Diabetes Overview

Type 2 diabetes is the fastest growing chronic disease in the United States, and the seventh leading cause of death.¹ According to the 2011 estimates recently released by the U.S. Centers for Disease Control and Prevention, nearly 26 million Americans of all ages have diabetes, with another 79 million considered at high risk for developing the disease.² And unless something changes, the future looks even worse, with current epidemiological trends indicating as many as one in three American adults could have diabetes by 2050.³

But there is some good news. Clinical studies have now documented that type 2 diabetes can be possibly delayed or prevented, even in individuals currently at high risk.^4,5 The key is intervention before the onset of full-blown disease. However, of the 79 million people considered at high risk, only a small percentage will develop diabetes within the next five years.⁶ A major challenge lies in identifying those individuals who are at highest risk for developing the disease, in order to effectively allocate your limited resources to those who need them most.

This is particularly important in light of studies that show that adverse changes in both the micro- and macrovascular environments can occur up to 10 years prior to diagnosis.^7,8

Diabetes is a progressive disease.

In individuals whose beta cells are functioning normally, insulin resistance is offset by compensatory hyperinsulinemia, which maintains relatively normal glucose metabolism. In this state, individuals may present with either normal or impaired glucose levels, but have not yet progressed to full-blown diabetes.

This balance can be maintained for only so long. Over time, insulin-producing beta cells in the pancreas begin to fail, reducing insulin secretion and resulting in postprandial hyperglycemia. As this destructive cycle continues, fasting hyperglycemia and hepatic overproduction of glucose follow, resulting in overt diabetes. This process typically begins 4, 7 or as many as 10 years prior to diabetes diagnosis.^6,7,8

Diabetes is a multifactorial disease process. Unfortunately, a fundamental weakness of traditional risk assessment methods is that they measure only one of several factors, and therefore can’t provide a comprehensive risk profile.

• Fasting plasma glucose (FPG) is the most commonly used method for assessing risk of type 2 diabetes. Unfortunately, the specificity of this test is poor.^9,10 Many individuals are identified as having impaired fasting glucose (IFG), yet their absolute risk of conversion to diabetes is only 5–10% per year.¹¹
• Oral glucose tolerance test (OGTT) is a more accurate method than FPG for risk assessment, however due to the inconvenience of the two-hour time period required to complete it, along with poor reproducibility;^12,13 this test is rarely used in primary care practice.
• Indexes using clinical information and laboratory tests are available,^14-17 but the inconvenience of individually calculating the indexes makes them impractical for routine clinical use.
• Genetics and family history provide limited utility since they do not produce actionable data and do not reflect the impact of lifestyle choices, making it difficult to determine which prevention strategies are necessary.^18,19
• HbA1c (glycosylated hemoglobin A1c) has been incorporated into the American Diabetes Association guidelines for diagnosing diabetes and monitoring historic glucose levels in addition to identifying those who may be at risk for the disease.²⁰ However, it measures only a single variable in a complex disease state.

A more complete picture of risk

Diabetes is a multifactorial disease that can progress undetected for many years, impacting multiple organ systems and resulting in a variety of complications. Since the risk of developing diabetes differs based on a range of variables, using a multivariable approach results in a more complete picture of risk.²¹

The PreDx Diabetes Risk Score assesses the underlying pathophysiology of type 2 diabetes by measuring seven biomarkers linked to biological pathways associated with diabetes progression. PreDx DRS results provide you with actionable data and the means to target your patients at highest risk with preventative strategies.