The 'Palette' of Type 2 Diabetes

[Indy51]

A Diabetologia study: Type 2 diabetes: a multifaceted disease

Abstract: Type 2 diabetes is a complex disease usually diagnosed with little regard to aetiology. In the broader sense, it is a mix of different clearly defined aetiologies, such as monogenic diabetes, that we need to be better at identifying as this has major implications for treatment and patient management. Beyond this, however, type 2 diabetes is a highly heterogeneous polygenic disease. This review outlines the recent developments that recognise this heterogeneity by deconvoluting the aetiology of type 2 diabetes into pathophysiological processes, either by measuring physiological variables (such as beta cell function or insulin resistance) or using partitioned polygenic scores, and addresses recent work that clusters type 2 diabetes into distinct subgroups. Increasing evidence suggests that considering the aetiological components of type 2 diabetes matters, in terms of progression rates, treatment response and complications. In other words, clinicians need to recognise that type 2 diabetes is multifaceted and that its characteristics are important for how patients are managed.

https://link.springer.com/article/10.1007/s00125-019-4909-y

 

[First.Officer]

....and that's if you can even get to see a suitably knowledgeable clinician/GP. And then it relies on the fact they recognise the above facts as stated. Usually a new diagnosis will consist of merely trying to stuff metformin down your throat.

 

[Daphne917]

....and that's if you can even get to see a suitably knowledgeable clinician/GP. And then it relies on the fact they recognise the above facts as stated. Usually a new diagnosis will consist of merely trying to stuff metformin down your throat.

Don’t forget statins because ‘all diabetics should take them’

 

[satindoll]

@Indy51 ,

Thanks for posting this..........Good catch with this one........... a must read for those that think they know everything but know not a lot.

 

[DCUKMod]

Thanks @Indy51 I haven't read it yet, but have always described T2 as a portfolio condition, so I've not been far off.

 

[Brunneria]

Oh @Indy51 what a gem of a paper
Thank you

WISH I had been a participant.
nearly 400 different gene contributors, and the risk ranging from 60% lifetime chance of developing 'T2' down to less than 7% alongside the rest of the population. And the various different system failures that lead to raised blood glucose and the lumping T2 diagnosis.

Have bookmarked this, for every time anyone says 'it is all about diet' OR 'it is all about exercise' OR 'it was all my fault because I ate a jaffa cake that one time'

Quote:
It would be interesting to see how deconvoluting the aetiological mechanisms for type 2 diabetes impacts on treatment response. Do individuals with diabetes who have a high lipodystrophy pPS have greater response to thiazolidinediones? Do those with a high beta cell deficiency pPS have altered response to sulfonylureas? This was recently demonstrated when these processes were captured by direct physiological measurement. In a clustering analysis of the ADOPT and RECORD (Rosiglitazone Evaluated for Cardiac Outcomes and Regulation of Glycaemia in Diabetes) studies, the insulin-resistant cluster responded better to thiazolidinediones and the older-patient cluster responded better to sulfonylureas [13].

and

Type 2 diabetes is a truly complex disease! In the broader sense, due to diagnostic challenges, it is a mix of different clearly defined aetiologies that we need to be better at identifying as this has major implications for treatment and patient management. Beyond this, type 2 diabetes is a complex disease driven by multiple pathophysiological processes resulting in a spread of clinical characteristics that to date are largely ignored when considering how we manage affected individuals. Whilst it may turn out to be clinically useful to group individuals with type 2 diabetes into subtypes based upon the main processes driving their diabetes, the case for this has not yet been made. It seems more likely that using continuous clinical and physiological measures, possibly combined with pPSs, is likely to be more valuable in predicting outcomes and guiding management.

Reminds me of this study:
https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30051-2/fulltext?elsca1=tlpr

 

[Caeseji]

Patient based care is needed not condition based care, it’s always going to be different.

 

[Guzzler]

Halfway through and Gosh! it is interesting stuff. Bump.

 

[Jaylee]

Fantastic read was that.
with T1, there's no clear "one size fits" as to triggering the autoimmune cause.

With T2 I always suspected it's not as clear cut as just "lifestyle." (That the tabloids like to fob us all off with.)



Thanks for finding this @Indy51

 

[ianf0ster]

I blame the government guidelines for my T2. All that 'High Carb, Low Fat is a healthy diet', and 'eating more fruit so as to get at least 5 a day'. Isn't it supposed to be going to 7 a day or more soon?

Actually I think the government guidelines are also at least pertly to blame for my needing the Coronary Artery Bypass, although genes, stress and sedentary lifestyle certainly didn't help.