The Natural History Of Type 2 Diabetes: Practical Points To Consider In Developing Prevention And Treatment Strategies

The Natural History of Type 2 Diabetes: Practical Points to Consider in Developing Prevention and Treatment Strategies

CLINICAL DIABETES
VOL. 18 NO. 2 Spring 2000
PRACTICAL POINTERS
Type 2 diabetes, previously referred to as adult-onset or non-insulin-dependent diabetes, progresses from an early asymptomatic stage with insulin resistance to mild postprandial hyperglycemia to frank diabetes requiring pharmacological intervention. Understanding this natural history of type 2 diabetes will guide primary care providers in formulating effective treatment regimens that reflect the pathological differences between these stages of the disease. The optimal medication regimen, when used in conjunction with dietary changes and exercise, will require modifications for each patient as the disease progresses.
The term impaired glucose tolerance (IGT) or pre-diabetes was first coined in 1979 by the World Health Organization and the National Diabetes Data Group to replace the terms borderline, chemical, and asymptomatic diabetes mellitus. In 1997, an expert committee of the American Diabetes Association recommended the following criteria for IGT: a normal fasting plasma glucose (<126 mg/dl) with a postprandial plasma glucose of >140 mg/dl but <200 mg/dl 2 h after a 75-g oral glucose challenge.1
This stage of mild postprandial hyperglycemia is an extremely useful marker of patients at risk for the eventual development of type 2 diabetes. Patients with IGT may benefit from timely patient education and perhaps even more aggressive forms of intervention, such as diet, exercise, or medication. An estimated 15.7 million Americans have type 2 diabetes, representing 5.9% of the population. Only two-thirds of those Continue reading

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Diabetes and heart disease linked by genes, reveals Penn-led study

PHILADELPHIA -- Type 2 diabetes (T2D) has become a global epidemic affecting more than 380 million people worldwide; yet there are knowledge gaps in understanding the etiology of type-2 diabetes. T2D is also a significant risk factor for coronary heart disease (CHD), but the biological pathways that explain the connection have remained somewhat murky. Now, in a large analysis of genetic data, published on August 28, 2017 in Nature Genetics, a team, led by researchers in the Perelman School of Medicine at the University of Pennsylvania, has first looked into what causes T2D and second clarified how T2D and CHD - the two diseases that are the leading cause of global morbidity and mortality, are linked.
Examining genetic sequence information for more than 250,000 people, the researchers first uncovered 16 new diabetes genetic risk factors, and one new CHD genetic risk factor; hence providing novel insights about the mechanisms of the two diseases. They then showed that most of the sites on the genetic known to be associated with higher diabetes risk are also associated with higher CHD risk. For eight of these sites, the researchers were able to identify a specific gene variant that influences risk for both diseases. The shared genetic risk factors affect new biological pathways as well as targets of existing drugs, including icosapent ethyl and adipocyte fatty acid binding protein.
The findings add to the basic scientific understanding of both these major diseases and point to potential targets for future drugs.
"Identifying these gene variants linked to both type 2 diabetes a Continue reading

Does 'Brown Fat' Explain a Link Between Temperature and Diabetes?

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Are rising temperatures around the world also increasing the rates of diabetes? A new study from the Netherlands suggests that there may be a link between warming global temperatures and a higher prevalence of the disease, but not all experts are convinced.
When the researchers analyzed average global temperatures and the rates of type 2 diabetes, they found that a 1.8-degree Fahrenheit (1 degree Celsius) increase in temperature was associated with an increase of 0.3 cases of diabetes per 1,000 people. In the United States, that would be the equivalent of more than 100,000 new cases of type 2 diabetes each year, according to the study, published Monday (March 20) in the journal BMJ Open Diabetes Research & Care.
The new research may be interesting, but it shows only an association between rising temperatures and diabetes rates, said Dr. Christian Koch, a professor of endocrinology at the University of Mississippi Medical Center who was not involved in the new study. Although both temperatures and diabetes rates are rising, "there's no causality" between the two, Koch added. [5 Ways Climate Change Will Affect Your Health]
Importantly, the study did not include two key factors when looking at this association: physical-activity levels and indoor climate control — namely, air conditioning, Koch told Live Science.
A possible link?
The study looked at the rates of type 2 diabetes in all 50 states, along with Guam, Puerto Rico and the U.S. Virgin Islands from 1996 to 2013. In addition, the researchers looked at data on the average temperatures in each state and territory f Continue reading

Why high blood sugar is not the main problem in diabetes

For as long as I have practiced medicine, the mantra of excellent diabetic care was tight blood glucose control. All the diabetes associations, the university professors, the endocrinologists, and diabetic educators agreed. The prime directive was “Get those blood sugars down into the normal range at all costs, soldier!” The only acceptable response was, “Sir! Yes, Sir!” Insubordination was not tolerated.
At first glance, lowering blood glucose as the primary therapeutic target seemed fairly logical. The underlying premise assumes that high blood glucose is the major cause of morbidity. But remember that high blood glucose is only the symptom. In type 1 diabetes, insulin levels are very low and in type 2 diabetes insulin levels are very high. The symptom is the same, but the diseases are essentially opposites. So how could the exact same treatment be beneficial in both cases?
It’s hard to imagine that the same solution exists for opposite problems. For example, we don’t use the same treatment for both underactive and overactive thyroids. We don’t use the same treatment for both over-eating and under-eating. We don’t use the same treatment for both fever and hypothermia. We don’t wash clothes by soaking in water and then dry clothes by soaking in water.
Type 1 diabetes is caused by lack of insulin, so logically, the cornerstone of management is the replacement of the missing insulin. Type 2 diabetes, however is caused by excessive insulin, so logically the cornerstone of management should be the reduction of the high insulin. Further, being predominantly a Continue reading

Tips for Dealing with Anxiety and Diabetes

While diabetes is typically a manageable disease, it can create added stress. People with diabetes may have concerns related to regularly counting carbohydrates, measuring insulin levels, and thinking about long-term health. However, for some people with diabetes, those concerns become more intense and result in anxiety.
Read on to find out more about the connection between diabetes and anxiety and what you can do to prevent and treat your symptoms.
Research has consistently uncovered a strong connection between diabetes and anxiety. One study found that Americans with diabetes are 20 percent more likely to be diagnosed with anxiety than those without diabetes. This was found to be particularly true in young adults and Hispanic Americans.
The link between anxiety and glucose levels
Stress can affect your blood sugars, though research tends to be mixed as to how. In some people, it appears to raise blood glucose levels, while in others it appears to lower them.
At least one study has shown there may also be an association between glycemic control and mental health conditions such as anxiety and depression, particularly for men.
However, another study found that general anxiety didn’t affect glycemic control, but diabetes-specific emotional stress did.
Other research has found that people with type 1 diabetes seem to be “more susceptible to physical harm from stress” while those with type 2 diabetes weren’t. One’s personality also seems to determine the effect to some extent as well.
People with diabetes may become anxious over a variety of things. These can include Continue reading