Show main content

What increases the risk of type 2 diabetes?

Scientific support: Dr. Theresia Sarabhai

Type 2 diabetes does not come on from one day to the next; it develops slowly over time. People with type 2 diabetes often do not notice any signs of it at first.

Scientists are working hard to discover precisely which factors lead to type 2 diabetes and how and why.

These factors may be part of why someone develops type 2 diabetes:


A range of factors makes it more likely for someone to develop type 2 diabetes:

  • High incidence of type 2 diabetes in the family
  • Old age
  • Overweight, high blood pressure and high blood lipid levels (such as cholesterol)
  • Unhealthy lifestyle:
    • Smoking
    • Lack of physical exercise
    • A low-fiber and/or high-fat diet
  • Diabetes in pregnancy
  • Drugs that affect glucose metabolism (such as cortisone as tablets)
  • Other hormonal diseases (such as polycystic ovary syndrome)

What is prediabetes?

Long before a person develops type 2 diabetes, they have a precursor called prediabetes.  A patient who has prediabetes will already have elevated blood glucose levels. The values are not quite high enough to qualify as diabetes.

Because the blood glucose levels are already higher than in people who have a healthy metabolism, people with prediabetes are at a higher risk of developing type 2 diabetes. You can lower the risk again with lifestyle changes such as more exercise and weight loss.

Good to know:

The precursor to type 2 diabetes is called prediabetes.

What is insulin resistance?

Before people get prediabetes or type 2 diabetes, they develop insulin resistance. Insulin resistance causes the cells, especially the cells in the muscles, liver, and fatty tissue, to no longer sufficiently react to the hormone insulin. When food is digested and blood glucose rises, insulin normally opens the doors to the cells. The glucose is then transported into the cells where it delivers important energy; for instance, it acts as “fuel” to the muscle cells for movement. With insulin resistance, the insulin can no longer effectively transport glucose from the blood into the cells.


It often takes several years to decades to go from insulin resistance to developing a high glucose level. During this time, those affected often do not notice any change to their metabolism.

What are the risks of insulin resistance?

Insulin resistance increases the risk not only of type 2 diabetes but also of high blood pressure, cardiovascular diseases, lipid metabolism disorders and overweight. If someone has all of these, experts refer to this as “metabolic syndrome”.


American Diabetes Association: Standards of medical care in diabetes – 2019. In: Diabetes Care, 2019, 42: S1-S193
Bundesärztekammer et al.: Patientenleitlinie zur Nationalen Versorgungsleitlinie Therapie des Typ-2-Diabetes. 1. Auflage. Version 1. 2015
Bundesärztekammer et al.: Nationale Versorgungsleitlinie Therapie des Typ-2-Diabetes. Langfassung. 1. Auflage. Version 4. 2014 (Gültigkeit abgelaufen, in Überarbeitung)
Hanefeld, M. et al.: Metabolisches Syndrom und Insulinresistenz. In: Der Gastroenterologe, 2017, 12: 300-304
International Diabetes Federation: The IDF consensus worldwide definition of the metabolic syndrome. 2006 (Letzter Abruf: 14.11.2019)
Landgraf, R. et al.: Therapie des Typ-2-Diabetes. In: Diabetologie, 2018, 13: S144-S165
McCracken, E. et al.: Pathophysiology of the metabolic syndrome. In: Clin Dermatol, 2018, 36: 14-20
As of: 14.11.2019