Introduction
Type 2 diabetes mellitus, often referred to as simply “diabetes type 2,” occurs when your body cannot use insulin properly in response to your blood glucose levels becoming higher than normal. This phenomenon is called insulin resistance to hyperglycemia. Your pancreas first tries to make extra insulin to compensate, but, over time, it cannot keep up and does not make enough insulin to bring your blood glucose levels down.[i]
This disease is largely preventable through keeping weight under control, eating a healthy diet, not smoking, limiting intake of sugary drinks, and exercising more.[ii]However, in a Centers for Disease Control and Prevention (CDC) report released July 2017, there are more than 100 million U.S. adults who are either currently living with diabetes or prediabetic which is over 9% of the entire population.[iii]According to the World Health Organization, since 2000, the number of people affected by diabetes will have increased by 114% in 2030.[iv]This research confirms the steady incline of the prevalence of diabetes, prompting the CDC to establish the National Diabetes Prevention Program targeting prediabetics. The research-based prevention program is a year-long process focusing on long-term results. It is structured and can be conducted online or in-person, specifically to prevent type 2 diabetes, and offers group support.[v]
While the program assists those already diagnosed as prediabetic, what of others who have not yet been diagnosed? What if we could more accurately predict type 2 diabetes mellitus through anthropometric measurement, the assessment of our body’s size, shape, and composition? A recent study published in the Journal of Diabetes Researchsuggests this is within our capability.[vi]Ming-Kuo Ting and affiliates of Taiwan performed a prospective cohort study using 3D scanning technology discussed below.
Materials and Methods
Sample
The study began with recruiting patients from the Department of Health Promotion and Examination of Chang Gung Memorial Hospital in Taiwanover a ten-year span, 2000-2010, totaling 8450 participants. The study would follow-up with participants on average 8.87 years, though the period of the study was February 200 through December 2013.
Parameters
The scanner used was LT3DCam by Logistic Technology Company. The researchers did assess the machinery for accuracy, noting the measurement for error was 1.2% (1 mm) for x- and y-axis and only 0.2% (less than 0.1 mm) for z-axis.
Ting et al. (2018) studied 39 measurements in four categories: body height, body weight, body mass index (BMI), and anatomical regions. The latter was further subcategorized into four regions: (1) trunk, (2) head and neck, (3) hip to lower limbs, and (4) upper limbs. The first region measured the profile, circumference, and width of both the chest and waist in addition to trunk volume and surface area. It was noted these measurements were divided between chest and waist due to physiological and anatomic differences between the men and women participants. The second region measured the volume, surface area, and width of the head in addition to the neck circumference. The third region measured circumference, width, volume, surface area, and circumference of hip and the left and right leg. Also measured were hip profile area, length of left and right leg, and circumference of left and right thigh. The fourth region measured volume, surface area, length of the left and right arm and the circumference of the left and right, upper and forearm of the arms.
Data Collection
Researchers gave participants a questionnaire upon recruitment. Within, the following information was collected: date of birth, sex, education, marital status, occupation, history of cigarette smoking, history of alcohol drinking, and history of betel nut chewing* as well as personal history of disease (including diabetes, hypertension, heart disease, chronic kidney disease, liver cirrhosis, and chronic hepatitis) and family history of type 2 diabetes mellitus. *Note: According to the World Health Organization, betel nuts (quids) are the fourth most commonly used psychoactive substance[vii]despite its known effects as a carcinogen of oral mouth cancer.[viii]
The information was then cross-referenced with medical chart review, if applicable, fasting blood glucose level, and blood pressure with a mercury sphygmomanometer. The presence of type 2 diabetes mellitus was confirmed through national registration database and insurance claim data using ICD-9-CM code 250.00.
Results
Of 8,450 participants, 2,068 cases of type 2 diabetes mellitus were identified. A table of their findings related to demographics can be accessed here. A table related to the 3D body measurements can be accessed here.
When studying the data, they used multiple Cox proportional hazard model for regression analysis. The objective was to determine the strength of the correlation between type 2 diabetes mellitus and their selected body measurements. A table related to this segment can be accessed here.
Discussion
Neck circumference, weight width, and thigh circumference were determined to be acceptable alternative biomarkers for predicting presence of type 2 diabetes mellitus.
Neck circumference had a positive correlation with waist circumference and BMI at the respective rates of r = 0.61 and r = 0.59 with both at p < 0.0001. The researchers suggested neck circumference could be used in place of waist circumference. They chose waist width to accompany neck circumference due to its being a visceral fat capacity indicator.
For both men and women, neck circumference were associated with higher age, weight, BMI, waist circumference, and hip circumference. It further is noted to be an alternative predictor for overweight or obese individuals.
Conclusion
Independently, neck circumference, waist width, and thigh circumference were the most useful measurements in predicting type 2 diabetes mellitus over long-term study. Specifically, combining neck circumference and waist width with corrective adjustment made through thigh circumference could predict the individual’s risk of developing the disease.
Take-Away;
As a medical student, I was scheduled to experience a variety of patients at hospital and non-hospital settings. During my clinical rotations, I was lucky enough to interact with many diabetic patients. Individuals who are diagnosed with diabetes, face many health issues, which affect their everyday life. These patients face other health issues, which are included but not limited to infections, ulcers, and neuropathy. Such problems take away an individual’s quality of life severely. One of my experiences was with a diabetic patient who was suffering from a diabetic foot ulcer. His medical condition limited him to a miserable life style with limited mobility, strict diabetic diet, and exercise plan. Lack of patient’s participation was my main concern.
Diabetic treatment plans tend to be such broad treatments and need to be medically evaluated from a multi-dimensional approach. In order to provide the best modified diet for my patient, I did not limit myself to my own knowledge and sought help from a dietitian. I thankfully was able to educate my patient about the benefits he would receive by complying with his medication, having a healthy diet, and exercising regularly. Because of many experiences like this, I am more determined to become a physician whose mission is to improve patient’s quality of life.
This study is relevant as a potential means of indicating the development of type 2 diabetes mellitus as precautionary. Individuals may wish to seek programs such as the National Diabetes Prevention Program offered by the CDC to prevent its onset.
Who is most likely to be “at-risk”?
The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) has identified individuals who are more likely to develop type 2 diabetes than others.[ix]This disease can affect adults and children, though is most prevalent among those aged 45 and older. If you have a family history of diabetes or are currently overweight or obese, you are also more likely to develop the disease. Diabetes has been identified most commonly in African Americans, Hispanic/Latinos, American Indians, Asian Americas, and Pacific Islanders. Other medical ailments may also play a role, including presence of high blood pressure, had gestational diabetes when pregnant, have low level of HDL cholesterol (the good one!) or a high level of triglycerides, are physically inactive, depressed, have poly-cystic ovary syndrome, have acanthosis nigricans, or have a history of heart disease or stroke.[x]This is not an exhaustive list.
Is there a way I can assess myself before speaking with my doctor?
The American Diabetes Association Diabetes Risk Test is a free, fast, and easy tool one can use to gauge their risk level, considering nearly one in four Americans have diabetes unknowingly.[xi]This test can be accessed here, where a PDF version is also available. It is still advised you speak with your doctor regarding your concerns.
I don’t have diabetes, but my child was recently diagnosed. Can you refer me to more information?
Your doctor has likely shared some valuable resources with you. One site which has been found to be a beneficial supplement is KidsHealth by The Nemours Foundation’s Center for Children’s Health Media. It can be accessed here. The information provided is evaluated for accuracy and medical review by pediatricians and medical experts.[xii]It offers articles, animations, games, and additional content which can be used to discuss the next course of action.
Disclaimer
The opinions expressed in this article are the author’s own and is provided for additional information. The resources, information, and opinions shared are for educational and informational purposes only. They are not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a physician of other qualified health provider with any questions you may have regarding a medical condition. Do not disregard professional medical advice or delay in seeking it because of something read on this site. Use the information provided at solely your own risk.
[i]American Diabetes Association. (n.d.). Type 2. Retrieved from http://www.diabetes.org/diabetes-basics/type-2/
[ii]Harvard T.H.Chan School of Public Health. (n.d.). Simple Steps to Preventing Diabetes. Retrieved from https://www.hsph.harvard.edu/nutritionsource/disease-prevention/diabetes-prevention/preventing-diabetes-full-story/
[iii]CDC. (18 July 2017). New CDC report: more than 100 million Americans have diabetes or prediabetes. Retrieved from https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html
[iv]Wild et al. (2004). Global prevalence of diabetes: estimates for the year 2000 and projections for 2030: response to Rathman and Giani. Diabetes Care.doi: 10.2337/diacare.27.10.2569-a
[v]CDC. (12 June 2018). National Diabetes Prevention Program: research-based prevention program. Retrieved from https://www.cdc.gov/diabetes/prevention/prediabetes-type2/preventing.html
[vi]Ting et al. (8 July 2018). Predicting type 2 diabetes mellitus occurrence using three-dimensional anthropometric body surface scanning measurements: a prospective cohort study. Journal of Diabetes Research. doi: 10.1155/2018/6742384
[vii]Wu et al. (2015). Betel quid use and mortality in Bangladesh: a cohort study. Bulletin of the World Health Organization. doi: 10.2471/BLT.14.149484
[viii]Hernandez et al. (2017). Betel nut chewing, oral premalignant lesions, and the oral microbiome. PLoS One. doi: 10.1371/journal.pone.0172196
[ix]NIDDK. (2017). Type 2 diabetes. Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/type-2-diabetes
[x]NIDDK. (2016). Risk factors for Type 2 diabetes. Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/risk-factors-type-2-diabetes
[xi]NIDDK. (n.d.). Diabetes Risk Test. Retrieved from https://www.niddk.nih.gov/health-information/diabetes/overview/risk-factors-type-2-diabetes
[xii]KidsHealth. (n.d.) About KidsHealth. Retrieved from https://kidshealth.org/en/parents/about.html