Simple Blood Test Could Predict Risk of Type 2 Diabetes

gamelover@AdobeStock_215309123

Scientists have discovered metabolites in the blood that accurately predict whether a woman who has experienced gestational diabetes during pregnancy will go on to develop type 2 diabetes (T2D) later.  The researchers believe that this simple test could lead to early diagnosis of woman at risk, and interventional treatment.

The research was published in the journal Plos Medicine.  

"There is a metabolic dysregulation that occurs in the group of women that will go on to develop type 2 diabetes that is present in the early postpartum period, suggesting that there is an underlying problem that exists already and we can detect it," said Michael Wheeler, Professor of Physiology at the University of Toronto and lead author on the paper, in a statement.

The current study builds on a previous study of 1033 women from 2016 – the Study of Women, Infant Feeding and Type 2 Diabetes After GDM Pregnancy (SWIFT). The new data comes from the same cohort of women who were followed over a longer time period during which more women developed T2D.

Baseline blood samples were collected between six and nine weeks after birth and then twice over two years. The women's health was followed through their electronic medical records for up to 8 years. During this time, 173 women developed T2D and their blood samples were compared to 485 women enrolled in the study, matched for weight, age, race and ethnicity, who had not developed the disease.

"This study is unique as we are not simply comparing healthy people to people with advanced disease," says Hannes Röst, a co-author on the paper. "Instead, we are comparing women who are clinically the same--they all had GD but are back to being non-diabetic post-partum.  This is the holy grail of personalized medicine to find molecular differences in seemingly healthy people and predict which ones will develop a disease," says Röst.

Researchers find that the blood of women who go on to develop T2D, contains a unique combination of sugar molecules, amino-acids and lipids.  Röst explains that this is indicative of underlying issues in protein and fat metabolism as well as glucose metabolism. In fact, the predictive power of the test dropped if amino-acids and lipids were excluded, suggesting that processes beyond sugar metabolism may occur very early in the development of the disease. The finding may help explain why complications occur in T2D patients even when blood sugar is tightly controlled with medications.

Wheeler and his-coauthors write that the metabolic signature they have identified can predict with over 85 per cent accuracy if a woman will develop T2D.

The researchers hope to turn their discovery into a simple blood test that women could take soon after delivery, perhaps during an early visit to the doctor with their baby. A simple test for early diagnosis of T2D in new mothers is important they say, because although it is recommended that women with gestational diabetes follow up with glucose challenges post-partum, many busy new mothers fail to comply.

The women from the SWIFT study are being invited back for a 10-year follow-up visit, where they will be tested for T2D .  This will help to further develop the test and and refine it to identify metabolic differences among race and ethnic groups that the test will need to take into account the researchers say.

Lai M, Liu Y, Ronnett GV, et al. Amino acid and lipid metabolism in post-gestational diabetes and progression to type 2 diabetes: A metabolic profiling study. PLoS Med. 2020;17(5):e1003112. Published 2020 May 20. doi:10.1371/journal.pmed.1003112