Not just sugar: tests that can detect metabolic disease years before diagnosis

Many of us leave blood tests feeling calm: the sugar level is normal, the cholesterol is not critical, and the doctor says everything looks fine. However, in recent years, a significant change has been taking place in the world of metabolic medicine. More and more experts believe that focusing only on the sugar value may miss the stage where the disease can still be prevented.

A comprehensive review recently published in the magazine FRONTIERS explains that metabolic diseases do not start on the day diabetes or high blood pressure is diagnosed. They develop gradually over years, and the body sends a series of early warning signals — long before the tests deviate significantly from the normal range.

Metabolic syndrome is actually a collection of risk factors working together: abdominal obesity, insulin resistance, high blood pressure, high triglycerides, low HDL (the good cholesterol), low-grade chronic inflammation, and oxidative stress. When several of these factors appear together, the risk of type 2 diabetes, fatty liver, heart disease, and stroke increases significantly. The good news is that the body signals these changes to us long before the onset of the disease — if only one knows how to look at the full picture.

Which tests should you know?

• Waist circumference: not only weight is important, but also the location of fat in the body. Abdominal fat is considered metabolically active and produces inflammatory substances that may increase the risk of insulin resistance and heart disease. Therefore, waist circumference has become one of the most important indicators for assessing metabolic risk.

• Triglycerides and HDL: these two values tell much more than many think. High triglycerides together with low HDL are a characteristic sign of metabolic disorder and often appear years before a diabetes diagnosis.

• Blood pressure: a slight and persistent increase in blood pressure is not just a heart problem. It may be part of the entire metabolic process, especially when it appears with excess abdominal weight and lipid disorders.

• Glucose and HbA1c: these are still important tests, but they do not tell the whole story. Sometimes sugar values are still normal, while insulin resistance already exists — a condition where the body is required to secrete more insulin to maintain a normal sugar level.

• Fasting insulin: although not performed in every screening test, a fasting insulin test can, in appropriate cases and at the doctor's assessment, help identify insulin resistance even before blood sugar rises.

• Liver function: slightly elevated liver enzyme values do not always indicate primary liver disease. Sometimes they can be the first sign of metabolic dysfunction-associated steatotic liver disease (MASLD), which is now considered one of the most common manifestations of metabolic disorder.

The new approach: do not look at one number

The most significant change in metabolic medicine is the shift from thinking of "one test — one answer" to a broad look at the totality of indicators. A doctor may see normal sugar, but if at the same time there is an increased waist circumference, high triglycerides, low HDL, blood pressure with an upward trend, and a family history of diabetes — the metabolic picture already looks completely different.

The integrative approach does not replace conventional medicine, it expands it. Alongside laboratory tests, it also examines factors that significantly affect metabolic health: sleep quality, stress levels, dietary habits, physical activity, muscle mass, lifestyle, and emotional state.

Studies from recent years indicate that chronic stress, lack of sleep, and lack of physical activity can worsen insulin resistance, increase chronic inflammation, and accelerate the development of metabolic diseases. Conversely, a Mediterranean diet, regular physical activity, quality sleep, and stress reduction techniques can improve metabolic health and reduce cardiometabolic risk.

A broad look at indicators, lifestyle, and personal factors may allow for early intervention, reduce the risk of diabetes, fatty liver, and heart disease, and above all, maintain health even before the disease develops.

Dr. Galina Shenkerman is a specialist in endocrinology and internal medicine and medical director at MEDBALANCE, a center for the treatment of metabolic diseases.