History and Types of Diabetes

The first sign of diabetes was discovered in 1500 B.C.E by the Egyptians. According to one study, ancient Indians were familiar with the condition and had even determined two types of the condition. They called it “honey urine” and tested for it by determining if the ants were drawn to the urine. The first mention of the word diabetes was by the Greeks. It means “to go through”, it was named this because of its main symptom: the excessive passing of urine through the body’s system.

Many ancient societies knew about the condition, but could not determine a cause, therefore in ancient times this condition was considered a death sentence. Diabetes was not thoroughly looked into until the early 20th century.  In 1910 an English physiologist named Sir Edward Albert Sharpey-Schafer’s conducted a study of the pancreas which lead him to discover that insulin was not being produced in diabetic people. The name insulin comes from the Latin term “insula” which means island. This refers to the insulin-producing islets of Langerhans in the pancreas. In 1921 a study was conducted by Frederick Banting and his student assistant, Charles Best. They removed insulin from dogs in a laboratory at the University of Toronto. They then removed the pancreases of multiple dogs and injected the insulin back into each pancreas. They found that doing this made the animals blood sugar reduce. They were later awarded a Nobel Prize in Physiology for their accomplishments in medicine. Eli Lilly and company in 1923 began mass production of insulin to use in humans. In the early 1900’s the survival rate of babies born to mothers with diabetes was half. This prompted Priscila White, MD to start the Joslin pregnancy clinic which continues to reduce risk of diabetes in pregnant women today. It is now one of the largest diabetes research centers in the world. The creation of the center has led to a 90 percent survival rate of the children born to mothers with diabetes.

Although steps were taken in our early history to begin combating this condition a cure has still not been found. In 2015, 30.3 Americans or 9.4% of the population was found to have diabetes according to the American Diabetes Association. This number is still growing, over 1.5 million new cases are found every year. Diabetes still remains the 7th leading cause of death in the United States. In 2015 79,535 deaths are listed as the cause of death and an astonishing 252,806 deaths have been linked to deaths. The likelihood of getting diabetes grows with age, 25.2% of people 65 and older have this condition.

I believe the way to combat this issue is to focus on the younger population to stop the problem early rather than suppressing the symptoms once they appear in adulthood. Almost 193,000 American under the age of 20 have been diagnosed with diabetes (approximately 0.25% of the population). In 2012 the annual incidence, which is the measure of how often the disease occurs, of type 2 diabetes was calculated to be 5,300. A conference held in Santa Monica in 2003 was called “Type 2 Diabetes in the Youth, The Evolving Epidemic”. This issue has become a medical and economic priority in the health world. Diabetes begins at birth, low weight and bad nutrition combined with poor lifestyle lead to the production of an insulin-resistant phenotype that causes diabetes. The current epidemic of poor exercise and obesity has led the worldwide number of people with diabetes to triple since 1981.

Obesity is one of the top factors that contribute to diabetes. In a cross-sectional survey of children 9-12 in Hong Kong, 38% of girls and 57% of boys were overweight, both sexes showed higher systolic blood pressure, triglyceride, and insulin and lower HDL cholesterol than a normal weight child. There is an ethnic difference of children within countries, African-American and Hispanic children between the age of four and twelve there has been an increase in the U.S of overweight children to 22%. On the contrast, non-Hispanic whites have an no real chance to their 12% overweight prevalence. These statistics show a strong correlation between childhood obesity and insulin resistance in early adulthood. Physical activity effects children and adults differently, children show a smaller increase in intramuscular inorganic phosphate-to-phosphocreatine ratio and a smaller decrease in pH. Obesity and diet effect children’s metabolisms. This is caused by high-fat concentrated diets. This diet leads to stunted growth hormones and epinephrine when it comes to exercise. Physical activity increases insulin sensitivity in children, obese children who start regularly exercising show a decline in fasting insulin that is reversed by going back to a healthy lifestyle. As discussed before, low birth weight and diabetic mothers have emerged as large risk factors. The Australian aborigine population was studied and showed high levels of physical fitness due to their hunter-gather lifestyle, with low BMI, blood pressure, and cholesterol, although elevated fasting insulin and triglyceride levels suggesting insulin resistance. Overtime the population evolved and unemployment rates rose along with: welfare dependency, poor education, overcrowded living conditions, and infectious diseases. This change in health and lifestyle lead to a rise in central obesity and early-onset type 2 diabetes.

The development of type 2 diabetes is associated with the off balance of both insulin sensitivity and secretion. A normal relationship between the two leads to normal glucose production. A main cause of insulin resistance is puberty. Statistics show that insulin sensitivity decreases by 30% during puberty and an increase of insulin secretion.

Once researchers knew what caused type 2 diabetes, they could start researching prevention methods. It has been proven by multiple studies that large lifestyle changes through dietary and physical adjustments are very effective with type 2 diabetes prevention and reduces the condition up to 60%. Weight loss is a major factor of prevention with 16% diabetes risk reduction for every kilogram of weight loss. Real life implementation studies in various populations have showed that less intense, lower cost lifestyles changes can be effective in the long term. Higher weight loss is reported in randomized control studies rather than less intense and less costly real-life implementation studies. However, little is known about the success in both these studies, the studies were to examine how successful weight loss can be in participants with high risk of type 2 diabetes.

One method of prevention is called the DE-PLAN project (Diabetes in Europe: Prevention using Lifestyle, physical Activity and Nutritional intervention). This prevention method was implemented in 17 countries across Europe. The study was conducted in nine independent Primary Health Care General Practitioners’ practices in Krakow, Poland. The study confused on everyday patients and people who lived in the city, all over 25 years old. Exclusion from the study was included: known diabetes or oral glucose tolerance test screen diabetes and also known chronic disease which would likely affect the study results. Questionnaires were given out in the practices. Patients with known risks were approaches by nurses or medical staff. Out of 800 questionnaires filled out, 184 participants completed the intervention study. The intervention followed the steps of the Diabetes Prevention Study, which was modified to the local health care. Nurses trained and certified in diabetes prevention gave the participants a ten-month plan focused on weight loss, reduced intake of total fat, reduced saturated fat intake, change from saturated to unsaturated fat, increase fiber consumption, and increase in physical activity. The first phase involved individual and group sessions to discuss diet and physical activity changes. Participants were encouraged to include their own social environment to the lifestyle adjustments.

After week four of the study, patients were offered recreational activities (aqua aerobics and gymnastics or football) twice a week and free of charge. Throughout the study the participants received six motivational phone calls and two letters. There was no further contact with the participants after the study except to receive measurements at one year. The results were examined after one year of the study. This showed that the participants weight was reduced by 5 kilograms and 23.4% lost 5% of their initial body weight. Most of the people who lost 5% of their body weight were women. In people who lost less than 5% of their body fat, there was not a large correlation between increased exercise and dietary changes. The results found that weight loss resulted in fat reduction and this was linked to glucose levels. A healthier lifestyle showed to balance out glucose levels proving that weight loss is a large factor in diabetes prevention. In the program 55% of the prevalence of type 2 diabetes over 3 years follow-up was explained by weight loss of 5 kilograms.

This is one of the first studies on how weight correlates to type 2 diabetes. This study shows how effective weight intervention is to reduce risk of type 2 diabetes. Weight loss was reported to be maintained by the participants even after the three-year mark.  According to BMC Public Health “in the current analyses we found that successful weight loss was independently predicted by a higher baseline BMI, lower education and a history of higher glucose, while among lifestyle factors, the reduction of total fat in the diet was a strong, independent predictor of successful weight reduction” (BCM Health). This study confirms that weight loss is a predominant factor in diabetes prevention. In the Diabetes Prevention Program 55% of the reduction in type 2 diabetes over 3 years follow up was explained by a weight loss of 5 kg. Diabetes prevention for people who are already at high risk is one of the biggest obstacles for the primary health-care. Even though the results of the study were modest, this calls for more efforts focused on prevention programs.

There have been many other studies that have had similar results to DE-PLAN. The Diabetes Prevention launches their own trial which was marked as the largest diabetes prevention studies with lifestyle changes to date with 3,234 participants. These participants were randomly given intense lifestyle modification programs to follow. This included: 850 mg of metformin twice a day (or placebo), 25% less calorie intake, 1200-1800 calorie diet and 150 minutes of exercise a week. The study was ended after three years because the data showed a “58% reduction in diabetes incidence in the lifestyle intervention group and a 31% reduction in the metformin group when compared to placebo” (Journal of Clinical Outcomes Management). Another method of weight loss is Bariatric Surgery. This surgery is considered for adults with a Body Mass Index above 35 and who have type 2 diabetes. This is more of intense approach if the diabetes has proven to be too difficult to handle with lifestyle changes or medicine. There are two different types of bariatric surgery. The first is called Gastric bypass surgery which involved shrinking the stomach (from the size of a fist to a thumb). This shortens the path food takes through the small intestine and limits the number of calories the body absorbs. This surgery cannot be reversed and is permanent after performed. The second form of surgery is Laparoscopic Gastric Banding. This is more popularly known as “Lap-banding”. This is a belt that is wrapped around the stomach that cinches the stomach so that the body will still feel full with less food in it. Unlike the Gastric bypass surgery this can be adjusted or reversed. Neither of these surgeries are cures for type 2 diabetes. These are only recommended to people who have tried lifestyle changing diabetes and saw little to no results. After either surgery it is recommended that patients still get regular screenings for people with diabetes, regardless if their glucose levels have normalized or not. The main risk factor of these surgeries is that people with normal blood glucose levels after surgery are at risk for hyperglycemia (excess of glucose in the bloodstream).

All of these methods show that the most proved and study approved way to prevent type 2 diabetes is through basic lifestyle changes. These include: less saturated fats, less calories intake, more fiber-based diet, and daily exercise. All of these factors contribute to weight loss which is the largest factor in reducing the likely hood of developing type 2 diabetes. If basic lifestyle changes can be made rather than resorting to bariatric surgery that is the less painful and costly way to prevent type 2 diabetes. While these studies have shown more moderate results, they prove that primary health care needs to focus their efforts on preventing quickly growing epidemic.

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