It is well known that the increased rate of diabetes 2 was mainly due to obesity and lifestyle. But that’s not the whole story. Genetic and epigenetic – changes in gene expression – also play an important role
‘re starting to see an increase in type 2 diabetes in lean people at a much younger age than usually associated with. the illness. This means that in addition to focusing on good diet and exercise, we need a better understanding of the groups most at risk of type 2 diabetes
These include many ethnic groups, women with a history of gestational diabetes and people with a family history of diabetes. In my clinical practice, I have seen teenagers and even children as young as seven, as well as younger patients of Oriental origin of Asia, Africa and East with type 2 diabetes
in the indigenous population in the center of Australia, rates of diabetes are among the worst in the world, about three times that of non-indigenous. Studies in some remote communities indicate a prevalence of type 2 diabetes up to 30%, compared with a rate of about 5% in the non-indigenous population type.
All this indicates that lifestyle decisions alone can not be responsible. We must stop the guilt and shame for a condition that has an association with the lifestyle, but for many it is a consequence of the toxic mix of genetics and modern life.
Rather than change lifestyle
Type 2 diabetes accounts for over 90% of all diabetes cases and affects people, mainly middle-aged and elderly who are overweight or they are obese.
Type 2 diabetes is thought to occur from a combination of factors: when the pancreas can not produce enough insulin; and when the insulin is unable to do their job, to regulate blood sugar.
Why these two factors occur is not completely understood. Physiology may vary among different populations, but generally refers to excessive fat storage, reduced muscle activity with poor absorption of glucose and genetic predisposition.
In contrast, type 1 diabetes is not related to factors of lifestyle, has onset in children or young adults, and refers to a complete destruction of insulin-producing cells (beta) in the pancreas.
The cause is unknown but may be related to genetic predisposition and an environmental trigger, such as a virus or a toxin.
Both types of diabetes can cause a number of serious complications, including limb loss, if not treated aggressively.
Genetic and epigenetic
Why are young people and type 2 diabetes getting thin? One theory is epigenetic.
epigenetic describes the biological process in which environmental factors can affect gene expression (where the gene codes for a particular biological function) instead of altering the genes themselves.
This process can occur as early as in the womb – before the child is born. – With consequences that affect gene expression during much of his life
Conditions such as obesity and gestational diabetes, where women without preexisting diabetes that develop during pregnancy, have the potential to alter gene expression in a developing fetus.
This can lead to a predisposition to a number of chronic diseases such as diabetes. Some ethnic groups have a much higher risk of gestational diabetes; Indigenous women have rates almost twice that of non-indigenous women.
The exact mechanisms that create such predispositions are not known and are the subject of intense investigation.
Many studies have demonstrated the aggressive early treatment for any signs of damage diabetes can better prevent complications such as heart disease, kidney failure or blindness.
Aggressive treatment means they should aim for levels of blood sugar to be as close to normal – between 4 and 5.5 mmol per liter and non-fasting glucose 4 to 7.8 mmol per liter – as possible. This often requires medication in addition to lifestyle changes intensive life.
Not only more expensive to treat complications once they are symptomatic, but the results are so poor. Comparison of some of the key studies of diabetes in the last 20 years, we have found a strategy targeting levels of blood glucose near normal resulted in fewer kidney, eye and heart complications compared with those who had a more relaxed target.
The main factor limiting perfect control of blood glucose is hypoglycemia. It is characterized by low levels of glucose in the blood, it can cause discomfort, confusion or even coma in extreme cases.
For this reason, we need new drugs that can better control blood sugar without the risk of hypoglycemia. Until we have these, the risk makes it acceptable to have a less-than-perfect control in some cases.
The modern drug treatment has generally improved, however, and do not have access to a range of therapeutic products that can be used effectively early in the disease. Lifestyle measures are an important part of treatment, but the benefit may diminish as type 2 diabetes progresses or worsens over time.
The elimination of stigma
Governments must recognize the importance of access to effective new therapies for diabetes and adequately fund clinical services to properly manage this complex chronic disease -. Especially in highly endemic areas, such as remote indigenous communities
Rates of premature death in people with type 2 diabetes are about three times higher than in the general population, largely due to heart disease and accident cerebrovascular. adjusted life years lost are greater for people with type 2 diabetes than in breast, lung or colon cancer.
There is a significant stigma and shame associated with the diagnosis of type 2 diabetes, especially in younger patients. This adds an unfortunate barrier to successful treatment. Until this improvement, we will continue to under-treat our patients and misinform our health care providers.
Author: Neale Cohen, General Manager of Diabetes Services, BakerIDI Heart and Diabetes Institute, Baker IDI Heart and Diabetes Institute