The Missing Decade in Metabolic Health: Early Signs Of Insulin Resistance, Pre-Diabetes and Heart Disease

Are We Catching Things Too Late?

We tend to treat metabolic as if it begins on the day that bloods become abnormal. It could be a raised HbA1C, a higher cholesterol or a ALT in the 50s. But are we catching things too late and are things quietly happening in the background without us noticing?

For a long time, metabolic health has been thought of as normal or abnormal. But your biology rarely changes overnight, especially when we are talking about chronic disease. Years before routine blood markers move outside the normal range the body is already fighting against small imbalances. Muscles, liver and pancreas are all working hard like a swan frantically kicking under the surface of a serene lake. These early metabolic shifts can be the first signs of insulin resistance, pre-diabetes or early heart disease.

The Silent Decade

Between these normal and abnormal blood tests lies a silent decade. Here, insulin resistance is gradually developing, visceral fat accumulating and chronic inflammation persisting day in day out.

This can take years. The body starts to ignore insulin more and more, the liver starts to store fat and low-grade inflammation becomes more rife. On the surface of things patients may just perceive this as getting older; feeling more tired, worsening sleep or ‘dad bod’ weight gain around the middle. These changes often mark the start of metabolic dysfunction that can lead to type 2 diabetes or cardiovascular disease later in life.

Why We Miss It

Patients may feel fine. Routine tests come back clear. Yet a patient’s future health trajectory is playing out without anyone noticing.

In my clinic, it is common to meet people experiencing tiredness, brain fog and gut problems with healthy looking blood tests. This can be a sign that metabolic flexibility is becoming stretched but has not yet broken. This is the time where lifestyle changes make the biggest difference but this opportunity can be easily overlooked because everything still looks normal.

Evidence from Long-Term Studies

There are some longitudinal studies that support this idea:

• The Whitehall II cohort shows that fasting insulin predicts diabetes development up to 13 years before diagnosis (Tabák et al., The Lancet, 2009).

• Ferrannini et al. show insulin resistance rises far before glycaemic markers change (Ferrannini et al., Diabetologia, 2010).

• Libby reports how atherosclerosis begins many years before a cardiovascular event (Libby, New England Journal of Medicine, 2021).

These highlight the fact that your body can give us many years of early warning signs. If the medical community only acts when routine bloods like HbA1C or cholesterol are raised, this is a missed opportunity. Identifying these patterns early can reduce the risk of diabetes, fatty liver and heart disease.

A Failure of Timing

This ‘missing decade’ is a failure of timing. Medicine waits for the disease rather than early signs of dysfunction. By this time simpler reversibility is more difficult and usually effects on health span have already begun to occur.

Once the disease process is obvious with standard testing, the process is already very much underway. You may have seen a reduction in muscle mass, a fatty liver and inflammatory processes that are difficult to reverse. Early intervention can help prevent cardiovascular disease and protect long-term metabolic health.

The Tools Already Exist

But the tools are already here. Fasting insulin and HOMA-IR, ApoB and TG:HDL ratio. Even simple measurements like waist-to-height. And a review of sleep and movement metrics that are measured to reasonable accuracy by everyday health wearables.

This does not require new technology. These tests are inexpensive and can run in tandem with your more standard health checks. Data from a smart watch or exercise tracker gives useful insights into things that matter to your metabolic health like recovery, sleep and stress.

Why They’re Not Used

So why are they not readily used?

This is due to a lack of system. Healthcare is structured to treat illness rather than maintaining health. Preventative testing takes time that sometimes is not available in NHS primary care. These markers fall outside funding frameworks and are therefore unused.

A Slow Moving System

Medicine can be a slow-moving ship that reacts to disease rather than anticipating it. These markers aren’t standard and don’t fit into a stretched system. Medical training remains focused on disease rather than prevention. They are too early for guidelines and too nuanced for routine care.

But change is coming. Private and public funded research into longevity and metabolic health means that prevention is becoming measurable. It is common for people to track steps, exercise, sleep and recovery. This data will feed back into the system so that we aren’t just relying on symptoms.

From Early Detection To Early Action

Early detection is considered the future of cancer care. This mindset should also apply to metabolic health. Futuristic machines and biohacking drugs are not today’s solution. The greatest opportunities to improve health and life span lie in the crossover between lifestyle and longevity medicine. Movement, diet, sleep, recovery, purpose and connection supported by early testing and data we have known for years. Detect early, act simply, and health span follows.

Take-Home Message

The “missing decade” is an opportunity. By shifting from reaction to anticipation, medicine can help people protect their energy, function and independence for decades to come.

At New Jackson Healthcare in Manchester, we use advanced metabolic and cardiovascular blood testing to identify early insulin resistance and heart disease risk. Our doctor-led approach focuses on prevention, performance and long-term health.