Why do people develop diabetes?

People with diabetes/pre-diabetes have insufficient insulin actions due to an abnormal structure and function of islets which contain clusters of insulin-secreting (beta) cells. There are very few islets located in our pancreas and their function and structure may be genetically determined.

Some young people with a lean build may develop diabetes especially if diabetes runs in their families.

Under stressful situations (e.g. being overweight, smoking, hepatitis B carrier) that require the body to secret more insulin to keep the blood glucose normal, subjects with a high genetic risk may decompensate and develop high blood glucose, leading to the onset of diabetes or pre-diabetes.

Why is it important to detect and control diabetes early?

Pre-diabetes and early diabetes (e.g. patients diagnosed for less than 5 years) can be easy and relatively non-costly to control through lifestyle changes, self-care and, sometimes, the use of drugs. However, due to the silent nature of the disease and the fact that risk conditions are not usually clearly identified, many people who are at risk of diabetes are not diagnosed, treated or controlled.

Due to time constraints and the non-urgent nature of the condition, high risk subjects and their care team may miss ‘the golden period’ of early intervention when the subject may lack sufficient knowledge or data to be motivated and empowered enough to manage their condition proactively.

People with diabetes, pre-diabetes and weight problems need time and education to learn and acquire new habits but these investments are worthwhile for long term benefits.

Why are asians more likely to develop diabetes?

People with diabetes tend to have a poorer beta cell function than those without. This is especially true in Asians who have low body weight, a good indicator for subpar beta cell function.

Many of these Asian people also harbor genetic and cultural factors (e.g. obesity, smoking, susceptibility to hepatitis B infection, high intake of calorie-dense foods) which put them at greater risk of developing diabetes under stressful conditions.

Due to this mismatch between host factors and external environment, subjects living in society undergoing rapid changes in lifestyle, especially those with genetic risks, require support and treatment to help them protect their islets and reduce diabetes risk.

Why do some people harbor these genetic traits?

Life is all about handling energy properly in order to grow, live, reproduce, and deal with bodily wear and tear and external stressors (e.g. illness, injuries and diseases). Our ancestors used to live in an environment where food was scarce and physical activity was strenuous and therefore subjects who could store and use energy efficiently were more likely to survive.

Some subjects were born during times of hardship and in order to survive, their genetic codes might have been modified to reduce energy requirement by having a smaller body build and organs to cope with the scarcity of food during such times.

However, in a rapidly modernizing society where food is abundant and the same degree of strenuous activity is rare, subjects carrying these genetic traits are more likely to gain weight which puts a strain on the beta cells and therefore increases their risk of having diabetes.

Why do some people have genetic risk but do not develop diabetes?

The chances of diabetes and many chronic diseases can be determined by different mixes of genetic and acquired factors which can be modified (e.g. lifestyle, smoking, obesity). Like many facts of life, how we play our cards is more important than what cards we hold or are given. Thus, despite having high genetic risks, a healthy lifestyle and regular surveillance of key health indexes can reduce our chances of these risk conditions translating into disease.

The risk of diabetes increases with age. The disease may occur earlier in those with genetic risks, and especially those with an unhealthy lifestyle and low awareness of health risks. This can ultimately result in their silent physical deterioration.

Thus, by testing and assessing your genetic risks, you will be more aware of your own health risk profile and take better control of your health whilst at the same time your health care team can use this information to tailor-make a personalized solution for you.