CHANGING CONCEPTS TYPE 1 & 2 DIABETES.
Summarized from Australian Doctor Supplement November 2009

Prof Len Harrison at IMR Melbourne reviewed links between "diabetogenic" environment and causes and classification of diabetes (Nature Reviews Endocrinology 2009;5:483-89).

* increasing numbers children,adolescents and adults have BOTH autoimmunity against beta cells (typical of Type I DM) AND Insulin resistance (classical of Type 2 DM)
* =DOUBLE DIABETES=Latent autoimmune diabetes in youth, latent autoimmune diabetes in adults and type 1.5 diabetes
* likely environment that fosters expressions of genes once posed only a low risk.

ENVIRONMENTAL CHANGES PROMOTING DIABETES:

1. Increased total intake of food:high fat, trans fatty acids, fructose, low fibre
2. Changes in exposure to pathogens (hygiene hypothesis)
3. Low levels Vitamin D as hormone as well as Vitamin assoc with increased risk Type 1&2 DM.
4. Heating and cooling of buildings has reduced need to expend energy to thermoregulate.
5. Shorter periods of sleep tend to increase weight gain.

POSSIBLE INTERVENTIONS:

1. healthy diet and exercise
2. normalizing sleep
3. re-acquaint with temperatures outside thermoneutral zone
4. vitamin D therapy serum levels >70ng/ml target
5. EARLY use METFORMIN and THIAZOLINEDIONES which might preserve beta cell function in type 2 and even type 1 DM.
6. PREVENTION IS ONLY SUSTAINABLE APPROACH

Protecting beta cells:

* 80% of beta cells have been destroyed by the time a patient presents with Type 1 DM, 60% when presenting with Type 2 DM.
* METFORMIN, STIGAGLIPTIN, THIAZONELINEDIONES might slow rate decline of beta cells.

CLASSIFICATION DIABETES (American diabetes association)

* >50 types!!Type 1 DM 10%
* Type 2 DM
* Gestational DM (5% all Aussie women), 13% women aged 45-49 and higher in Aboriginals, torres straits islanders and south Asian women.