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risk factors for diabetes mellitus type 2 & risk factor reduction

Etiology: risk factors 1) age > 45 years 2) obesity a) increased weight gain relative to height during an infant's first 3 months of life [3] b) weight gain after 50 years of age [7] c) greatest risk factor [10] d) increased waist circumference, waist-to-hip ratio, central adiposity [12] 3) western culture diet - not whole grains - not brown rice: confers lower risk than white rice [6] 4) lack of exercise - sedentary lifestyle, including watching TV [16] 5) previous gestational diabetes 6) chronic glucocorticoid use, including a) oral glucocorticoids b) inhaled glucocorticoids [9] c) topical glucocorticoids [26] 7) impaired glucose tolerance 8) higher fasting plasma glucose within the normal range is a risk factor for young men [1] 9) black, hispanic or native American ethnicity 10) habitual sleep duration of < 6 hours/night 11) hypertension a) use of diuretics [2,13] b) nighttime hypertension - taking antihypertensives at bedtime reduces risk [20] 12) dyslipidemia - use of statins [13] - low LDL cholesterol [21] 13) smoking (see CARDIA study) 14) low serum sex-hormone binding globulin (serum SHBG) [5] 15) sweetened beverages [17,18] - risk associated with sugar-sweetened beverages & artificially-sweetened beverages [17] - 18% higher risk per 1 serving daily of sugar-sweetened beverage [18] - sugar-sweetened beverages associated with excess risk for type 2 diabetes & cardiovascular disease [30] 16) moderate alcohol consumption may lower risk - lowest risk amoung Danish men consuming 14 drinks/week & women consuming 9 drinks/week [22] 17) long-term use of proton pump inhibitors is associated with increased risk of type 2 diabetes [31] 18) from QDiabetes [25] - schizophrenia, bipolar affective disorder, learning disabilities, polycystic ovary syndrome, atypical antipsychotic use * risk-scoring systems with positive predictive values < 50% [4] * QDiabetes used in U.K. [25] Management: - diet & excercise is the best strategy [19] - fruits & vegetables, Mediterranean diet - a diet rich in antioxidants may help decrease the risk of type 2 diabetes [23] - antioxidants specified include: fruits, vegetables, wine, coffee, & tea [23] - a plant-based diet may reduce risk of type 2 diabetes [27] - weight reduction - exercise - lifestyle intervention including behavioral strategies for >= 150 minutes of moderate physical activity/week more effective than metformin in preventing type 2 diabetes - lifestyle intervention (diet & exercise) reduces incidence of type 2 diabetes by 27% vs 18% for metformin, relative to placebo [19] - diet & exercise intervention not enhanced by support from trained lay volunteers with type 2 diabetes [28] - after adjustment for physical activity & other confounders, each hour spent watching TV associated with a 3.4% increase in risk [16] - moderate to vigorous physical exercise can reduce incidence of diabetes in obese patients by ~50% [29] - metformin may benefit high-risk patients [15] - number needed to treat = 5 - lifestyle modification & weight-reduction & insulin-sensitizing medications (metformin) lower risk for developing diabetes (NNT=24) but results fade with time [24] - coffee may confer lower risk, see coffee & risk of diabetes - plain water, low-fat milk, & coffee is associated with lower risk [30] - replacing sweetened beverages with unsweetened one [17] - green leafy vegetables, confers lower risk - whole fruits, including apples, grapes, & blueberries, may lower risk for type 2 diabetes [11] - blueberries (RR = 0.74), grapes or raisins (RR = 0.88), apples or pears (RR = 0.93) conferred the lowest risk [11] - night time light exposure between 12:30 AM & 6 AM increased risk of type 2 diabetes, as much as 1.5-fold [32] - Tianqi*, a capsule containing 10 Chinese herbal medicines, delays progression to diabetes in high-risk patients [14] * Tianqi is used in China for treatment of type 2 diabetes

Related

coffee & risk of diabetes diabetes mellitus type 2 (insulin-resistant)

General

health risk factor(s)

References

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  2. Internal Medicine World Report vol 21, 2006
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  31. Loosen SH et al. Long-term use of proton pump inhibitors (PPIs) is associated with an increased risk of type 2 diabetes. Gut. 2022. Aug;71(8):1687-1688 PMID: 34725199
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