Healthy lifestyle may counteract genetic predisposition to type 2 diabetes – medwireNews

medwireNews: A family history of diabetes is associated with a younger age at type 2 diabetes diagnosis, but this could be delayed by following a healthy lifestyle, suggest data from the Joint Asia Diabetes Evaluation (JADE) Register.

The study, by Juliana Chan (The Chinese University of Hong Kong, Shatin) and colleagues, also found that self-management, defined as a healthy lifestyle plus regular self-monitoring of blood glucose (SMBG), was associated with better control of cardiometabolic risk factors, particularly when there was a family history of diabetes present.

Overall, 59.5% of 86,931 patients with type 2 diabetes from 427 clinics in 11 Asian countries or regions between 2007 and 2021 had either a parent or sibling affected by diabetes, but the prevalence ranged from 39.1% in Vietnam to 85.3% in Malaysia.

The mother alone was the most commonly affected relative (13.2%) followed by the father alone (9.8%), siblings alone (11.5%), and then various combinations of the three.

The mean age at diabetes diagnosis was 49.8 years, but the researchers found that people with a family history of diabetes were diagnosed a significant 4.6 years earlier than those with no family history (mean 47.9 vs 52.5 years).

Within the family history group, patients with both parents affected with or without an affected sibling had the youngest mean age at diagnosis (44.6 years) followed by those with a single affected parent with or without an affected sibling (47.7 years), and those with affected siblings only (51.5 years). The difference among the groups was statistically significant.

In addition to a significantly younger age at diagnosis, the researchers found that individuals with a family history of diabetes were more likely than those without a family history to be educated to middle school level or above (82.0 vs 71.6%), be employed (48.1 vs 40.4%) and perform regular SMBG (73.5 vs 65.9%).

They were less likely, however, to report aspects of a healthy lifestyle, namely adhering to a balanced diet, not using alcohol or tobacco, or taking part in regular physical activity.

Chan and team then investigated whether family history interacts with unhealthy lifestyles to bring forward the age at diagnosis. They found that individuals with a family history who reported fewer than two healthy lifestyle behaviors were diagnosed earliest, at a mean of 46.0 years. Those with two or more healthy behaviors and no family history were the oldest at diagnosis, at a mean of 52.8 years.

Of note, the mean age at diagnosis was similar between individuals with a family history of diabetes who reported adhering to two or more healthy lifestyle behaviors and those with no family history but a less healthy lifestyle (48.2 vs 50.1 years).

For cardiometabolic risk factors, the investigators report that people who had two parents with diabetes were a significant 12% more likely to have hypertension and 21% more likely to have dyslipidemia than those with no family history, after adjusting for potential confounders. The risks were also significantly elevated for people who had one parent affected, at 12% and 22%, respectively. Conversely, family history of diabetes was not associated with a significantly increased risk for hyperglycemia.

The researchers also observed that self-management was associated with a significantly higher likelihood of achieving a glycated hemoglobin level below 7% (53 mmol/mol), blood pressure below 130/80 mmHg, and a low-density lipoprotein cholesterol level below 2.6 mmol/L in all participants. The interactions were stronger, however, among individuals with than without a family history of diabetes.

Writing in BMC Medicine, Chan and co-authors conclude that having a family history of diabetes “brought forward the age at diagnosis by nearly 5 years although this could be delayed by healthy lifestyles.”

They continue: “Similarly, although patients with [family history] had worse control of cardiometabolic risk factors than the [non-family history] group, they appeared to benefit more from self-management.”

The team suggests that although biogenetic markers and algorithms may improve prediction, diagnosis, and management of patients with complex diseases such as type 2 diabetes, family history “is a simple proxy which can be used to identify high-risk individuals for intensive education and empowerment to delay disease onset and improve clinical outcomes.”

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BMC Med 2022; 20: 249