Replies to This Discussion

Permalink Reply by Melitta on March 31, 2011 at 8:22pm

Type 2 diabetes is not autoimmune. The WHO and Expert Committee on the Diagnosis and Classification of Diabetes Mellitus state that "Although the specific etiologies of Type 2 diabetes are not known, autoimmune destruction of beta-cells does not occur."

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Permalink Reply by Susi (Ladalife) on March 31, 2011 at 8:52pm

Hi Melitta,

The article is here. It could be something we don't yet know about. The crux of the article says (about T2)

Researchers identified for the first time a pancreas-attacking immune system cell, known as an islet reactive T cell, in a group of people who had recently been diagnosed with type 2 diabetes.

Who knows? Maybe that research will go somewhere and will fill some missing links regarding causes for T2s.

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Permalink Reply by Melitta on March 31, 2011 at 9:55pm

Hi Susi: Unfortunately, the Diabetes Forecast summary is brief and I can't find the Diabetes Care article, so I can't tell if this is actually something new or if it is the same misdiagnosis story of "we found antibodies in all these people with "Type 2" diabetes" which really means, "we didn't correctly diagnose these people as Type 1." The definition of Type 2 diabetes has not yet been changed by WHO/Expert Committee.

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Permalink Reply by Natalie ._c- on March 31, 2011 at 10:19pm

I've heard of what Susi's talking about, too. But if the definition of Type 1 is autoimmunity, then it would move these people into the Type 1 category. But the interesting question to me is, are there people with autoimmunity who DON'T lose all or nearly all beta cell function? In that case, they might FUNCTION like Type 2's, even with auto-immunity. Also, were they categorized as far as insulin-resistance? If they have no or little insulin-resistance, then that's more of an argument leaning toward Type 1, but then again, there are Type 1's with insulin-resistance too. There is so much unknown about Type 2!

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Permalink Reply by Susi (Ladalife) on March 31, 2011 at 11:42pm

Hey Melitta,

Is this the same 'expert' committee who make no mention of LADA, Mody and other forms of diabetes in any publication I can see, classifying all diabetes into T1, T2 & Gestational? The same "expert" committee who say plain as day on their website that T2: is largely the result of excess body weight and physical inactivity? It's way too broad, if you ask me.

Another article entitled, "Inflammatory mediators and islet ß-cell failure: a link between type 1 and type 2 diabetes" was published in 2003 and I'm sure there are earlier articles. I remember years ago the link between an autoimmune component and Type 2 was firmly established, but it was linked more to lifestyle causing the autoimmune problem. Purely on the basis of this, the WHO could reclassify T2 as autoimmune. I don't think it's a simple as that, though.

In that report, it says "identified for the first time....." yet if you do a search for "islet reactive T cell" there's plenty of data. One article I looked at was published in 1992. So, who knows what that article is about. Maybe they just actually looked for that islet reactive T cell for the first time in T2s, which I suspect is unlikley?

So yes, maybe you're right - um... we looked and um... we found antibodies.

It doesn't explain the cause of them being there in the first place. Not all antibodies come from some unknown source or trigger. We are fighting infections and all sorts of ills, all the time, with antibodies. Seems to me it's only called an autoimmune condition when the antibodies are unexpected and do something that causes disease. Otherwise they're mostly doing what they're supposed to be doing.

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Permalink Reply by Brian (bsc) on April 1, 2011 at 5:37am

Well, I guess I have repeatedly said that the classification and diagnostic criteria leave much to be desired. And Melitta is right, the so called expert committee does define type 1 - Immune mediated as "β-cell destruction, usually leading to absolute insulin deficiency." But it then goes on to note as it relates to specific antibodies ((GAD, II-2, ICA, and IA-2) "One and usually more of these autoantibodies are present in 85–90% of individuals when fasting hyperglycemia is initially detected."

But the diagnoistic critera then define Type 2 as "ranging from predominantly insulin resistance with relative insulin deficiency to predominantly an insulin secretory defect with insulin resistance." And it is important to note that Ralph DeFronzo (the leading researcher) suggests that by the time patients are diagnosed with a fasting glucose > 126 mg/dl, they have already lost 80% of their β-cell function. So Type 2s also extensively suffer insulin β-cell destruction.

So by the diagnostic criteria, 10-15% of patients diagnosed as T1 could quite correctly be diagnosed as T2. And the diagnosis of T2 is a "diagnosis of exclusion." The same experts suggest that in T2 "Although the specific etiologies are not known, autoimmune destruction of β-cells does not occur, and patients do not have any of the other causes of diabetes listed above or below." Now it may be that it is discovered that some T2s have an different autoimmune condition, but we must also remember that T2 is not "one thing." That same researcher (DeFronzo) suggests that there are eight separate defects in T2 (shown below), only one of which is classic insulin resistance (and could be explained by obesity).



I am actually quite distraught that the leading voices in public health have undertaken a "War on Obesity" as the way to cure and prevent T2 diabetes. Obesity does not "cause" T2 and it does not distinguish the types.

In my view, there is a great deal of overlap between T1 and T2 and there is a also a huge amount of diversity within both the T1 and T2 communities. It doesn't bother me that the media can't get this stuff right, the doctors struggle with it. What really bothers me is the fr*gg*n "war on obesity," it is misguided for T2 and even more whacked for T1.

ps. The experts do recognize MODY in a third category, but they don't mention LADA because "rightly" it is considered T1.

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Permalink Reply by LaGuitariste on April 1, 2011 at 6:01am

Thank you for this interesting, useful post.

Now, will you pretty please whisper this into my sister's ear while she is sleeping? Perhaps she'll take in the information if she hears it from you, because when I try to engage her on the subject all she hears is "...blah--blah--blah...".

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Permalink Reply by Melitta on April 1, 2011 at 7:54am

I should have said in my earlier post that in some ways, Type 1 autoimmune disease is simple, and I personally view Type 2 diabetes as incredibly complex. As BSC/Brian says, it's mostly defined as "everything that is not autoimmune." I am glad that Dr. DeFronzo is doing his excellent work, but the message is not getting "out there," but I really think that more effort needs to be put into getting to the bottom of the (probable) myriad of diseases that make up "Type 2 diabetes" and work towards some true answers rather than this simplistic and misguided "war on obesity."

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Permalink Reply by Kathleen on March 31, 2011 at 11:00pm

I have often needed to explain the differences. At one stage I was completely cynical towards Type 2 diabetics. But the more I read and find out about it I feel slightly ashamed. I think in terms of the media's ability to differentiate - Its not done very well. Australia for one has such growing problem of T2D that they often only advertise, "check your waist line", "eat healthy",
"family history"..blah blah blah. And it is for that reason that I believe we don't have equal support. And rightly so I guess, of course as a nation they are going to focus on an epidemic. Diabetes is a money making machine. However - Us Type 1's live in the shadow of a majority who can sure themselves. And that's where it gets frustrating. I'm truly sick of hearing people ask my mother if her ''daughter is overweight?'' and asking me if I drank too much soft drinks as a child. Maybe in some ways even some Type 2 diabetics are shown in a bad light. Seeing as I never considered that it was out of some peoples control...

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Permalink Reply by dishers on January 24, 2013 at 11:22am

is there any one or can you tell me what tests they use to determine if your type 1 or type 2? I have been diagnosed about 13 or more years being type 1 but I am not sure, the doctors I have seen well lets just say I think they like their golf clubs more then their patients. so just wondering what the procedure would be to determine if your type 1 or 2

thanks in advance, hope someone replies. LOL

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Permalink Reply by Brian (bsc) on January 24, 2013 at 11:34am

The current best practice for diagnosing diabetes is to test for T1 by checking for the occurence of any one of the antibodies (GAD, ICA and IA2) which indicate an autoimmune problem and also to check the c-peptide to determine whether too little insulin is being produced. If you have an autoimmunity and your insulin production is deficient, then you are T1. These tests are not "definitive" as only 85-90% of patients who have T1 actually test positive for antibodies. There is no test for T2, the diagnosis of T2 is given as a diagnosis of exclusion (i.e. if you have diabetes, but aren't T1, then you must be T2).

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Permalink Reply by dishers on January 24, 2013 at 11:47am

Thanks Brian, would that be under different names. I have like 10 pages of blood and urine tests that a new place did up for me, I am curious to if any of those tests would tell me. they say I am type 1 and I do need insulin. They think I was undiagnosed as a child but think I have always had it. I am now suffering with my eyes, kidney's and I have nerve damage all through my body.
very painful. on top of that I have trigger thumb. LOL. I just want to know for myself if I am type 1 or 2 my mothers side has type 2 diabetes and my grandfather on my fathers side i know had type 1, that is all I really know since I was adopted. know my mothers side of the family but not my fathers.
I also understand that type 2 is hereditary and type 1 probably isn't, so makes me wonder for myself what I am.

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