Talk:Diabetes

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No cure

"Diabetes mellitus is currently a chronic disease with no cure" has been tagged as not cited. This source however says "benefits of gastric bypass in severely obese patients is the ability to cure diabetes" [1] So I agree with TvD this needs to be clarified. Doc James (talk · contribs · email) 20:09, 3 November 2009 (UTC)

ref added however the article contradicts itself. Says no cure than has two sections on cures?Doc James (talk · contribs · email) 20:29, 3 November 2009 (UTC)

Agree. I found a ref that effectively says that it has no cure from the abstract, and added it, but the other found by Jmh649 indeed seems to contradict it. We probably need 1)a bunch of recent reviews on therapy of diabetes to see what's going on and 2)to change the sections to "therapy", which in my understanding (I am not a native English speaker) is a more appropriate term. --Cyclopia^talk 20:47, 3 November 2009 (UTC)

Management is usually what we used for complicated conditions. This whole wiki area is rather disorganized. Jmh649 / Doc James Doc James (talk · contribs · email) 21:01, 3 November 2009 (UTC)

The question of cure has arisen here before, see the talk archive. Type 1 is curable with a pancreas transplant (not clincally rasonable in most cases), or with addition of external beta cells. The Edmonton Protocol results were encouraging but haven't borne clinical fruit. Type 1 has been cured in mice.

Type 2 is much more complex. Whatever is the cause, we have no clinical approaches which reverse it. The bariatric surgery mentioned is very suggestive, very preliminary, very encouraging and has not been reduced to clinical practice. It is not, thus, a cure in that sense. It may be the beginnings of one. Or not. There is less contradiction within the article than at first appears. Wording which doesn't fit the situation should be tweaked. ww (talk) 07:38, 4 November 2009 (UTC)

So there are sort of cures and sort of not cures that work sometimes but often not. This nuance need to be described rather than stating that there is not cure IMO. In medicine all absolutes seem to turn out wrong.Doc James (talk · contribs · email) 17:53, 4 November 2009 (UTC)

There are cures for diabetes mellitus. Testosterone in examply completely cures diabetes mellitus type 2. Diabetes mellitus type 2 is easy to cure, just testosterone --Testosterone vs diabetes (talk) 20:19, 4 November 2009 (UTC)

A published review that supports this statement?Doc James (talk · contribs · email) 20:07, 4 November 2009 (UTC)

Are the citations good enough for the statement of testosterone as cure of diabetes mellitus? --Testosterone vs diabetes (talk) 20:19, 4 November 2009 (UTC)

It is mentioned that testosterone may help and is under study [2] but I have not seen any evidence suggesting widespread "cure" without weight loss. Please post the studies here if I have missed them. Doc James (talk · contribs · email) 20:44, 4 November 2009 (UTC)

Moment, testosterone indeed is not used to lose weight. Testosterone reduces abdominal fat (which is linked to hypogonadism and T2M) but increase muscle mass, therefore testosterone do not decrease the weight (I guess there are no correlations between weight and T2M).

Anyway, look at this: [PMID12809074]. Is it a good source?--Testosterone vs diabetes (talk) 21:29, 4 November 2009 (UTC)

Sorry will clarify. Relationship between diabetes and fat mass. It is fat mass that is the endocrine organ an obsolete weight is only a commonly used proxy.Doc James (talk · contribs · email) 21:31, 4 November 2009 (UTC)

This study was of 48 people with type 2 diabetes and visceral obesity and showed an improvement in visceral obesity and total body fat. One would thus expect an improvement in blood sugar control from this change alone. The Hba1c value was still 8.6% which is far from the normal of less than 6%. Therefore no cure of diabetes was found.Doc James (talk · contribs · email) 21:38, 4 November 2009 (UTC)

Yes, but from 10.4 to 8.6% Hba1c is a significant improvement, it means that testosterone is a cure.--Testosterone vs diabetes (talk) 17:13, 5 November 2009 (UTC)

No, as the person still have diabetes. I may be a partial treatment but is in no way a cure. Also if one was to stop the treatment I assume it would worsen again. And we need a much larger study before using this as a treatment. One that looks at long term morbidity and mortality. Hba1c is only a surrogate marker. What people really care about is am I going to go blind / die. I still treat patients with diabetes aggressively when there Hba1c is 8.6% BTW.Doc James (talk · contribs · email) 17:22, 5 November 2009 (UTC)

This study state (http://www.ncbi.nlm.nih.gov/pubmed/19712802): "The present study shows that testosterone supplementation given on top of optimal medical therapy improves functional capacity, large-muscle strength, and glucose metabolism in elderly patients with CHF". It means testosterone is a cure.

I understand you, I'am not a doctor, but I think that diabetic patiens are interested in other things (Will i get blind? Will I loose foots? Will I die?), and testosterone can avoid that.--158.194.199.13 (talk) 17:36, 5 November 2009 (UTC)

This is also not a cure. The above was 12 weeks long and involved 70 patients. Does not look at rates of blindness or amputation or death. And the key work is ON TOP OF optimal medical therapy. A cure is that you no longer need treatment for diabetes as you no longer have it. ie with gestational diabetes insulin is usually not longer needed post delivery as the patient has normal blood suger.Doc James (talk · contribs · email) 17:42, 5 November 2009 (UTC)

Yes, I understand you. It depends on what we mean for "cure". If you think to take something once and to do not have diabetes anymore...yeah...diabetes (like every chronic endogenous disease) has no cure. If diabetic people have more cortisol and less testosterone, it means that this desturbs is chronic. To cope this problem is necessary to take something that fight this tendence, always!

If for us "cure" means something that can cope with effectiveness diabetes, we may say that cure for diabetes exists: its name is testosterone.

PS: indeed bilateral adrenalectomy removes immediately and perennially diabetes mellitus. It can be a cure for the first definition, but it is not very reasonable. Anyway better testosterone--Testosterone vs diabetes (talk) 19:25, 5 November 2009 (UTC)

The definition of cure of diabetes is discussed here [3] Doc James (talk · contribs · email) 21:54, 5 November 2009 (UTC)

Problems with recent "cure is difficult" edit

A recent edit changes the text of the article to note that cure is difficult. This is incorrect. Cure is possible for Type 1 only with a pancreas transplant, and that is rarely clinically available or reasonable. All other Type 1 cures in humans are at most experimental. Including prophylactic approaches such as the vaccine proposals.

The gastric bypass surgery cure for Type 2 is not just gastric bypass, but a particular type of bariatric surgery. And it's not a cure, if by cure is meant something in routine clinical use. It is not currently understood, not approved by assorted medical bodies, etc. Might be the harbinger of something great, but...

All other alleged cures are either experimental, mythical, or fraudulent. We do not understand diabetes in sufficient detail to cure it (or them, there being several diseases) and have not found an accidental cure.

This article is read a great many people, mostly layfolk. We should NOT make claims about cure that are not real, or are based on linguistic word shaving. Cure for Diabetes, any type is not "difficult", it is currently clinically non-existent. And WP should not, in this article nor in any other, say anything which can be interpreted otherwise.

In addition, this editor removed a recent literature citation in the process of noting that cure is difficult. The reference should be returned to the article, as it was directly on point, and no citation to cure is difficult was made. ww (talk) 23:01, 4 November 2009 (UTC)

You can refer to me as James by the way rather than this editor. Noting that a cure is difficult is IMO better than stating a cure does not exist and than having entire paragraphs and pages for that matter on the "cure". There is also many peer reviewed published article which support a "cure" in a limited sense. I found a number of equal quality references that state that bariatric surgery is a "cure". For example "Although weight loss surgery generally results in a loss of 50–70% excess body weight and “cures” diabetes in 77% of patient" [4] We also have PMID 17964919.

Difficult may not be the best wording any other suggestions? A cure however is occasionally possible with a pancreatic transplant in type one, bariatric sugery in type two, and dilivery in gestational diabetes.Doc James (talk · contribs · email) 23:18, 4 November 2009 (UTC)

Here is the ref we had. Scharfmann R, Duvillie B, Stetsyuk V, Attali M, Filhoulaud G, Guillemain G (2008). "Beta-cell development: the role of intercellular signals". Diabetes Obes Metab. 10 Suppl 4: 195–200. doi:10.1111/j.1463-1326.2008.00953.x. PMID 18834447. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link) "Is no cure except pancreatic transplants" is not a phrase I am happy with. Either there is no cure or there is a cure but it is difficult and often does not work or in some cases is even worse than the disease.Doc James (talk · contribs · email) 23:46, 4 November 2009 (UTC)

This article from 2009 discusses the nuances of cure vs remission terminology. Unfortunately I have a three month embargo on the online complete version. Grrr http://care.diabetesjournals.org/content/32/11/2133.short?rss=1 Doc James (talk · contribs · email) 23:50, 4 November 2009 (UTC)

<-- I didn't track the editor by name, so didn't know who it was. The problem with the approach James suggests is that there are many cures in print. Exotic diets, ancient Indian supplements and meditation, magic pills from many places, exercises or some kind or other, .... A case report of the results of some kinds of surgery is very interesting, and may be a sure (for some patients, which?) or not. A mere published report is really insufficient for such a bold statement, or even several. Note it, mention the possibilities, note the early innings, ... but do not use the loaded word cure in this context. There is so much quackery, that WP should be very very careful. A check of the archives will turn up extensive discussion amongst editors here on this question within the last few months. To some extent, the editorial stance on it was settled then.

IN any case, for diseases with such large systemic effects, cure implies more than just glucose regulation improvement.

Thoughts on this issue from other editors here? ww (talk) 04:43, 9 November 2009 (UTC)

We often use the phrase the "cure is difficult" when it verges on impossible but very rare events do occur that we wish not to discount. Are you able to get a copy of the paper above on terminology of "cure". It just came out. We need to specifically state that the exotic diets and magics pills are unsupported by evidence however we have case studies of pancreatic transplants and studies of obesity surgery.

Have you seen any guidelines / reviews that state that no cure exists?Doc James (talk · contribs · email) 13:38, 9 November 2009 (UTC)

Who is this "we" you talk about, kemo sabe? It's a kind of inverted meaning to say 'cure is difficult' when there is no known cure is actually meant. We can't be so clever in our word usage in an article such as this. It's a first reference for lots of folks and so plain meaning is by far best. As for the citation, no I haven't read it. The only statements of no cure I can remember seeing in print were from such things as Joslin's Diabetes Mellitus. I'm sure quite a few ADA publications say much the same thing. There is no clinically available treatment which produce s a cure in the sense of no longer have to be concerned about those things diabetics must be concerned with: eye trouble, kidney trouble, cardiac trouble, nerve damage, wound failure, ...

The question should not be, how can you say there's no cure, but rather how can you say there is a ciure(s), albeit difficult. ww (talk) 01:03, 10 November 2009 (UTC)

Provide references and I will be happy to look at them.Doc James (talk · contribs · email) 02:09, 10 November 2009 (UTC)

Research just a few years old finds the underlying mechanisms to small studies that had found type 2 can frequently be "cured." If you fear book advertising, use this cite [[5]], or many of the cites by other articles below the text. Or this cite [[6]] Here's the book cite: Zinbarg (talk) 01:46, 21 November 2009 (UTC)

It is already on the subpage and is not significant enough for the main page.Doc James (talk · contribs · email) 03:09, 21 November 2009 (UTC)

What kind of doctor are you? Recent research finds that type 2 can be usually (roughly 80% of patients in 7 studies I've found so far) cured should be in the main page!!!! You are not current with research. Please get current before you make changes. I have provided the link above. I know that it's hard to get patients to really improve their diets, but that doesn't mean it won't generally work. I just read this discussion section again, and wanted to add that there's nothing exotic about eliminating saturated fat from your diet. The underlying metabolic mechanisms are now (very recently) known, and several good research studies exist finding a high proportion of "cured" patients in less that 3 months of dietary change.Zinbarg (talk) 06:15, 22 November 2009 (UTC)

I am a medical doctor. But that of course is beside the point. Were have you shown research that demonstrates the 80% "cure"? The two papers are associations above. Not treatment. Obesity of course causes about 70% of obesity so if you could "cure" obesity you could "cure" diabetes. And this has been done to some extend with bariatric surgery.Doc James (talk · contribs · email) 19:05, 22 November 2009 (UTC)

Copyright

Must of the text of this page is shared with http://www.diabeticsanonymous.org/pathphysiology.html Both are under GNU copyright but it is difficult to see who originated the text. I assume they have copied from use? Either way much is unreferenced.Doc James (talk · contribs · email) 20:45, 3 November 2009 (UTC)

They stole it from here. No attribution = GFLD violation. JFW | T@lk 21:01, 8 November 2009 (UTC)

Not surprised really. We need a legal team to go after sites not appropriately crediting Wikipedia. :-) Should I return the content? I was not particularly good as it was unreferenced.Doc James (talk · contribs · email) 22:16, 8 November 2009 (UTC)

At university we are not allowed to reference Wikipedia so no one does it. They tell us it's not a reliable source. —Preceding unsigned comment added by 91.106.40.120 (talk) 23:18, 10 April 2010 (UTC)

Map of prevalence is needed

Here is a great map of the prevalence. All we need to do is make our own. http://www.oxan.com/worldnextweek/2007-11-08/Diabetesmedicaltimebomb.aspx Doc James (talk · contribs · email) 22:11, 3 November 2009 (UTC)

Cool! If there some world map template that can be filled with colours, I can try to do that. --Cyclopia^talk 12:00, 4 November 2009 (UTC)

Found template here. I'll try to do that in the next few days. --Cyclopia^talk 12:21, 4 November 2009 (UTC)

http://commons.wikimedia.org/wiki/User:Lokal_Profil has helped me create about 6 or so maps in the past. He does a very good job. Asked if maybe he could help with this. Still not sure how to do it myself.Doc James (talk · contribs · email) 17:24, 4 November 2009 (UTC)

Shouldn't just be a matter of coloring it, following the example (maybe using a different hue), with Inkscape or Gimp? --Cyclopia^talk 19:41, 4 November 2009 (UTC)

Like this one http://www.diabetesatlas.org/map but use reds instead of blues. One has to click on the country to get the data out. Maybe would could create a table like List_of_countries_by_traffic-related_death_rate Doc James (talk · contribs · email) 20:12, 4 November 2009 (UTC)

I think it is not possible to insert this map.

• It reports predicted statistics which can be false or true.

• It is not written excatly how they did the predictations.

For that reasons I think that the map is not reliable and it is necessary to find another one with real statistics.--Testosterone vs diabetes (talk) 20:20, 4 November 2009 (UTC)

This is a good point indeed. The map seems to come from an apparently not so bad source (Internal Diabetes Federation) but a map with current statistics would be better indeed. I personally would include both. It would be nice to find the original document of the IDS projections. --Cyclopia^talk 20:26, 4 November 2009 (UTC)

Yes one is a prediction by the WHO which I think is less interesting than the current rates of DM. Here is all the WHO data. http://www.who.int/diabetes/facts/world_figures/en/index.html It does given absolute numbers for 2000 and we would have to divide by the population to get percentages. The WHO is as good as we will get.Doc James (talk · contribs · email) 20:38, 4 November 2009 (UTC)

Thw WHO map is definitely better and I think it is reliable. I would suggest you to do not insert the other map.--Testosterone vs diabetes (talk) 21:31, 4 November 2009 (UTC)

Yes I agree only the current data. I do not like future trends. Believe that they are an inappropriate use of statistics in biology. Will stick with the 200 data.Doc James (talk · contribs · email) 21:40, 4 November 2009 (UTC)

Done Doc James (talk · contribs · email) 22:19, 5 November 2009 (UTC)

Nonreliable sources related with alleged relationship between diet and diabetes mellitus

I think that the sources related the alleged relationship between diet and diabetes mellitus are not faithfully, because it is not written which were the criteria they've choosen for the controls.

I'am italian and I work in Czech Republic. According to the WHO undisputted data, Czech Republic has a much minor prevalence of diabetes mellitus (less than one half) even if czech sanity is much better than italian. It is also clear that czech diet contains more fats and sugars than italian, therefore I may declare that eat huge quantity of fats and sugars (like czechs do) decreases the possibilities to get diabetes. Of course that's false, the real reasons by which czech diabetes prevalence is much minor than italian is that simply czechs are stronger than italians (it means more muscle and therefore more testosterone and IGF-I. Testosterone deficiency is highly related with diabetes mellitus).

It is alwais misleading speak about exogenous parameters without take in consideration endogenous factors.--Testosterone vs diabetes (talk) 14:50, 8 November 2009 (UTC)

We need sources that state this before we can use it.Doc James (talk · contribs · email) 15:15, 8 November 2009 (UTC

)

Is the word "almost" misleading?

Right near the beginning of the article, one can read that presently, "almost" (sic) all people with Type One diabetes need to take insulin injections. Since Type One diabetes is insulin-dependent diabetes, should we eliminate the word "diabetes" here? I would have thought that all Type One diabetics would, and that if they did not, they would be Type Two diabetics. ACEOREVIVED (talk) 21:23, 29 November 2009 (UTC)

There is inhaled insulin and pancreatic transplants.Doc James (talk · contribs · email) 22:19, 29 November 2009 (UTC)

Also, a person might be diagnosed in the very, very early stages of the disease when the only symptoms are antibodies and slightly higher blood sugar. That person would be able to manage without insulin at least for a while. Not a good choice, but possible.Sjö (talk) 06:17, 30 November 2009 (UTC)

Cure, or a better word for it

I read and see reports that type 2 can be cured with diet. Search (saturated fat diet diabetes) google scholar and the PubMed web site and you find many conclusive studies. It's mostly strictly reducing intake of saturated fat and hydrogenated oils. Cells that are saturated with fats have ~blocked receptors to insulin (resistance), and fewer mitochondria (leading to poor insulin response). Eating whole plant foods helps, possibly through lowered inflammation (CRP down). Barnard came up lots in those searches, so I bought his book [[7]], which is full of first class references; he claims a cure. Last Friday (I think), Dr. Oz on his show stated that type 2 could generally be cured, and showed a sample menu for a diet that would foster compliance. He insisted that current patients be in frequent consultation with their physicians to reduce medications properly because the change is usually rapid. Less than a month to see results. Dr. Barnard's studies found 80% success. As long as the patients stay on the "diet" (Oz said it's how we all should eat all the time ... he does), they will have normal blood glucose levels without medication. If we don't have a "cure" what should we call it, and why isn't it better represented in the article?Zinbarg (talk) 18:31, 8 December 2009 (UTC)

Please provide pubmed references... What you will find is that Oz's claims are not actually supported by research. I stated the same above. His book is not nearly sufficient evidence. Doc James (talk · contribs · email) 18:35, 8 December 2009 (UTC)

Please see this article, which is about gene expression promoted by a diet of fat and glucose as well as high levels of inflammation related cytokines found in the obese results in cells that "produce fewer and smaller mitochondria than is normal," and are thus prone to insulin resistance.[[8]] I'll past the whole text if you don't have access. Gene expression works BOTH WAYS.

Take a look at these two studies[[9]][[10]]

Here's underlying mechanism and studies[[11]][[12]][[13]][[14]]

There are no large random gold standard studies yet, but at lease one is in progress. All I know for sure is that I gave that book to my Mom's caregiver who is now cured. There's an analyst in my office who took medication for diabetes for 7 years, and now doesn't need any. Any doctor would be remiss if they didn't strongly recommend a very low saturated fat diet.Zinbarg (talk) 19:52, 8 December 2009 (UTC)

The first paper is the economist. Not a WP:RS for medical aspects pertaining to treatment. None of the subsequent papers mention cure only that it helps manage diabetes. But we already say that dietary modification improves glycemic control. And that lossing weight is good for diabetes. The papers by the way are not talking about dietary saturated fat but the saturated found in adipose tissue. They do not support the assertion that eating less fat will improve diabetes only that losing weight will improve diabetes.Doc James (talk · contribs · email) 19:59, 8 December 2009 (UTC)

What better source than the Economist? It's the best global business publication. Great editors. The article just discusses a nice piece of research. Please read that research, and don't just dismiss the Economist. Gene expression works both ways, and represents a "cure."

I don't really care about the Barnard book, just it's references. The references were generally small studies, but statistically strong. The glucose levels become normal. How do you define cure?

Dr. Oz could be source in the text as a doctor and medical writer. The huge guy on the Oz show with HORRIBLE health will be cured in a few weeks. I think he said he drank 7 gallons of water a day. Not the first to be cured on the Oz show. There are several books that could be cited (as promoting this low saturated fat cure).

The PubMed studies (I think two of them) find normal glucose levels from low fat diet. There tons of time on "management" in the wiki text, and very little on current diet research. That's back asswords.Zinbarg (talk) 20:24, 8 December 2009 (UTC)

The economist is a business journal not a medical publication. Please provide medical publications. Without a review published in a medical journal stating that this is a cure this statement is not ready to be added. Dr. Oz is not notable as a diabetes expert. From his page he appears to be an alternative medicine practitioner.

Now before we go one which study show the 80% cure rate?Doc James (talk · contribs · email) 20:35, 8 December 2009 (UTC)

I thought you would read and understand the Economist article, and check the reference, not just dismiss the whole thing because you don't think the periodical is worthy. It's a great reference in a great periodical. Please, why shouldn't that be included in with possible causes and cures?

These two studies are specifically diet (not adipose fat) and diabetes.[[15]][[16]] Why do you reject these published studies?

The 80% is in the Dr Barnard book and his second published study linked above.Zinbarg (talk) 20:50, 8 December 2009 (UTC)

I do not have easy access to the economist. Email it to me if you could. It however is still not a WP:RS for a medical article.

Ref 23 involved 49 people... It than states "Hb A(1c) changes from baseline to 74 wk or last available values were -0.34 and -0.14 for vegan and conventional diets, respectively (P = 0.43)." which mean no sig difference. These are hardly big changes. Normal is less than 6.5 many have values arround 10 for HbA1C.

Ref 22 say the the benefit is primarily due to weight lose. "Although this effect is primarily attributable to greater weight loss" and that this is a management not cure of DM. "The presently available literature indicates that vegetarian and vegan diets present potential advantages for the management of type 2 diabetes"

Barnard's book is not a reliable source. I need to see a peer reviewed publication that shows an 80% cure.

So to some up these two small studies in no way claim a cure. They also do not say anything we do not already have in the article referenced to better sources.Doc James (talk · contribs · email) 21:05, 8 December 2009 (UTC)

Here's a great study. [[17]] 89% avoided. Not a cure, but something really big lifestyle wise is going on, much of it fat intake, and Wiki misses the mark. Is is legal to email the Economist article when it's protected? Is it legal to paste it into the discussion?Zinbarg (talk) 00:19, 9 December 2009 (UTC)

I do find places in the article where this potential (case management or cure) diet is mentioned. But, there's NOTHING in Causes, Management, or Epidemiology. 89% avoided in the elderly! Again, Wiki misses the mark. I'll run changes by you here first. I guess I forget about trying to add a Cure section, but I'd like something notable.Zinbarg (talk) 00:29, 9 December 2009 (UTC)

Looks like I'm not set up to send emails here.Zinbarg (talk) 00:31, 9 December 2009 (UTC)

Yes agree with the above. Should be added to the section on prevention if it is not already discussed. It however does not say anything about treatment therefore does not belong there. Will look into the cause section more tonight. If you go to my user page on the left if you are using the beta there will be an email this user button.Doc James (talk · contribs · email) 00:33, 9 December 2009 (UTC)

(undent) This is were one would add diet related information.. Diabetic diet Doc James (talk · contribs · email) 08:17, 9 December 2009 (UTC)

Absolutely. Thanks for the heads up on another place to add research. You're right to say DR Oz (show) doesn't belong in an encyclopedia, but you have to wonder he's put this guy on the show and made a promise (if you eat this you'll be essentially cured). He'd be a fool to not be confident that it would work. When I go the you email page, it gives me an error message when I try to send.Zinbarg (talk) 22:23, 10 December 2009 (UTC)

Lifestyle

Well I agree the lifestyle section needs to be improved. What you added did not make sense.

"Low-risk lifestyle groups were defined by physical activity level (leisure-time activity and walking pace) above the median; dietary score (higher fiber intake and polyunsaturated to saturated fat ratio, lower trans-fat intake and lower mean glycemic index) in the top 2 quintiles; never smoked or former smoker more than 20 years ago or for fewer than 5 pack-years; alcohol use (predominantly light or moderate); body mass index less than 25 (calculated as weight in kilograms divided by height in meters squared); and waist circumference of 88 cm for women or 92 cm for men.[[18]]

]]Doc James (talk · contribs · email) 15:42, 17 December 2009 (UTC)

I'm sorry for the mistakes. I'll rewrite, and bring it here first. From the same study, how about:

• ===Lifestyle===

The causes of type 2 diabetes is not fully understood, but lifestyle factors may be important to the development of the disease. In one study, group participants whose "physical activity level and dietary, smoking, and alcohol habits were all in the low-risk group had an 82% lower incidence of diabetes." Those lower risk lifestyle factors included "physical activity level (leisure-time activity and walking pace) above the median; dietary score (higher fiber intake and polyunsaturated to saturated fat ratio, lower trans-fat intake and lower mean glycemic index) in the top 2 quintiles; never smoked or former smoker more than 20 years ago or for fewer than 5 pack-years; alcohol use (predominantly light or moderate); body mass index less than 25 (calculated as weight in kilograms divided by height in meters squared); and waist circumference of 88 cm for women or 92 cm for men."..."When absence of adiposity (either body mass index <25 or waist circumference < or =88/92 cm for women/men) was added to the other 4 low-risk lifestyle factors, incidence of diabetes was 89% lower.Obesity is found in approximately 55% of patients diagnosed with type 2 diabetes. In another study of dietary practice and incidence of diabetes, "foods rich in vegetable oils, including non-hydrogenated margarines, nuts, and seeds, should replace foods rich in saturated fats from meats and fat-rich dairy products. Consumption of partially hydrogenated fats should be minimized."

In the last decade, type 2 diabetes has affected more children and adolescents, probably in connection with the increased prevalence of childhood obesity.

Environmental exposures may contribute to recent increases in the rate of type 2 diabetes. A positive correlation has been found between the concentration in the urine of bisphenol A, a constituent of polycarbonate plastic from some producers, and the incidence of type 2 diabetes.Zinbarg (talk) 16:07, 17 December 2009 (UTC)Zinbarg (talk) 17:31, 17 December 2009 (UTC)

Made a few changes to the wording as the cause is mostly known. Also better to summarize the text than to quote it. Looks better though.Doc James (talk · contribs · email) 17:45, 17 December 2009 (UTC)

I started out fixing a couple typos but then added detail to "diet," and a sentence. I should have done it here to your last article version.Zinbarg (talk) 18:27, 17 December 2009 (UTC)

I am not sure we need to definte a healthy diet right there as we discuss the influence of fats two sentences down. Maybe we could just link to health diet? Doc James (talk · contribs · email) 18:42, 17 December 2009 (UTC)

I thought "diet" was too vague. There are zillions of diets out there. But you're right, it's terribly repetitious. I guess I mostly wanted the 89% finding. I'll cut out the (diet details).Zinbarg (talk) 18:48, 17 December 2009 (UTC)

We have a page on healthy diet which defines the term via the WHO. Move some of the wording around. Do not really think we need the rest of the def. Just make sure the healthy diet page has it which it does.Doc James (talk · contribs · email) 18:52, 17 December 2009 (UTC)

I think what you've done is fine. Much better. Thank you.Zinbarg (talk) 18:59, 17 December 2009 (UTC)

Insulin resistance

Here's a study linking saturated fat to insulin resistance, mitochondria, and type 2 diabetes.[[19]]Zinbarg (talk) 19:43, 17 December 2009 (UTC)

No mention is made to dietary consumption of fats. This may belong under pathophysiology somewere but does not give any indication to treatment or cause.Doc James (talk · contribs · email) 19:46, 17 December 2009 (UTC)

Not dietary consumption, but cells basically saturated with fat. "The insulin-stimulated rate of glucose uptake by muscle ... was associated with an increase of approximately 80 percent in the intramyocellular lipid content (P=0.005). This increase in intramyocellular lipid content was most likely attributable to mitochondrial dysfunction, as reflected by a reduction of approximately 30 percent in mitochondrial phosphorylation." I know you hate the book, but can't we use it to avoid NOR but speculate on probable mechanisms?Zinbarg (talk) 19:57, 17 December 2009 (UTC)

Diabetes is a huge topic with tons of published review. Using book will just makes things way to complicated. This page still needs a great deal of work to make sure it reflects current scientific consensus. This is I must emphasis determined by peer reviewed publications not books.Doc James (talk · contribs · email) 20:10, 17 December 2009 (UTC)

I agree with the peer review aspect. I was just trying to get around violating NOR. Is this OK in 1.2? of the article?:

Type 2 diabetes

Main article: Diabetes mellitus type 2

Type 2 diabetes mellitus is characterized by insulin resistance which may be combined with relatively reduced insulin secretion. The defective responsiveness of body tissues to insulin is believed to involve the insulin receptor, and may involve higher intramyocellular lipid content and mitochondrial dysfunction.[[20]] Diabetes mellitus due to a known defect are classified separately. Type 2 diabetes is the most common type.

In the early stage of type 2 diabetes, the predominant abnormality is reduced insulin sensitivity. At this stage hyperglycemia can be moderated by a variety of lifestyle changes, and medications that improve insulin sensitivity or reduce glucose production by the liver. As the disease progresses, the impairment of insulin secretion occurs, and therapeutic replacement of insulin often becomes necessary.Zinbarg (talk) 20:17, 17 December 2009 (UTC)

MODY

I read in a recent review (McCulloch et al., "Classification of diabetes mellitus and genetic diabetic syndromes", 2010, kindly provided by Doc James): "In the new classification, the MODY subtypes have been eliminated, and replaced by specific descriptions of the known genetic defects". Does that refer to the proposed classification or has the international classification been changed to eliminate MODY? Just to ascertain.. --CopperKettle 18:46, 23 January 2010 (UTC)

Yes that is what it means. Uptodate however is not the best to reference to as people have limited access. Best to find a review that say the same thing. Vaxillaire M, Froguel P (2008). "Monogenic diabetes in the young, pharmacogenetics and relevance to multifactorial forms of type 2 diabetes". Endocr. Rev. 29 (3): 254–64. doi:10.1210/er.2007-0024. PMID 18436708. {{cite journal}}: Unknown parameter |month= ignored (help) Doc James (talk · contribs · email) 19:04, 23 January 2010 (UTC)

Thank you! I'll look into it.. So MODY itself still exists, only the old subtypes are replaced with the names of defects, as I understand. --CopperKettle 19:19, 23 January 2010 (UTC)

Our MODY article has been ahead of the curve in that respect for about 4 years. It could however stand to be updated with a couple even newer types. alteripse (talk) 19:43, 23 January 2010 (UTC)

Renaming proposal

How about renaming Diabetes mellitus and deafness to Maternally transmitted diabetes and deafness syndrome, per OMIM record? Or is it good as it is? --CopperKettle 13:19, 1 February 2010 (UTC)

New article proposal

How about creating new article for OMIM 500002, Mitochondrial myopathy with diabetes? Or is it already here under some other name? --CopperKettle 13:20, 1 February 2010 (UTC)

New Reaserch

New discoveries in stem cell reaserch have lead to the possiblity of a new cure. Could somebody possible insert a stub from http://en.wikipedia.org/wiki/Stem_cell_treatments#Diabetes —Preceding unsigned comment added by 198.166.238.141 (talk) 15:11, 23 February 2010 (UTC)

Fats and diabetes

It is not my intention to hurt feelings or cause dissension, but the following information is absolutely false:

Diets that are very low in saturated fats reduce the risk of becoming insulin resistant and diabetic.[43][44]

Saturated fat does not cause one to develop diabetes at all. A high carbohydrate diet can cause diabetes. For more information please see Gary Taubes "Good Calories Bad Calories" for a good introduction and reference to the pertinent research in this area.

Moreover, diets that are high in both carbohydrates (cereals such as wheat, oats, corn, rice, etc. and sugar in any form) and fat (particularly non natural fat such as any type of margarine) are even worse. For example, avoid foods such as hamburgers and french fries, pizza, doughnuts, muffins, cookies and candy. These food items are a combination of both fat and carbohydrate (often refined carbohydrate).

The following is only partially true:

In another study of dietary practice and incidence of diabetes, "foods rich in vegetable oils, including non-hydrogenated margarines, nuts, and seeds, should replace foods rich in saturated fats from meats and fat-rich dairy products.

There is nothing wrong with a diet that includes nuts and seeds, but it does not need to replace meat and dairy products. Instead it would be better to limit the amount of polyunsaturated fat in your diet, e.g. sunflower oil, and increase the amount of mono-saturated fat in your diet e.g. olive and Canola/rapseed oil.

The following statement is true:

Consumption of partially hydrogenated fats should be minimized."[12]

Although it would be best to eliminate margarine altogether in favor of using real butter and coconut oil instead. —Preceding unsigned comment added by 195.60.68.148 (talk) 07:53, 4 March 2010 (UTC)

Diet/Portion Symbols

I’ve just spent the past hour (admittedly not every single second, but most of it) trying to find information about the diabetes symbols (the triangles, squares, etc.) that you see on the nutrition information of some food products. It’s proving to be exceedingly difficult however. I figured that the main diabetes wiki page would ostensibly be a good place to find a reference link to the information but there is none here.

I think it would be good if someone who knows of a page that has the information could put a link on the page and/or create a Wikipedia page (if one does not exist) about diabetes diet symbols and relevant information. Synetech (talk) 16:53, 11 March 2010 (UTC)

Yes I agree that would be useful.Doc James (talk · contribs · email) 23:02, 15 April 2010 (UTC)

Edit request from Aura99, 28 April 2010

{{editsemiprotected}}

Please add the following link to the Exterbal links section

NHS Evidence - Diabetes search results

Aura99 (talk) 13:03, 28 April 2010 (UTC)

 Not done per WP:EL. OhNoitsJamie ^Talk 14:00, 28 April 2010 (UTC)

LADA?

May I ask why there is no mention of LADA (the so-called type 1.5), the late onset variant of type 1 diabetes? --The Pink Oboe (talk) 23:53, 19 May 2010 (UTC)

Edit request from Moonshamu, 27 May 2010

{{editsemiprotected}}

'cessation' is misspelled in the sentence, "Adequate treatment of diabetes is thus important, as well as blood pressure control and lifestyle factors such as smoking cesation [sic] and maintaining a healthy body weight." and must be edited (last sentence of 4th paragraph). Thank you.

Moonshamu (talk) 03:08, 27 May 2010 (UTC)

 Done Spitfire19 (Talk) 03:40, 27 May 2010 (UTC)

Reads like once you've got Type 2 the primary treatment is Meds only

Hi Doc. I provided you with two articles discussing new findings on type 2 diabetes. You seem to have dismissed both, one austensively because it was from the Economist. Both were from the Economist, but they both were reviews of recent peer reviewed published studies. I'll get those studies. Both articles/studies indicated that there is dietary causation that can potentially be reversed. Partly gene expression reversion, partly reversed metabolic syndrome, but generally due to a significant reduction in blood lipids. That reduction can be achieved most effectively by eliminating refined sugars and carbohydrates, as well as animal fats from the diet. Several small studies find significantly reduced to alleviated symptoms from diets very low in animal fat (and low in calories, especially fast carbs).

Sounds silly, but on the DR Oz show, all participants (from the audience who practice the diet) have gotten off all meds within a few months. The diet (they say) is easy and tasty. They do get lots of help from Dr Oz's medical staff (specific meals and exercise information, and motivational aid).

Why isn't at least some mention of lifestyle change included as a potential front line treatment?Zinbarg (talk) 23:46, 27 May 2010 (UTC)

One is still online[[21]]

Here's the other as text:

"The origin of diabetes

Don't blame your genes Sep 3rd 2009 From The Economist print edition

GENES are acquired at conception and carried to the grave. But the same gene can be expressed differently in different people—or at different times during an individual’s life. The differences are the result of what are known as epigenetic marks, chemicals such as methyl groups that are sometimes attached to a gene to tell it to turn out more of a vital protein, or to stop making that protein altogether.

Many researchers believe epigenetic marks hold the key to understanding, and eventually preventing, a number of diseases—and one whose epigenetic origins they are particularly interested in is type 2, or late-onset, diabetes. Juleen Zierath and her colleagues at the Karolinska Institute in Stockholm, Sweden, are trying to find out how people develop insulin resistance, the underlying cause of type 2 diabetes.

Insulin is a hormone produced by the pancreas. When all is going well, it lets cells know when they need to mop up glucose from the blood, usually just after a person has eaten. If the hormone is absent or is produced in insufficient quantities because of damage to the pancreatic cells that secrete it, the result is classical (or type 1) diabetes. But people with insulin resistance—and thus the late-onset version of the disease—do produce insulin. Their problem is that their glucose-absorbing cells cannot heed its advice. The sugar stays in their bloodstreams, where it damages the vessels, leading to ailments such as heart disease, kidney failure and blindness.

As they report in Cell Metabolism, Dr Zierath and her team decided to look at one of the main consumers of glucose: muscle tissue. They took muscle biopsies from 17 healthy people, 17 people with type 2 diabetes and eight people with early signs of insulin resistance, so-called “pre-diabetics”. They then compared the patterns of the methyl groups attached to the genes of the healthy volunteers with those of the diabetic and pre-diabetic ones.

As it turned out, they found hundreds of genes in which the patterns differed systematically, so to whittle the problem down they concentrated on those involved in the function of the mitochondria. These are the components of a cell that extract energy from glucose and use it to manufacture a chemical called ATP, which is the universal fuel of biological processes. Having fewer or less effective mitochondria causes a drop in demand for glucose, and might thus cause a cell to become insulin resistant.

Even narrowing the question down like this, though, left 44 genes to look at. Of these, Dr Zierath and her team picked one called PGC-1 alpha for further study. This gene is involved in the development of mitochondria, and the extra epigenetic marks the researchers found on it in diabetics and pre-diabetics had the effect of instructing the cells the marked genes were located in to produce fewer and smaller mitochondria than is normal.

The next question was how those marks got there. It is well known that poor diet and lack of exercise make insulin resistance more likely, so one hypothesis is that these things change the epigenetic marks on genes such as PGC-1 alpha. To test that idea, the researchers bathed cells in glucose and fats (chosen as surrogates for bad diet and lack of exercise for obvious reasons) and also in inflammation-producing proteins called cytokines. These proteins, they knew, are produced abundantly in the obese. And obesity, the consequence of bad diet and lack of exercise, is another risk factor for type 2 diabetes. Lo and behold, doses of both fats and cytokines caused PGC-1 alpha to be methylated.

Next, Dr Zierath wanted to know if she could prevent that. So, this time, before bathing the healthy cells in fats or cytokines, the team added a chemical that blocks the activity of DNMT3B, an enzyme which they found methylates PGC-1 alpha. When that was done, no extra methyl groups appeared.

These findings have two interesting implications. First, the fact the team was able to stop PGC-1 alpha being methylated suggests that a drug might be developed to do the same. Second, they show that bodily abuse can stretch all the way down to the genetic level. As Dr Zierath puts it, “we are not victims of our genes. If anything, our genes are victims of us.”"Zinbarg (talk) 00:00, 28 May 2010 (UTC)

Lifestyle changes are actually mentioned before medications in the treatment section. Obesity is the cause of 85% of diabetes. Please see WP:MEDRS for an explanation of sourcing requirements.Doc James (talk · contribs · email) 00:09, 28 May 2010 (UTC)

I'm trying to add information about treatment, not cause. "Obesity is the cause of 85% of diabetes" is not accurate. Correct to say obesity is associated with in 85%. The "cause" is (citing the studies) lifestyle driven metabolic syndrome, producing high levels of saturated fats in cells, leading to cellular insulin resistance.

Re sourcing. Those are very high-end studies that easily meet WP:MEDRS requirements inclusion in Wikipedia.

There is no "Treatment" section. There is "Management," which is misleading: "Diabetes mellitus is a chronic disease which is difficult to cure." Type 2 is evidently not necessarily a chronic disease.

There is "Lifestyle modifications" under "Management," but it doesn't say anything about diet, let alone reduced consumption of saturated fats.

There's "Support," but it doesn't even mention dietary education. I'll look into "The diabetic diet," but the main body should introduce dietary educational support.

There is "Prognosis," that wrongly treats type 1 and type 2 as one in terms of prognosis. It focuses on managing blood sugar, and ignores reducing insulin resistance via diet (and exercise, in another studies).

Finally, I find "Pathophysiology," "At this stage hyperglycemia can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce glucose production by the liver. As the disease progresses, the impairment of insulin secretion occurs, and therapeutic replacement of insulin may sometimes become necessary in certain patients.[citation needed]," where treatment is inaccurately limited to medications and insulin therapy.Zinbarg (talk) 02:41, 28 May 2010 (UTC)

I missed "Genes," which ignores the recent findings about gene expression.Zinbarg (talk) 02:44, 28 May 2010 (UTC)

If you want to use medical review articles to improve it feel free. Management and treatment are however the same thing and it does not matter which one you us.Doc James (talk · contribs · email) 02:46, 28 May 2010 (UTC)

Unindent. I've got to get copies of the original studies. Looks like they will by hard copies. I'm afraid the best thing we can present (after the offical reference we can still link to Econ) to our wiki audience is the economist articles.Zinbarg (talk) 16:10, 29 May 2010 (UTC)

Which studies do you want (PMID numbers )? I might be able to help you get them.Doc James (talk · contribs · email) 17:10, 29 May 2010 (UTC)

Reorganization

Currently the main diabetes page attempts to cover everything which than result in duplication on the subpages pertaining to the particular type. I am thinking of moving much of the information to the sub articles and just leaving a brief overview of each type here.Doc James (talk · contribs · email) 08:19, 29 May 2010 (UTC)

I agree. It's a jumbled mess. Put differently, diabetes is two distinct diseases, both marked by insulin resistance.Zinbarg (talk) 01:19, 30 May 2010 (UTC)