the top risk factors for diabetes, as well as how to prevent diabetes.
But first, a quick refresher on the origins of diabetes, starting with the role of insulin. Your pancreas produces this vital hormone when the food you eat is turned into sugar (aka glucose) and released into your blood. Insulin acts like a key, unlocking your cells so the glucose can enter and get turned into energy. But if cells no longer respond to insulin, or the pancreas can’t produce enough of it, too much glucose stays in your blood. This spells bad news for your health, because chronically high blood sugar puts you at risk for a host of health problems including heart disease, stroke, kidney failure, and even blindness.
We lay out the risk factors for diabetes to empower, not scare you. Understanding what’s at stake can motivate you to get proactive about your health. “You’re more in control than you think,” says Saberi. “Metabolic complications can be reversed if caught early. You just need to commit to a plan that’s clear and simple to execute.”
Here, we’ll break down the risk factors for diabetes and how you can combat each one.
The risk: You’re at greater risk of developing prediabetes and type-2 diabetes if a sibling or parent has the condition. One large study in the journal Preventing Chronic Disease by public health officials at the Michigan Department of Community Health studied the disease rates of more than 10,000 participants. They found that people who have a first-degree relative with diabetes are 14.3 percent more likely to have the condition as well, compared to those without a family history (3.2 percent). Another study found that people with first-degree family members with diabetes are at a two to six times increased risk of developing it compared to those with no family history. Why does your relatives’ health matter so much? While much of diabetes is about how you live your life, especially the foods you eat, “genetics undoubtedly plays a role,” says Saberi. “In fact, the risk of developing type 2 diabetes increases with the number of affected family members.” Behavioral factors can be learned from family, as well (your mom eats a high sugar diet, you eat a high sugar diet…). “But those habits can be unlearned,” Saberi emphasizes. “We all have the power to modify our behavior and adopt a lifestyle that promotes better eating habits, exercise and sleep—all fundamentally important to preventing diabetes.”
How to combat it: Even if diabetes runs in your family, it doesn’t mean you’re automatically doomed to get it, too. The disease is 100% preventable with the right lifestyle and diet changes. Keep in mind: Undiagnosed diabetes is thought to account for nearly 30 percent of total diabetes prevalence in the United States, so if you know you have a family history, the most important thing you can do is get what’s known as an A1C test. With a simple blood draw, the test serves as a snapshot of your average blood sugar levels over a period of about three months. At your next checkup, alert your health professional to your family history and ask to get checked. “While being diagnosed with prediabetes or diabetes can be a frightening experience, the good news is that when caught at the early stages, the systems that regulate glucose are still functioning,” Saberi says. “So it’s really an opportunity to take action and turn things around.”
The risk: Your chance of developing type 2 diabetes increases as you age, which is why the American Diabetes Association (ADA) suggests yearly A1C screening after age 45, or younger if you have other risk factors. But don’t think you’re off the hook until then. Research shows that more adults are developing diabetes earlier due to lifestyle choices—namely, eating an unhealthy diet and skipping out on exercise. An estimated 28 million adults between the ages of 18-44 have prediabetes, with 11.7 million developing diabetes by the time they’re between 45 to 64, the CDC estimates in their 2020 National Diabetes Statistics Report.
How to combat it: You can’t turn the clock back of course, but you can start prioritizing your health right now, no matter how old you are. It’s easy to feel invincible when you’re younger, but the earlier you start adopting a healthy lifestyle, the easier it’ll be to stick with it—and reap the long-term benefits. Get your A1C levels tested at your next check-up and use that as your baseline. If you’re in the healthy range, keep up the good work. If you need to bring your numbers down, talk to your doctor about creating a personalized plan you can start asap. Using a continuous glucose monitor (CGM), which attaches painlessly to your arm and measures your blood sugar around the clock, can help. It shows you your response to food and activity in real time, so you can zero in on the diet and exercise routines that will work best for your unique body chemistry.
The risk: Nearly 90 percent of adults with diabetes are overweight or obese with a body mass index (BMI) over 25, according the same CDC report. Why does extra weight mess with glucose control? Saberi explains: “Obesity, especially, visceral obesity or belly fat, increases the risk for type 2 diabetes through insulin resistance. This happens, in part, because fat cells begin to release molecules that make it harder for insulin to do its job. As a result, the pancreas has to go into overdrive and produce even more insulin. That’s called hyperinsulinemia, and it can lead to increased hunger and accelerated weight gain”
How to combat it: If you focus on bringing your weight down, even a little bit, the payoff can be huge for your blood sugar and total metabolic health. The Diabetes Prevention Program (DPP) (run by the National Institute of Diabetes and Digestive and Kidney Diseases) developed an intervention program that required participants to lose just 7 percent of their body weight and maintain about 150 minutes of exercise per week over the course of six months. The results were staggering: Researchers saw a 58 percent reduction in the incidence of diabetes among those who followed the plan. To put it in real terms, someone who starts at a weight of 200 pounds could lose just 14 pounds and exercise a little more than 20 minutes a day to cut their risk by more than half. No drugs, no extreme dieting or exercise — just life-changing health benefits.
The risk: We all need to be concerned about blood sugar control and our overall metabolic health (more on that below), but certain groups should pay extra attention. According to the same CDC report, the prevalence of diabetes is highest among American Indians and Alaska Natives (14.7%), followed by those of Hispanic origin (12.5%), and then African Americans (11.7%). Asians and white Americans had the lowest rates. Why do ethnicity and race play a role? While the link isn’t fully clear, research has shown that genes may be a factor in developing diabetes. And according to a Harvard Health report, some groups may have genetic factors that impact how well the pancreas produces insulin and how efficiently the body responds to that insulin.
How to combat it: Again, knowledge is power when it comes to blood sugar control. Stay alert to your risks and check in with your doctor on making the appropriate lifestyle adjustments earlier in life. A1C testing is a must, and using a CGM can help you understand the precise foods that send your blood sugar spiking, as well as the foods that keep you stable. Belly fat is another diabetes risk factor that is more common in these same ethnic communities, so pay attention to weight around your middle. The more you focus on the factors in your control, the less your race and ethnicity will play a role.
Gestational Diabetes During Pregnancy
The risk: Gestational diabetes is a temporary form of the condition that develops during pregnancy, when the placenta makes hormones that cause more sugar to build up in the blood. If your pancreas is unable to meet the demand for more insulin, you may develop diabetes until you give birth. Somewhere between two to 10 percent of pregnant women get this diagnosis. Scientists still aren’t sure exactly what causes gestational diabetes, and why some women develop it while others don’t. If you are among them, you’ll need to be vigilant about controlling your blood sugar levels even if your numbers go down after you give birth. According to the CDC, nearly half of all women who develop gestational diabetes go on to develop type 2 diabetes later in life.
How to combat it: If you keep up with regular doctor’s appointments throughout your pregnancy, your doctor will check your blood sugar levels during the second trimester (this can also be done during the first if you have other risk factors). It’s important to keep up with prenatal care, because when left untreated, gestational diabetes can cause serious problems, like preeclampsia, which causes high blood pressure and can be fatal. While there’s very little you can do to prevent it (so don’t beat yourself up if you do get a gestational diabetes diagnosis), you can focus on maintaining a healthy weight before you conceive and staying in the healthy weight gain zone during your pregnancy. Eating a nutritious diet and getting regular exercise (cleared by your doc) may also help (see our gestational diabetes meal plan). The same goes post-pregnancy: If you continue to eat well and return to a healthy weight, you’ll lessen your chances of developing type 2 later in life. The CDC recommends getting your A1C levels tested between six to 12 weeks postpartum and then every few years after that to make sure your numbers don’t start creeping up. If you go on to have more children, be sure to tell your doctor because a recurrence of gestational diabetes will be more common if you’ve experienced it before.
The risk: Polycystic ovary syndrome — PCOS—is a hormonal disorder that is one of the most common causes of infertility. With PCOS comes irregular periods, infrequent ovulation, and an increase in male hormones called androgens (which can cause the most visible syndrome: heavier than normal facial hair). And, as it turns out, women with PCOS are more likely to be insulin resistant, which raises blood glucose levels, amping up the risk of developing diabetes. More than half of all women with PCOS go on to develop type 2 diabetes, according to the CDC. Read more about PCOS and diabetes.
How to combat it: While it’s still unclear what causes PCOS, weight gain has been shown to be a factor. If your periods are irregular, you should definitely speak with your doctor about what you’re experiencing every month to see if PCOS may be the culprit. PCOS often goes undiagnosed, so don’t be shy about speaking up if your cycle feels off to you. The earlier your doctor can diagnose you, the earlier you can experience relief. Treatment can range from lifestyle changes that allow you to lose weight so you reach a healthy range, as well as birth control pills that slow androgen production. And because of the increased diabetes risk, your doc may put you on diabetes meds even if you don’t have the disease yet because those meds (like metformin) can also help regulate ovulation. Not only will treatment help if you’re trying to get pregnant, it can also help slow the progression of diabetes, too.
The risk: Metabolic syndrome occurs when you’re outside the healthy range across some or all of five different health metrics, which include: blood sugar levels, blood pressure, triglycerides, cholesterol, and waist circumference. When you’re beyond the normal range in at least three of these, you’re considered to have metabolic syndrome because, when taken together, these disorders can significantly increase your risk of developing heart disease, diabetes, or stroke.
How to combat it: Focus on your numbers. The key here is to develop a lifestyle that brings your blood sugar levels, blood pressure, triglycerides, cholesterol, and your waist circumference all into a normal range. (You can read more about those targets here.) Waist circumference is easy for anyone to measure, but you’ll need a blood test to know if you’re at risk for the other factors, because they don’t often have early warning signs or symptoms. As with all the other risk factors for diabetes, a healthy lifestyle (which includes eating well, exercising regularly, and not smoking) can have a stunningly positive impact on all of these components.
Can you prevent diabetes if it runs in your family?
Yes! “The risks are certainly increased with a family history of diabetes.” says systems physiologist Maziyar Saberi, PhD. “And this could vary from individual to individual based on their genetics. But we are still talking about risk, not certainty, and we have great control in preventing the onset if we commit to taking the right steps.” Stay focused on eating a healthy diet, exercising regularly, and making sure your A1C levels remain within a normal range.
How to prevent diabetes?
The best way to prevent diabetes is to understand the risk factors for diabetes that are within your control, which includes maintaining a healthy weight while eating a healthy diet and exercising regularly. Not smoking and getting regular check-ups at the doctor are vital, as well.
Is diabetes genetic or hereditary?
Some genetic components play a role in who develops diabetes, which is why it’s important to know your family history of the condition. If a parent or sibling has diabetes you’re 15 percent more likely to develop it too. But don’t stress out: This isn’t an unavoidable fate. If you’re proactive about staying healthy and monitoring your blood sugar levels, you can overcome your family history and live a diabetes-free life.
What are the risk factors for Type 2 diabetes?
There are 7 key factors that may increase your risk of developing diabetes that you should be aware of:
- Family history of the disease
- Being over age 45
- Overweight or obesity
- Polycystic Ovary Syndrome (PCOS)
- Gestational diabetes during pregnancy
- Being African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander
- Metabolic Syndrome, which mean you have three or more of the following:
- High blood sugar levels
- Waist size over 40 inches for men, and 35 inches for women
- High blood pressure
- High cholesterol
- High triglycerides