Diabetes risk runs in families: How one person’s prediabetes may signal risk for the whole family

About 830 million people live with diabetes globally. This chronic metabolic disease, over time, could lead to serious damage to the heart, blood vessels, eyes, kidneys, and nerves. This is why early detection is crucial. A new study has now found that early detection is possible by looking into the family history.

A study led by Dr. Tainayah Thomas, Stanford University found that early detection of individuals at risk for diabetes is possible by analysing the electronic records of people living within the same household for risk factors. The research is set to be presented at this year’s Annual Meeting of the European Association for the Study of Diabetes (EASD) in Vienna, Austria (15-19 September).

Diabetes is a chronic metabolic condition that occurs when the body either doesn’t produce enough insulin or can’t effectively use the insulin it produces, leading to high blood sugar levels. If not managed properly, it could lead to heart disease, kidney damage, and vision problems.

Previous research has shown that a diabetes diagnosis within a family may improve health behaviours at the household level. This is because the one person having diabetes may increase awareness of diabetes risk factors such as obesity, high blood pressure, and abnormal blood fats in the household. But most of the studies were only focused on its effects on spouses/ partners and on individuals with full-blown type 2 diabetes. It did not include other household members, such as adolescent children or those at high risk for diabetes.

In the new study, the researchers also examined the impact on other family members. Using electronic health records (EHR) and administrative data, they tried to identify co-insured household members aged 10 years or older who live with adults diagnosed with prediabetes, to assess diabetes risk factors within the household.

The researchers identified an index cohort of adults with prediabetes were defined as fasting plasma glucose - 100–125 mg/dL, and HbA1c: 5.7–6.4% and their co-insured household members in 2023. Risk factors were also assessed in both adults and children aged 10 and older. The risk factors for adults were a body mass index over 25, hypertension, abnormal blood fats, cardiovascular disease, or a history of gestational diabetes. For children (aged 10-17), overweight or obesity, measured by age and sex-specific growth charts, was the key indicator.

The researchers analyzed 356,626 adults with prediabetes with average age 51 years for males 52% for females, and nearly 60% had obesity. More than half lived in multi-person households, allowing researchers to assess 364,563 co-residing household members — 238,247 adults and 126,316 children.

They found that there was a 65% risk factor for adult household members, and 35% of children developed diabetes, due to overweight or obesity. Also, 20% of adult household members had prediabetes based on laboratory results, and 12% had type 2 diabetes. For children, 285 cases of type 2 diabetes were identified, though prediabetes was not measured in this study.

The study found that almost 30,000 adults with type 2 diabetes lived in the same households as adults with prediabetes, but the authors note it’s unclear if those cases had already been diagnosed. “Of course, many of these people will have been diagnosed with prediabetes or type 2 diabetes, but a significant number could be unaware of their diagnosis and thus could be identified by our study. These are huge numbers of people identified with both prediabetes and type 2 diabetes. If even only a small proportion of these are newly diagnosed, this would make a significant public health impact,” Dr Thomas explains, in a statement.

“For the children, parents might consider doing further tests in those cases where the children are living with overweight or obesity and have diabetes risk factors, but have not yet been diagnosed. It is also of cours,e an opportunity to make lifestyle changes to reduce the chances of metabolic complications in both adults and children,” she adds.

So, if you have a family history of diabetes, should you be worried? “To our knowledge, this novel study is the first to describe the use of electronic health record-based measures to assess household diabetes risk for adults with prediabetes. Our study highlights that diabetes risk is clustered within households, however, very few studies and health system prevention programs enroll households/families reflecting a missed opportunity for population-level diabetes prevention,”

Dr Thomas shares.

She adds, “All health systems could use this approach as a data-driven strategy to better and more systematically identify people at high risk for diabetes. This strategy could allow health systems to identify and tailor diabetes prevention messaging and programs to entire households instead of just individuals.”