New Study Reveals Complexity of Diabetes

Ongoing research of diabetes reveals a disease much more complex, and prevalent, than anyone ever imagined.

By Jordan Lite

If you thought diabetes was old news, think again.

Japanese researchers studying patients who suddenly developed a severe form of diabetes say a process different from the one that causes other type 1 cases may be responsible.

Scientists at Osaka University evaluated 56 diabetic patients and found that 11 of them lacked the antibodies that are the typical markers for type 1 diabetes.

"The precise mechanism of beta-cell destruction in patients with this subtype of diabetes is not known ... A viral cause is suggested," the researchers write in the study published Feb. 3 in the New England Journal of Medicine. They add that none of the patients showed any signs of a virus.

Doctors can list any number of factors that may put a person at risk of developing diabetes. But even when someone actually does develop the disease, the trigger is never known for sure. Like the scientists who conducted the study, other doctors have seen patients come down with diabetes seemingly out of nowhere. In fact, at least 10 percent of people don't have the key antibody markers when they first learn of their type 1 diabetes, the study notes.

"What helps me in this paper is the appreciation that diabetes is very complex," said Lori Laffel, M.D., chief of pediatrics at the Joslin Diabetes Center in Boston.

The disease is only growing more complicated — and more common.

Between 1980 and 1994, the number of people in the United States with diabetes increased by 39 percent, according to the Centers for Disease Control. African-Americans are disproportionately affected.

In fact, there are more than 30 conditions that may cause diabetes or diabetic-like symptoms, according to the Juvenile Diabetes Foundation.

Between 90 percent and 95 percent of all people with diabetes in the United States have type 2, according to the Centers for Disease Control. Of special concern to many health care workers is the rising number of children with the disease. Until recently type 2 was believed to develop in adulthood as people built up a resistance to insulin or simply lacked enough of it.

And, although health officials don't yet have statistics on the extent of the problem, a recent study by the University of Cincinnati College of Medicine found that between 8 percent and 46 percent of all new pediatric cases are type 2. They blame a lack of exercise and bad eating habits, and warn that children who develop diabetes so young risk heart, kidney, vision and circulation problems decades before they would otherwise.

"The outcome of the disease of diabetes in general is linked to the length of diabetes," said Anne Fagot-Campagna, M.D., a medical epidemiologist at the Center for Disease Control's division of diabetes translation. "If children develop the disease early in life the outcome may be very bad — they might develop complications very early … as young adults."

Unlike children with type 1 diabetes, in which the pancreatic beta cells responsible for producing insulin are ultimately destroyed and require insulin injections to maintain an appropriate blood sugar level, children with type 2 diabetes are treated much like their adult counterparts, with diet and exercise. This strict diet and exercise regimen serves two purposes, to control the diabetes and to bring down their weight.

But that’s not all there is to diabetes. There are many other cases in which diabetes, or diabetes-like symptoms, occur.

Another small percentage of young people develop a form of diabetes similar to type 2 called maturity-onset diabetes of the young(MODY). Unlike the relatively quick cessation of insulin production that distinguishes type 1, MODY develops gradually as an insulin deficiency and is thought to be the direct result of various genetic mutations.

Scientists believe that MODY is an autosomal dominant genetic disorder, meaning that children of one parent with the disease and one without any of the MODY gene mutations have a 50 percent chance of inheriting it. It usually is treated like type 2 diabetes, though in some cases it is so mild as to need no treatment at all, according to physicians at the Joslin Institute. MODY usually develops by age 25.

Diabetes also is linked to polycystic ovary disease, in which women have elevated levels of male hormones. Thirty percent of women with this condition develop type 2 diabetes by age 40, according to the Juvenile Diabetes Foundation.

Symptoms of diabetes can also be produced by genetic defects such as leprechaunism and the pineal gland disorder Rabson-Mendenhall syndrome. Pregnancy, pancreatitis, pancreatic cancer and hormone disorders such as gigantism and Cushing's syndrome are also linked with diabetes-like symptoms.

As much as you thought you knew about understanding and caring for diabetes, it's imperative to stay tuned; new research and developments are occurring all the time.



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