Risk Factors for Diabetes

Risk Factors for Diabetes

Also called: Diabetes Risk Factors, Diabetic Risk Factors


About 1.5 million Americans a year are diagnosed with diabetes, and hundreds of thousands more develop the disease but go undiagnosed, according to the American Diabetes Association (ADA). Nearly 21 million Americans live with the disorder, more than double the number diagnosed in 1980, according to the Centers for Disease Control and Prevention (CDC).

Understanding risk factors can help people prevent certain types of diabetes, such as type 2 diabetes (by far the most common type of diabetes), and avoid complications arising from diabetes, including type 1 diabetes.

A family history of diabetes and genetics are two of the strongest links to developing certain types of this disease. Like age, race and sex, they are uncontrollable risk factors. However, there are also many diabetes risk factors that can be reduced.

Controllable risk factors include diet, weight, level of activity and stress. For instance, there is a strong link between obesity and type 2 diabetes. Habits, such as lack of exercise, smoking and excessive use of alcohol, are also risk factors for diabetes as well as other conditions related to diabetes, such as cardiovascular disease.

Though there is no guarantee that modifying a lifestyle will prevent diabetes, the change may inhibit or delay the development of the condition. A person who is at higher risk for diabetes should take preventive measures as recommended by a physician. These adjustments can help reduce the risk of developing diabetes and the medical complications associated with the condition.

About risk factors for diabetes

Because the cause of each type of diabetes is different, the risk factors vary. Forms of diabetes include:

  • Type 1 diabetes. The pancreas can no longer produce insulin, resulting in high glucose in the blood and no fuel for the body.
  • Type 2 diabetes. The body cannot properly use insulin to convert glucose into fuel. Insulin resistance and prediabetes typically develop before type 2 diabetes.
  • Gestational diabetes. This type develops during pregnancy and generally resolves itself after delivery. The cause is not completely understood but is linked to genetics, being overweight or obese and hormonal changes. Women who develop gestational diabetes have a 40 percent greater risk of developing type 2 diabetes later in life.
  • Latent autoimmune diabetes of adulthood (LADA). A variation of type 1 diabetes that has some characteristics of type 2 diabetes and is closely linked to genetic causes.
  • Secondary diabetes. Diabetes caused by another condition, such as pancreatitis, or a medical treatment, such as pancreatectomy or corticosteroids.
  • Double diabetes. A condition in which people with type 1 diabetes develop insulin resistance, a hallmark of type 2 diabetes, typically because of excess weight, physical inactivity and unhealthy eating habits.
  • Maturity-onset diabetes of the young (MODY). A rare type of diabetes that is caused by genetic mutations.
  • Wolfram syndrome. A rare genetic disorder that includes insulin-dependent diabetes, hearing problems, vision problems and diabetes insipidus.

Risk factors can generally be divided into two categories:

  • Uncontrollable factors. Traits with which a person is born and cannot be changed. Uncontrollable risk factors closely linked to diabetes include:

    • Age. Type 1 usually occurs before the age of 30, whereas type 2 often occurs after age 45. MODY is also closely tied to age, with most cases developing before age 25.
    • Family history. A family history of diabetes is one of the strongest links to developing the disease. If a mother or father has diabetes, there is a greater chance their child will develop diabetes than a child whose parents do not have diabetes. The risk for diabetes also increases if a brother or sister has diabetes. Family history influences risk of all forms of diabetes but appears to be stronger in some types than others. For example, people with MODY, LADA or Wolfram syndrome inherit genetic abnormalities for these conditions.  Researchers are refining genetic tests to help predict diabetes in families with a history of the disease.
    • Race. Certain races are more prone to developing a specific type of diabetes, especially type 1 and type 2. It is believed that diabetes may be caused by inherited traits with a race or ethnic group, as well as lifestyles that are common with that race.
    • Sex. Though males make up slightly less than half the U.S. population, they account for 53 percent of the adult cases of diabetes, according to the National Institutes of Health (NIH). The prevalence of diabetes in men and women was similar until 1999, when a growing disparity began, according to the U.S. Centers for Disease Control and Prevention (CDC). An estimated 10.5 percent of American men and 8.8 percent of American women had diabetes in 2005. Research to account for the discrepancy is lacking.

  • Controllable factors. Risk factors that can be changed by an individual. Some risk factors that can be reduced include:

    • Weight. Excess weight is a major risk factor for type 2 diabetes, double diabetes and gestational diabetes. Recent research indicates obesity can also cause earlier onset of type 1 diabetes in some cases. Extra pounds can cause metabolic problems, including high blood pressure and unhealthy cholesterol levels. Obese individuals also tend to develop Insulin resistance. All of these factors can increase a person’s risk of developing type 2 diabetes.
    • Lifestyle. Low activity levels and poor exercise habits place a person at high risk for diabetes, particularly type 2 and double diabetes. Stress can also contribute. Keeping active helps reduce weight, cholesterol, blood pressure and stress, which in turn lowers the risk for developing diabetes or its complications.
    • Smoking and alcohol. By not smoking and limiting the use of alcohol, individuals can reduce their risk of developing type 2 diabetes. In other types of diabetes, avoiding these elements can help prevent further medical complications.

Sources of secondary diabetes are sometimes controllable but sometimes not. For example, pancreatitis is often due to alcohol abuse but can also be due to genetics or other causes. Diabetes caused by medication, which often resolves after the drug is discontinued, may be preventable if another treatment is available but may be unavoidable if the drug is essential.

The uncontrollable and controllable traits for diabetes can be related to one another. For example, a child who is born into a family of people who have diabetes and who has poor eating and exercise habits is likely to develop those habits as well. The combination of a history of diabetes and an unhealthy lifestyle places that child at a higher risk for developing diabetes.

Diabetes is on the rise in the United States and worldwide, especially for people of certain ages and ethnic groups. Although it is impossible to change certain factors, individuals can reduce their risk by maintaining a healthy, active lifestyle.

Type 1 diabetes risk factors

Although type 1 diabetes may occur in anyone, there is a greater risk of developing the disease with the following factors:

  • Family history of diabetes (parent, sister, brother)
  • Age less than 30
  • White race, particularly Northern European ancestry
  • Certain genes
  • Children fed breast-milk substitutes

Family history plays a clear role in the risk for developing type 1 diabetes. The risk changes depending on which family member has the diabetes. According to the ADA, a person’s risk is affected as follows for each family member diagnosed with diabetes:

Type 1: Family MemberPerson’s Risk
Father6 percent
Mother with child born
before age 25 
4 percent
Mother with child born
after age 25 
1 percent
Both parents10 to 25 percent
Sibling  6 percent
Identical twinup to 50 percent

Family history is not the only hereditary factor that can contribute to type 1 diabetes. Individuals may inherit certain DNA and antibodies that place them at risk for developing type 1 diabetes. The genes (HLA-DR3 and HLA-DR4) are useful in predicting the risk for type 1 diabetes, particularly in children. Special tests may be conducted to examine the DNA and determine the existence of antibodies. If the parents are white, have diabetes and have these genes, the children are at the highest risk for developing type 1 diabetes. However, not all people who have these genes will develop type 1 diabetes.

Researchers believe that environmental factors, not just genetics, contribute to the development of type 1 diabetes. In studies conducted by the ADA on identical twins, it was discovered that genetics alone could not be responsible for type 1 diabetes. Identical twins have identical genes, yet when one twin has type 1 diabetes, the other has at most a 50 percent chance of developing the disease. Although some environmental factors may contribute to the development of type 1 diabetes, it is unclear which factors increase the risk.

It is suspected that viruses and possibly early nutrition may be risk factors. However, there is no clear evidence that suggests changing controlled factors can lower the risk for developing type 1 diabetes.

Type 2 diabetes risk factors

About 19 million Americans, many of them undiagnosed, have type 2 diabetes, according to the National Institutes of Health. This number represents 90 to 95 percent of all the cases of diabetes. Although anyone can develop type 2 diabetes, it is more likely to occur if the person:

  • Has insulin resistance, prediabetes (impaired glucose tolerance) or metabolic syndrome
  • Is overweight or obese
  • Has a family history of diabetes
  • Is over the age of 45
  • Is black, Hispanic, Native American or Asian
  • Is physically inactive
  • Has high blood pressure
  • Has an unhealthy level of cholesterol
  • Eats unhealthily
  • Smokes
  • Heavily uses alcohol (some research shows that modest consumption of alcohol can reduce the risk of diabetes)
  • Suffers from stress
  • Is male
  • Is a woman with a history of gestational diabetes, giving birth to a baby weighing more than 9 pounds (macrosomia) or polycystic ovarian syndrome
  • Was exposed to certain chemicals, including the Vietnam War defoliant Agent Orange and, according to some research, bisphenol A, an ingredient in many consumer plastics

A family history of diabetes is considered to be an even greater risk factor with type 2 diabetes as compared to type 1. According to the ADA, the chance of a child developing the disease in a family with type 2 diabetes is as follows:

Type 2: Family MemberChild’s Risk
Either parent* who developed
diabetes before age 50  
14 percent
Either parent* who developed
diabetes after age 50  
8 percent
Both parents have diabetes50 percent
Identical twinup to 75 percent

        *NOTE: According to the ADA, some scientists believe the risk is
        higher with the mother than the father.

Certain genes may be inherited that make a person more prone to developing type 2 diabetes. In addition, lifestyles may be passed onto children. If the parents have a diet high in saturated fat and do little exercise, the children may adopt those unhealthy habits.

Obesity is strongly linked to type 2 diabetes, especially for people who carry the extra body fat around their waist (are apple shaped). The risk of developing type 2 diabetes increases as body weight increases.

Weight is closely linked to many other risk factors. High-calorie diets combined with poor exercise habits contribute to a person being overweight or obese and developing insulin resistance, high blood pressure, hyperlipidemia, metabolic syndrome and, in women, polycystic ovarian syndrome.

Other possible factors include sleep apnea, insufficient or excess sleep and, in men, low levels of testosterone (hypogonadism), according to recent research.

Smoking and consuming large amounts of alcohol can also elevate glucose (blood sugar) and increase risk of this disease. If an individual is at risk for developing diabetes, the greatest way to reduce the risk is to maintain a healthy lifestyle.

Gestational diabetes risk factors

Gestational diabetes is a condition occurring during pregnancy. A woman who was not previously diagnosed with diabetes develops high glucose (blood sugar) levels and may display other symptoms of diabetes. In most cases, symptoms of diabetes disappear following the birth of the baby.

Although all women can get gestational diabetes, a woman is at higher risk if she:

  • Is overweight before becoming pregnant
  • Is black, Hispanic, Native American or Asian
  • Is over the age of 35
  • Has a family history of diabetes
  • Previously gave birth to a baby weighing more than 9 pounds (macrosomia)
  • Previously gave birth to a stillborn baby
  • Had gestational diabetes with a previous pregnancy
  • Has glucose in her urine (glucosuria)
  • Has too much amniotic fluid (polyhydramnios)

According to the American Diabetes Association (ADA), once a woman has gestational diabetes, she has a two out of three chance of developing it again during a future pregnancy. Gestational diabetes also increases the risk for developing type 2 diabetes later in life by 40 percent, according to the ADA.

If a woman develops gestational diabetes, it is important that she develop a healthy lifestyle to reduce the risk of diabetes in the future.

MODY and LADA risk factors

Maturity-onset diabetes of the young (MODY) is a rare form of diabetes that is often misdiagnosed as type 1 diabetes or type 2 diabetes. There is a strong genetic factor in developing MODY, and six genes have thus far been linked to the cause of this disorder.

MODY runs in families, and 50 percent of children whose parents have MODY will develop the disorder themselves. With the exception of heredity, there are no other factors known to increase the risk of developing MODY.

Latent autoimmune diabetes of adulthood (LADA) is an adult form of type 1 diabetes. This condition is frequently misdiagnosed as type 2 because of its late onset. The risk factors are similar to those of type 1.

Secondary diabetes risk factors

Many conditions have been linked to secondary diabetes, including:

  • Pancreatitis (inflammation of the pancreas)
  • Pancreatic cancer
  • Hemochromatosis
  • Hepatitis C
  • Growth hormone disorders such as acromegaly
  • Cystic fibrosis
  • Inherited neuromuscular diseases such as muscular dystrophy and Huntington’s chorea
  • Insulin resistance syndromes such as ataxia-telangiectasia and leprechaunism
  • Chromosomal disorders such as Down syndrome, Klinefelter syndrome and Turner syndrome

People with some other conditions, including asthma, colorectal cancer, gout and epilepsy, have been found to have an increased incidence of diabetes.

Total pancreatectomy results in diabetes, and partial removal of the pancreas may. Medications that may cause hyperglycemia, insulin resistance and diabetes include corticosteroids, other immunosuppressives, estrogens, injected contraceptives, anabolic steroids, antiretroviral (HIV) drugs, beta blockers (a class of antihypertensives), diuretics, certain anticonvulsants, antidepressants, antipsychotics and chemotherapy drugs.

Prediabetes risk factors

Prediabetes is a condition in which the level of glucose (blood sugar) is higher than normal but not yet high enough to be considered diabetes. It often but not always leads to type 2 diabetes, and the risk factors are similar.

Although prediabetes can occur in everyone, the individuals with these traits are at the greatest risk:

  • Black, Hispanic, Native American or Asian race
  • Overweight or obesity
  • Family history of diabetes
  • Low physical activity
  • High blood pressure
  • Unhealthy cholesterol levels (low HDL, high LDL, high VLDL, high triglycerides)
  • History of gestational diabetes (females)

With a healthy diet, exercise, and maintenance of ideal body weight, a prediabetic person can greatly reduce the chances of developing type 2 diabetes. Monitoring blood pressure and cholesterol levels with the assistance of medical professionals can also help prevent or delay prediabetes from becoming diabetes.

Reducing risk factors for diabetes

Many risk factors, such as age, race and family history, cannot be changed. Changing other factors, however, can lower the chances of developing diabetes. To help delay or prevent diabetes, people should:

  • Reach and maintain a healthy body weight
  • Choose a good diet rich in high-fiber plant foods, without excess calories and low in saturated fats, trans fats, starches and sugars
  • Be active and exercise regularly (as advised by a physician)
  • Control blood pressure and cholesterol
  • Avoid smoking
  • Limit use of alcohol
  • Manage stress
  • Take medications or follow other treatments as prescribed by a physician

For individuals who are in one of the high-risk groups for diabetes, it is even more important to follow these recommendations. Lifestyle habits usually are passed from parents to children. By maintaining a lifestyle with a healthy diet and exercise, the parents will be helping themselves and future generations.

Questions for your doctor about risk factors

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about risk factors for diabetes:

  1. Do I have risk factors for diabetes?
  2. Which type or types of diabetes am I at risk of?
  3. Should I undergo any genetic testing, glucose testing or other testing?
  4. Which risk factors can I control?
  5. Is there anything I can do to compensate for uncontrollable risk factors?
  6. How much do my various risk factors increase my chances of developing diabetes?
  7. How can I reduce my risk of developing diabetes or diabetic complications?
  8. Can the amount of alcohol I drink increase or decrease my risk of diabetes?
  9. Do I have insulin resistance, prediabetes, metabolic syndrome, high blood pressure, unhealthy cholesterol levels, pancreatitis, hemochromatosis or another condition that increases my risk of diabetes?
  10. Can any of my medications increase my risk of diabetes? If so, are there any good alternative treatments for me?
  11. Do my family members have an increased risk of diabetes? Should they have a glucose test or undergo other screening?
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