German Physicians Have Identified Six Different Forms of Prediabetes

Type 2 diabetes is the most common type in the US. Before being diagnosed with the disease, patients go through a prediabetic phase in which their blood sugar is at the threshold of hyperglycemia. German physicians have identified six different forms of prediabetes that predict the progression of the disease and its complications.

Diabetes Test

Diabetes Test

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Type 2 diabetes, also known as diabetes mellitus, is the most common of the three types of diabetes in the US. According to the CDC, type diabetes accounts for 93% of all cases of diabetes and 1 in 10 americans suffers from the disease . This disease is characterized by resistance to insulin, a hormone synthesized by the β cells of the islets of Langerhans in the pancreas. Insulin is no longer able to regulate blood glucose levels, and the patient eventually suffers from hyperglycemia (blood glucose concentration above 1.26 g/l on an empty stomach). When it becomes chronic, hyperglycemia leads to symptoms and complications that define type 2 diabetes. It occurs with age, especially in people over 45, and is favored by obesity and a sedentary lifestyle.

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It is a chronic disease that does not occur overnight. The prediabetic phase, in which blood glucose levels are just below the threshold for hyperglycemia, between 1.10 and 1.25 g/l, can last for many years before symptoms start to show.

German physicians at the University Hospital of Tübingen, in collaboration with two research centers specializing in diabetes, have identified six forms of prediabetes by analyzing the physiological characteristics of nearly 900 individuals. Details of the study were published in Nature Medicine.

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The six forms in the prediabetic phase

The 899 prediabetic volunteers underwent medical tests to determine the distribution of their body fat, the amount of fat around the liver, blood lipid levels, and their genetic predisposition to type 2 diabetes. They also underwent a glucose tolerance test to monitor their blood glucose levels. The development of these indicators was monitored for almost 25 years.

The doctors were able to identify six different groups of pre-diabetics:

  • Groups 1 and 2: thin people with no insulin problems. Low risk for diabetes.
  • Group 3: not overweight, but with insufficient insulin secretion. High risk for diabetes.
  • Group 4: overweight, but healthy metabolism. Low risk for diabetes.
  • Group 5: obesity and high fat around the liver. High insulin resistance. High risk for diabetes.
  • Group 6: Obesity and high levels of visceral fat. Complications occur before diabetes is diagnosed. Significant risk of mortality.

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This classification was confirmed by analysis of a second cohort of 7,000 subjects, this time in England. Doctors hope this clasification it will allow them to identify those most at risk of type 2 diabetes earlier and suggest appropriate preventative treatment.


Pathophysiology-based subphenotyping of individuals at elevated risk for type 2 diabetes



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