FAMILY HEALTH HISTORY

Diabetes Mellitus

Overview

INTRODUCTION

Diabetes mellitus is a chronic disorder characterized by hyperglycemia because of insulin resistance, or inadequate insulin secretion. Diabetes mellitus is mainly classified as type 1 diabetes, type 2 diabetes, and gestational diabetes.1

Type 1 diabetes is caused by the loss of insulin-producing beta cells in the islets of Langerhans of the pancreas, resulting in insulin deficiency.2 Type 2 diabetes, on the other hand, is characterized by impaired insulin action or insufficient production of insulin by beta cells.2 Failure to produce insulin in Type 1 diabetes is immune-mediated where there is T cell-mediated loss of pancreatic beta cells.2 Whereas, the pathogenesis of type 2 diabetes involves a more complex interplay between genetic and environmental factors.2

Worldwide the prevalence of diabetes is increasing. Currently, a staggering 537 million adults aged between 20 to 79 years live with diabetes.3 By 2030, this number is expected to rise to 643 million, and by 2045, it will reach 783 million.3 Globally, the adult diabetes burden is 206 million in the Western Pacific, 90 million in Southeast Asia, 73 million in the Middle East and North Africa, 61 million in Europe, 51 million in North America and the Caribbean,  32 million in South and Central America and 24 million in Africa.3 Type 2 diabetes accounts for 90% of all diabetes cases.3

Diabetes is deemed a modern preventable pandemic.4 Globally, it is one of the top 10 causes of mortality worldwide.5 Diabetes incurs significant economic burden to the individual, family, healthcare system, and the country as a whole. The diabetes-related cost is estimated to increase globally by 2030.6  It may be possible to reduce the likelihood of developing the disease in the future by early identification of those at risk. Family health history(FHH) is a well-established non-modifiable risk factor for the development of diabetes in the family.7 Thence, health care providers and individuals can use knowledge of FHH of diabetes to determine genetic risk early and implement health promotion and disease prevention strategies. Moreover, FHH can be further integrated into health surveillance and tracking to strengthen the overall health system in improving health outcomes.

FHH in Diabetes

A family’s health history is an important component of assessing future risk of acquiring common chronic diseases.8 The presence of diabetes in the family is an important risk factor for the development of diabetes.7 FHH  is a strong predictor, independent and easily measurable risk factor for type 2 diabetes.9 Those with a family history of diabetes among first degree relatives are more likely to suffer from the condition than those without a family history of diabetes.10  FHH of diabetes has stronger effect on men than women.11  The chances of someone developing diabetes early are higher if they have FHH.12 In addition to type 2 diabetes, FHH is a major risk factor for gestational diabetes as well.

FHH information is critical for an individual, healthcare providers and overall health system. For healthcare providers, the knowledge of family health history of diabetes helps in risk assessment of developing type 2 diabetes for an individual and family. FHH is not just positively associated with type 2 diabetes as a risk factor but also with increased risk awareness and risk-reducing behaviors among type 2 diabetes.13 FHH of diabetes has proven to be a simple yet powerful tool in promoting healthy behaviors among those at risk.14   

 If an individual is aware about the risk related to FHH of diabetes, they can self-recognize and adopt healthier lifestyle changes as preventative measures for the development of type 2 diabetes. In a study, FHH-based preventative approaches have positively influenced those identified as at risk in making better lifestyle choices.15 It has also been shown that with knowledge of FHH it is possible to detect glycemic dysregulation among children so that prevention strategies could be implemented early.16

Evidence

COUNTRY SPECIFIC DATA ON PREVELANCE OF FHH

  1. Family history of diabetes and the risk of gestational diabetes mellitus in Iran: A systematic review and meta-analysis (IRAN)
    • The overall odds ratio of family history for developing GDM was estimated as 3.46 (95% CI: 2.80–4.27).
    • This meta-analysis study revealed that the family history of diabetes is an important risk factor for the gestational diabetes mellitus
  2. Family history of diabetes, lifestyle factors, and the 7‐year incident risk of type 2 diabetes mellitus in middle‐aged Japanese men and women. (JAPAN).1
    • Family history of diabetes was associated with the incident risk of diabetes,
    • The age and sex‐adjusted HR for type 2 diabetes in participants with a family history of diabetes was 1.82 (95% confidence interval 1.36–2.43) as compared with those without a family history of diabetes.
  3. Undiagnosed diabetes mellitus and associated factors among adults in Ethiopia: a systematic review and meta-analysis (ETHIOPIA).2
    • The pooled odds of developing diabetes mellitus among participants with a family history of diabetes mellitus were about 3.56 times higher than those without a family history of diabetes mellitus (OR = 3.56, 95% CI (2.23, 5.68)).
  4. Comprehensive risk profiles of family history and lifestyle and metabolic risk factors in relation to diabetes: A prospective cohort study. (CHINA)
    • FH was associated with 2.33-fold increased risk of diabetes, followed by high metabolic risk (1.90-fold) and high lifestyle risk (1.34-fold)
  5. Familial history of diabetes and clinical characteristics in Greek subjects with type 2 diabetes. (GREECE)
    • Excess maternal transmission of T2D in a sample of Greek diabetic patients
    • The presence of a family history of diabetes resulted to an early onset of the disease to the offspring.

Tools and Resources

AVAILABLE DIABETES RISK SCORING TOOLS THAT INCLUDE FHH OF DIABETES

Family health history remains a gold standard for predicting chronic disease risk. FHH is component of several available risk assessment tools targeted for diabetes. Here are some of the validated tools available:

  1. My Family Health Portrait http://kahuna.clayton.edu/jqu/FHH/html/index.html
  2. The Australian type 2 diabetes risk assessment tool (AUSDRISK). https://www.health.gov.au/resources/apps-and-tools/the-australian-type-2-diabetes-risk-assessment-tool-ausdrisk/tool
  3. Diabetes UK, Know diabetes Fight Diabetes, https://riskscore.diabetes.org.uk/start
  4. 60 second type 2 diabetes risk test, https://diabetes.org/risk-test
  5. Test to prevent, https://www.idf.org/type-2-diabetes-risk-assessment/
  6. The Diabetes Risk Assessment (DRA)/ https://pss.hpb.gov.sg/DRA/GetQuestions
  7. Prediabetes Risk Test/ National Diabetes Prevention program/ https://www.cdc.gov/prediabetes/pdf/Prediabetes-Risk-Test-Final.pdf
  8. Indian Diabetes Risk Score (IDRS), India
  9. RAPID score, Pakistan
  10. FINDRISC tool
  11. Qdiabetes
  12. Leicester Risk Assessment (LRA)
  13. Cambridge Risk Score (CRS)
  14. Canadian Diabetes Risk Assessment Questionnaire (CANRISK)
  15. Take the risk test(ADA)
  16. MultiCare Health System, Center for Healthy Living/Cardiac and Diabetes Services, Type 2 Diabetes Risk Assessment Tool

References

  1. Care, M. Standards of Medical Care in diabetes — 2020. 43, (2020).
  2. Zaccardi, F., Webb, D. R., Yates, T. & Davies, M. J. Pathophysiology of type 1 and type 2 diabetes mellitus: A 90-year perspective. Postgrad. Med. J. 92, 63–69 (2016).
  3. IDF Diabetes Atlas. (International Diabetes Federation, 2021).
  4. Singer, M. E., Dorrance, K. A., Oxenreiter, M. M., Yan, K. R. & Close, K. L. The type 2 diabetes ‘modern preventable pandemic’ and replicable lessons from the COVID-19 crisis. Prev. Med. Reports 25, 101636 (2022).
  5. Lin, X. et al. Global, regional, and national burden and trend of diabetes in 195 countries and territories: an analysis from 1990 to 2025. Sci. Rep. 10, 14790 (2020).
  6. Bommer, C. et al. Global Economic Burden of Diabetes in Adults: Projections From 2015 to 2030. Diabetes Care 41, 963–970 (2018).
  7. Kyrou, I. et al. Sociodemographic and lifestyle-related risk factors for identifying vulnerable groups for type 2 diabetes: A narrative review with emphasis on data from Europe. BMC Endocr. Disord. 20, 1–13 (2020).
  8. Ginsburg, G. S., Wu, R. R. & Orlando, L. A. Family health history: underused for actionable risk assessment. Lancet 394, 596–603 (2019).
  9. Scott, R. A. et al. The link between family history and risk of type 2 diabetes is not explained by anthropometric, lifestyle or genetic risk factors: The EPIC-InterAct study. Diabetologia 56, 60–69 (2013).
  10. Annis, A. M., Caulder, M. S., Cook, M. L. & Duquette, D. Family history, diabetes, and other demographic and risk factors among participants of the national health and nutrition examination survey 1999-2002. Prev. Chronic Dis. 2, 1–12 (2005).
  11. Hilding, A. et al. The impact of family history of diabetes and lifestyle factors on abnormal glucose regulation in middle-aged Swedish men and women. Diabetologia 49, 2589–2598 (2006).
  12. Alharithy, M. K., Alobaylan, M. M., Alsugair, Z. O. & Alswat, K. A. Impact of family history of diabetes on diabetes control and complications. Endocr. Pract. 24, 773–779 (2018).
  13. Hariri, S. et al. Family history of type 2 diabetes: A population-based screening tool for prevention? Genet. Med. 8, 102–108 (2006).
  14. Choi, J. et al. Association between family history of diabetes and clusters of adherence to healthy behaviors: Cross-sectional results from the health examinees-gem (hexa-g) study. BMJ Open 9, 1–13 (2019).
  15. Ard, D., Tettey, N.-S. & Feresu, S. The Influence of Family History of Type 2 Diabetes Mellitus on Positive Health Behavior Changes among African Americans. Int. J. Chronic Dis. 2020, 1–8 (2020).
  16. Denton, J. J. & Fernandez, J. R. The role of family history of diabetes as a predictor of insulin activity in a sample of diverse, normal weight children. Endocr. Metab. Sci. 3, 100090 (2021).

The information on this page was compiled by:

Pratiksha Gyawali, MBBS, MD
Faculty Department of Clinical Biochemistry, Kathmandu University School of Medical Sciences

Dhulikhel Hospital, Kavrepalanchok, Nepal