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Simpson RW, Shaw JE, Zimmet PZ. The prevention of type 2 diabetes--lifestyle change or pharmacotherapy? A challenge for the 21st century. Diabetes Res Clin Pract 2003; 59:165-80. [PMID: 12590013 DOI: 10.1016/s0168-8227(02)00275-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diabetes mellitus is occurring in epidemic proportions in many countries. In Australia 7.4% of people over 25 years of age have diabetes (mostly type 2) and comparable or higher prevalences have been reported in the United States and a number of Asian countries. The enormous economic and social cost of this disease makes a compelling case for prevention. Epidemiological studies have shown clearly that type 2 diabetes results from an interaction between a genetic predisposition and lifestyle factors including obesity, sedentary behaviour and both calorie excess and various dietary constituents. The natural history of type 2 diabetes includes a preceding period of impaired glucose tolerance (IGT)/impaired fasting glucose (IFG) which provides an opportunity for targeted intervention within large communities. Lifestyle intervention studies have consistently shown that quite modest changes can reduce the progression from IGT to diabetes by 50-60%. It may, however, not be possible to translate these successful findings to larger cohorts or maintain the lifestyle changes longer term. This has lead to consideration of pharmacotherapy. While small studies with sulphonylureas are inconclusive, benefits have been found for metformin, acarbose and troglitazone. Big intervention studies with ramipril, rosiglitazone, valsartan and nateglinide are underway. Pharmacological intervention raises a whole range of ethical, economic and practical issues not the least of which is the problem of long term therapy of the 'otherwise well'.
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Affiliation(s)
- R W Simpson
- Department of Diabetes and Endocrinology and Monash University Department of Medicine, Box Hill Hospital, Arnold St, Box Hill 3128, Australia.
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Erasmus RT, Blanco Blanco E, Okesina AB, Mesa Arana J, Gqweta Z, Matsha T. Importance of family history in type 2 black South African diabetic patients. Postgrad Med J 2001; 77:323-5. [PMID: 11320276 PMCID: PMC1742028 DOI: 10.1136/pmj.77.907.323] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess the family history of diabetes in type 2 black South African diabetics with emphasis on the parental phenotype. DESIGN Prospective case-control study in which family histories were obtained from patients. SETTING Diabetic clinic of a provincial teaching hospital in the Transkei region of South Africa. SUBJECTS A total of 1111 type 2 diabetics attending the diabetic clinic and 687 controls. MAIN OUTCOME MEASURES History of diabetes in parents, siblings, maternal and paternal grandparents, aunts, and uncles. RESULTS Altogether 27.3% of diabetic subjects had a family history of diabetes compared with 8.4% in the control group (p<0.01). Among the group with positive family history 82.6% reported only one diabetic family member, while 17.4% reported at least two relatives; 6.6% had a diabetic relative from both maternal and paternal sides, and 87.8% had first degree relative with diabetes. Among them there was a significant maternal aggregation with 64.7% of patients having a diabetic mother compared with 27% who had a diabetic father (p<0.01). No maternal effect was observed among the second and third degree relatives. Patients with positive family history had an earlier onset of diabetes than those without family history (p<0.01). CONCLUSION These data suggest that type 2 diabetes is heritable in black South African diabetics. It is also likely that maternal influences may play an important part.
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Affiliation(s)
- R T Erasmus
- Department of Chemical Pathology, Faculty of Medicine, University of Transkei, Private Bag XI, Umtata, South Africa.
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Abstract
Type 2 diabetes is a major cause of morbidity and mortality resulting from its microangiopathic and macroangiopathic complications. Current approaches to its management and to the prevention of diabetic complications are difficult to implement effectively, and there is little evidence to date that these approaches are reducing the impact of this disease. The recognition that type 2 diabetes usually has a prolonged prediabetic phase raises the possibility that the emergence of hyperglycemia and the atherosclerotic complications associated with diabetes may be preventable by the institution of early treatment modalities. Sufficient data suggest that life-style modification or pharmacotherapy directed at improving insulin sensitivity or insulin secretion in subjects with impaired glucose tolerance may reduce progression to diabetes. Two long-term prospective, controlled trials have been initiated to test this hypothesis.
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Affiliation(s)
- R B Goldberg
- Department of Medicine, University of Miami School of Medicine, Florida, USA.
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Abstract
Immigration almost always involves major cultural changes in dietary, social and health-related beliefs and behaviour. Two years after the arrival of the earliest Yemenite immigration wave to Israel, about 30 years ago, the prevalence rate of diabetes in that population was almost nonexistent (approximately 0.06%), increasing to approximately 12% 25 years later. Obesity and hyperlipoproteinemia were not always correlated with diabetes. Ethiopians, mainly from the northern regions, first immigrated to Israel ten years ago. At that time, their prevalence rate of diabetes was 0-0.4%. Though it is too early to determine the overall prevalence rate in this population, 5-8% rates have been reported after up to 5 years in Israel. The objective of the present work was to study the effect of the diversity of ethnic food patterns and adaptability on the nutritional status of Ethiopian immigrants. Two groups were studied--teenagers and adults. After 2 and 18 months in Israel, adult Ethiopians who arrived in Israel in 1991 (n = 426) had an average body mass index (BMI) of 20-22 kg/m2, which was below western values; a waist:hip ratio (WHR) of 0.9 suggested abdominal fat accumulation. Fasting serum- glucose levels were within the norm, whereas insulin levels were high (24 micrograms/mL). Plasma triglycerides (TG) increased with age, from about 100 to 150 mg/dL, whereas cholesterol and lipoprotein levels remained stable and normal. The BMI of Ethiopian teenagers (n = 15) 5-7 years in Israel was similar to that found in adults. Fasting serum insulin levels were significantly lower in boys than in girls (approximately 16.6 vs approximately 18.6 microU/mL, respectively). Cholesterol values were significantly higher in girls than in boys (approximately 184 vs approximately 150 mg/dL); TG, high density and low density lipoprotein values were normal. These data indicate the existence of early signs of risk factors for diabetes, which may not manifest itself clinically unless provoked. Several causes, rendered detrimental by progress, could be setting the stage for early manifestation of risk factors for cardiovascular disease and diabetes. Of these, two are of pertinence to this work: a genetic endowment for low-energy output and the thrifty genotype, and maternal undernutrition.
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Affiliation(s)
- N Trostler
- Institute of Biochemistry, Food Science and Nutritional Science, Faculty of Agriculture, Hebrew University of Jerusalem, Rehovot, Israel
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Abstract
Cats are one of the few species that develop a form of diabetes mellitus that is clinically and histologically analogous to human type 2 diabetes mellitus. Figure 9 summarizes the etiologic factors thought to be involved in the development of feline and human type 2 diabetes. The main metabolic characteristics of type 2 diabetes mellitus are impaired insulin secretion and resistance to the action of insulin in its target tissues. Impaired beta cell function occurs before histologic changes become evident. The characteristic histologic finding in cats with type 2 diabetes is deposition of amyloid in pancreatic islets. Amyloid deposition occurs before the onset of clinical signs, but does not seem to be the primary defect. Pancreatic amyloid is derived form the recently discovered pancreatic hormone amylin. Amylin is synthesized in pancreatic beta cells, and is co-stored and co-secreted with insulin. Amylin has been postulated to be involved in the pathogenesis of feline diabetes mellitus both through its metabolic effects, which include inhibition of insulin secretion and induction of insulin resistance, and via progressive amyloid deposition and beta cell degeneration. Increased amylin concentration has been documented intracellularly in cats with impaired glucose tolerance and in the plasma of diabetic cats, and supports the hypothesis that amylin is involved in the pathogenesis of type 2 diabetes. Obesity is a common finding in diabetic felines and is a contributing factor to the insulin resistance present in type 2 diabetes. Clinical signs of diabetes develop once total insulin secretion decreases to 20% to 25% of normal levels. Many diabetic cats have been treated successfully with oral hypoglycemics, but 50% to 70% of diabetic cats are insulin dependent. Based on histologic evidence, this is the result of extensive amyloid deposition and subsequent beta cell degeneration, rather than autoimmune destruction of pancreatic beta cells associated with type 1 diabetes. Alternative ways of treating type 2 diabetes currently are being investigated. Amylin antagonists recently have been proposed as a novel treatment to reverse the deleterious effects of excessive amylin concentrations. The gastrointestinal hormone glucagon-like peptide-1 may also prove useful in treating diabetic cats, because of its stimulatory effect on insulin secretion and synthesis, and the absence of significant hypoglycemic effect.
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Affiliation(s)
- T A Lutz
- Institute of Veterinary Physiology, University of Zůrich, Switzerland
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Pillay TS, Langlois WJ, Olefsky JM. The genetics of non-insulin-dependent diabetes mellitus. ADVANCES IN GENETICS 1995; 32:51-98. [PMID: 7741025 DOI: 10.1016/s0065-2660(08)60203-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- T S Pillay
- Department of Medicine, University of California, San Diego, La Jolla 92093, USA
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McCarthy MI, Hitman GA, Shields DC, Morton NE, Snehalatha C, Mohan V, Ramachandran A, Viswanathan M. Family studies of non-insulin-dependent diabetes mellitus in South Indians. Diabetologia 1994; 37:1221-30. [PMID: 7895952 DOI: 10.1007/bf00399796] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Though a genetic basis for non-insulin-dependent diabetes mellitus (NIDDM) is clear, the likely mode of inheritance is not known. The segregation of NIDDM was studied in 64 nuclear South Indian pedigrees (449 individuals) ascertained through an affected proband having both parents and more than 1 sibling alive and available for oral glucose tolerance testing. A high proportion of parents were found to be of abnormal glucose tolerance [89 of 128 (70%) diabetic and 11 of 128 (9%) impaired]. Complex segregation analysis was performed using (1) POINTER which implements the mixed model and distinguishes major gene, multifactorial and non-transmitted environmental contributions to affection and (2) COMDS which implements an oligogenic model with major gene, modifier gene and environmental contributions to a) affection and b) diathesis (an ordered polychotomy amongst non-affected family members, based on 2-h plasma glucose level). Using POINTER, there was no formal support for a major gene and the most parsimonious solutions were achieved with multifactorial models. Using COMDS, we found i) significant improvements in models when information on glucose levels in nondiabetic family members (diathesis) was included, ii) support for segregation of a diallelic gene as well as background familial resemblance, and iii) under the best-supported model, this diallelic locus featured incomplete dominance (d = 0.8) and a disease-predisposing allele frequency of 14%. In South Indians, segregation of NIDDM is inadequately described by simple major gene models: more complex models provide more satisfactory descriptions. This finding, if applicable in other populations, has important implications for the search for diabetes-susceptibility genes.
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Affiliation(s)
- M I McCarthy
- Cellular Mechanisms Research Unit, London Hospital Medical College, UK
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McCarthy MI, Froguel P, Hitman GA. The genetics of non-insulin-dependent diabetes mellitus: tools and aims. Diabetologia 1994; 37:959-68. [PMID: 7851690 DOI: 10.1007/bf00400458] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- M I McCarthy
- Medical Unit, London Hospital Medical College, UK
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Dornhorst A, Merrin PK. Primary, secondary and tertiary prevention of non-insulin-dependent diabetes. Postgrad Med J 1994; 70:529-35. [PMID: 7937445 PMCID: PMC2397691 DOI: 10.1136/pgmj.70.826.529] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- A Dornhorst
- Department of Medicine, University College London, Whittington Hospital, UK
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Lutz TA, Rand JS. A review of new developments in type 2 diabetes in human beings and cats. THE BRITISH VETERINARY JOURNAL 1993; 149:527-36. [PMID: 8111613 DOI: 10.1016/s0007-1935(05)80037-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Cats appear to be one of the few non-human species that develop a type of diabetes mellitus analogous to human Type 2, or non-insulin-dependent diabetes mellitus (NIDDM). In this review, some current theories on diabetogenesis are discussed. In both cats and human beings, Type 2 diabetes is characterized by impaired insulin secretion due to a functional defect in pancreatic beta-cells, and insulin resistance. In both species, amyloid deposition occurs in pancreatic islets and is derived from the newly discovered pancreatic hormone islet amyloid polypeptide (IAPP), or amylin. Amylin also reduces insulin secretion and induces insulin resistance. Thus, the hypothesis of amylin being intimately involved in the pathogenesis of human and feline Type 2 diabetes appears justified. Obesity is a frequent concomitant problem in feline and human Type 2 diabetes and contributes to the insulin resistance characteristic of the disease.
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Affiliation(s)
- T A Lutz
- School of Veterinary Science, University of Queensland, St. Lucia, Brisbane, Australia
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McCarthy MI, Hitchins M, Hitman GA, Cassell P, Hawrami K, Morton N, Mohan V, Ramachandran A, Snehalatha C, Viswanathan M. Positive association in the absence of linkage suggests a minor role for the glucokinase gene in the pathogenesis of type 2 (non-insulin-dependent) diabetes mellitus amongst south Indians. Diabetologia 1993; 36:633-41. [PMID: 8359581 DOI: 10.1007/bf00404073] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Mutations of the glucokinase gene have been implicated in the development of glucose intolerance in pedigrees with maturity-onset diabetes of the young. However, the contribution of the glucokinase gene to the aetiology of common Type 2 (non-insulin-dependent) diabetes mellitus is uncertain. We have studied the role of the glucokinase gene in the pathogenesis of Type 2 diabetes in South Indians, using both population-association and linkage methodology. A pair of CA-repeat sequences (GCK(3') and GCK(5')) straddling the glucokinase gene were employed as markers, each subject being typed using the polymerase chain reaction and polyacrylamide gel electrophoresis. Comparisons of allele frequencies at these markers were made between 168 Type 2 diabetic subjects and 70 racially-matched control subjects. No differences in allele frequencies were apparent at the GCK(5') marker; however, there were significant differences in allele frequencies at the GCK(3') marker between the Type 2 diabetic subjects and control subjects (chi 2 = 11.6, df = 3, p = 0.009) with an increase of the z allele (78.0% vs 66.4%) and a decrease of the z + 2 allele (13.7% vs 25.0%) amongst the diabetic subjects. Linkage between glucose intolerance and the glucokinase gene was studied in 53 nuclear pedigrees under a variety of genetic models. Linkage was excluded (lod score < -2) at a recombination fraction of zero under five of the ten models used and highly unlikely (-2 < lod score < -1) under the others. The combination of positive association and negative linkage suggests that glucokinase acts as a minor gene influencing the development of Type 2 diabetes within this population.
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Affiliation(s)
- K E Suckling
- SmithKline Beecham Pharmaceuticals, Welwyn, Herts, U.K
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Tuomilehto J, Knowler WC, Zimmet P. Primary prevention of non-insulin-dependent diabetes mellitus. DIABETES/METABOLISM REVIEWS 1992; 8:339-53. [PMID: 1307523 DOI: 10.1002/dmr.5610080403] [Citation(s) in RCA: 58] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- J Tuomilehto
- National Public Health Institute, Department of Epidemiology and Health Promotion, Helsinki, Finland
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Hamman RF. Genetic and environmental determinants of non-insulin-dependent diabetes mellitus (NIDDM). DIABETES/METABOLISM REVIEWS 1992; 8:287-338. [PMID: 1307522 DOI: 10.1002/dmr.5610080402] [Citation(s) in RCA: 141] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- R F Hamman
- University of Colorado School of Medicine, Department of Preventive Medicine and Biometrics, Denver 80262
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15
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Abstract
Although environmental factors are important triggers of non-insulin-dependent diabetes mellitus (NIDDM), heredity plays a major role in the pathogenesis of the disease. Insulin resistance manifested as impaired activation of glycogen synthase and thereby storage of glucose as glycogen in skeletal muscle is demonstrable early on in NIDDM relatives, suggesting that NIDDM could be an inherited muscle disease. On the other hand, insulin deficiency is almost unequivocally present before manifest diabetes develops. An intensive search for candidate genes for NIDDM has been initiated; so far it has not been possible to ascribe NIDDM to any alterations in the human genome. Given the heterogenous nature of NIDDM, its age-dependent penetrance and strong influence of environmental factors, it may not be fruitful to use NIDDM as an end-point in genetic linkage or association studies. It is more likely that DNA defects result in either insulin resistance or insulin deficiency, which in turn, can both lead to NIDDM. In accordance with the thrifty gene hypothesis, the insulin resistance gene has protected individuals during long periods of starving by storing energy as fat rather than as glycogen in muscle. The abundance of food in Western society has made this once protective gene a deleterious one, suggesting that these individuals are not equipped with the metabolic machinery to handle overeating.
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Affiliation(s)
- L C Groop
- Fourth Department of Medicine, Helsinki University Hospital, Finland
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