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Natural History of Type 2 Diabetes September 7, 2015

Millions of people are diagnosed with having diabetes. Type 1 diabetes mellitus is when the body is unable to produce insulin and type 2 diabetes mellitus is when the body is resistant to insulin and hyperglycemia.

Type 1 diabetes is known to happen at a young age for children but for older adults, type 2 diabetes is common and is known as adult-onset or non-insulin dependent diabetes.

The natural history of type-2 diabetes came into play back in 1979 when the World Health Organization and the National Diabetes Data Group coined the term “impaired glucose tolerance” (IGT) and pre-dabetes to replace terminology such as borderline, chemical and asymptomatic diabetes mellitus.

Patients with IGT can benefit from being educated by their physician because it can be eliminated through diet, exercise and medication.

Over 15.7 million Americans are said to have type-2 diabetes and for those who are diagnosed can receive treatment. But the ratio for those who are treated and those who are potential type-2 diabetes is quite staggering.

Type 2 Diabetes Mellitus is a Disorder

Type 2 Diabetes is a hetereogenous disorder that incorporates three basic metabolic defects which include a resistance to insulin, a defect of the body’s inability to secrete insulin and an increase in glucose production in the liver.

What causes this is yet unknown but research into the natural history of type-2 diabetes have shown that it is common among ethnic minority groups such as Latinos, African Americans, Asians and American Indians. Also, it is known that obesity, aging and an inactive lifestyle can lead to insulin resistance.

Prevention of Type 2 Diabetes Melitus through Weight Loss and Dieting

To help delay the progress of diabetes, the natural history of type-2 diabetes includes a preceding period of impaired Glucose Tolerance (IGT) and combined with impaired fasting glucose (IFG) which can both provide a targeted intervention within larger communities.

In a six year study (Malmo Feasibility Study) done on type-2 diabetics, asymptomatic type 2 diabetic patients and subjects with IGT were given instructions for a diet and physical training. With those who achieved weight loss, the treated group had glucose tolerance which was normalized in more than 50% of those with IGT and 50% of the early diabetic patients were in remission at the end of a study period.

Studies have shown that people who practiced a healthy diet and focus on weight loss and improved fitness was beneficial to glucose tolerance and was overall beneficial in their road to treatment and normalizing glucose tolerance.

Prevention of Type 2 Diabetes Mellitus through Pharmacological Agents

For those who are unable to focus on a healthy diet and have an improved healthy fitness plan can also receive treatment by their physician with pharmacological agents.

There are several oral antidiabetic agents that are available as treatment. Sulfonylureas can reverse insulin resistance by improving a hyperglycemia component of insulin resistance in the body. Although, this would not have any significance in those who have IGT. A caveat of sulfonylureas is that individuals have the risk of having hypoglycemia and even possible weight gain.

Of the various insulin sensitizers that have shown any benefits towards those with IGT is the use of Thiazolidinediones or troglitazone therapy which in a study, 80% of those who underwent 12 weeks of the therapy reverted to normal glucose tolerance.

Knowing the natural history of type-2 diabetes, It is very important to talk to a physician if you exhibit symptoms but also to go over various prevention methods available to you.

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