Is type 2 diabetes 'diabetes' as currently understood?

Blood glucose monitoring. Credit: Wikipedia

The current way of diagnosing type-2 diabetes using blood glucose levels needs to be revised, research by scientists from The University of Manchester and King's College London suggests.

The findings, published in the journal PLOS ONE today (3 September), show the current method of diagnosis - using - means patients are diagnosed too late so that their may already be damaged.

Type 2 diabetes, which affects over 90% of all adults with diabetes, often leads to heart damage and blood vessel problems in the brain, eyes and kidneys. It is closely linked to increasing levels of obesity, lack of exercise, unhealthy diets and our aging population.

The study focused on young, previously pregnant women followed up in Greater Manchester after being identified as at increased, intermediate and low risk of developing type-2 diabetes. Researchers examined biochemical markers in the blood before glucose became elevated – so before the patients reached the pre-diabetes stage.

Their findings show that changes in types of blood fat metabolites - naturally occurring particles that come from and make up fats in the blood - appear to be good indicators of developing type-2 diabetes. The changes in these particles were detectable well before changes in blood glucose that now define type-2 diabetes or pre-diabetes.

Professor Kennedy Cruickshank, lead author of the study and Professor of Cardiovascular Medicine and Diabetes, in the Division of Nutrition at King's College London, formerly at The University of Manchester, said his team's findings could be important for future diagnosis and, in turn, treatments.

Professor Cruickshank said: "We found that several groups of fat metabolites, also linked to body fat, were changed in the blood, as were others including some amino acids and to some extent vitamin D, before increased.

"Blood vessels become damaged as part of the condition, but problems in the vessels arise before high blood sugar sets in during a 'pre-diabetes' period.

"The current method of categorising type-2 diabetes solely by a patient's glucose level means that many will already have suffered blood vessel damage and will experience poorer outcomes.

"Our study overall adds weight to the argument that type-2 diabetes should not be classified as 'diabetes' as we currently understand it from just measuring ."

The authors argue that rather than concentrating purely on glucose-directed treatments, which do not improve blood vessel health, a new, quite different definition of type-2 diabetes is required, partly based on the distribution of fat metabolites in the blood in the pre-diabetes stage.

Dr Simon Anderson, co-author of the study and National Institute for Health Research Clinical Lecturer in Cardiology from The University of Manchester, said: "This long-term study of women in Greater Manchester adds to growing evidence about the major role that fats and fat metabolites play in the health of blood vessels, and in diabetes per se.

"To help clarify the metabolic conditions that lead to the development of type-2 diabetes, further assessment of the total chemicals in the blood – the metabolome - is necessary.

"In the long-term we aim to identify a biomarker or a disorder in a chemical pathway that is linked to blood vessel health and subsequent diabetes.

"Ultimately this might translate into a specific blood test to identify people at risk of type-2 diabetes early on but most importantly, it may allow advice on lifestyle modification at an earlier stage to reduce the long-term impact of diabetes."

The team say more work is now needed to validate this alternative approach to diagnosing, treating and preventing diabetes.

Work is now ongoing at King's to establish earlier treatments for vessels and the heart in people at risk of diabetes, while researchers in Manchester are looking at the risk of developing diabetes for children born from mothers with gestational diabetes and varying degrees of fatness.

Explore further

Blood glucose levels measured in hospitalized patients can predict risk of type 2 diabetes

Journal information: PLoS ONE

Citation: Is type 2 diabetes 'diabetes' as currently understood? (2014, September 3) retrieved 24 August 2019 from
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Sep 07, 2014
I suffer from Idiopathic Neuropathy/Poly-neuropathy and Fibromayalgia, both official diagnosis. According to my best blood test results, after repeating testing, I don't have a blood sugar disorder, so the doctor says I don't have Diabetes.

My nerve pains cover my entire body (except when treated with Neurontin) and are worse than what is described in those Diabetic Nerve Pain medicine commercials.

My neurologist who shall remain nameless claims I do not have a neurological disorder, but there may be some "unknown poison or toxin," in my body. On the other hand, my primary care provider claims I do have a neurological/neuromuscular problem, but that he doesn't know what it is and doesn't think anyone can diagnose it better than he already has. His exact words were something like, "Maybe they'll know after an autopsy, but you won't be alive then." That may be a coarse joke, but it's what he said.

Sep 07, 2014
In addition to two different types of Pins and Needles sensations, one "prickly" and ranging from minor to moderately severe, and the other "hard jabbing," and ranging from moderate to level 10 pain, I also experience, sometimes, a burning sensation. The Pins can be anywhere.

AT the neurology clinic, each time I go I fill out the symptoms page, and I feel almost like I have to make up new entries in the margins, because their page doesn't have check boxes for my symptoms.

This is NOT "Tingling" and it's freaking stupid as hell that Neurologists classify this as "Tingling".

Then the last time I saw the neurologist, I had described my pain level to him EVERY time, and I started talking abotu the symptoms again, and he's like, "You don't feel that much pain do you?"

I'm like, "Yeah, it's been like that the whole time. I've been telling you and the nurses that for a year now."

Anti-depressants do not stop the pain. Only thing so far that does is Neurontin.

4*600mg per day currently.

Sep 07, 2014
If it is Diabetes, I don't know what I'm supposed to do about it. I eat much less sugar and starches than I did when these symptoms first appeared.

I also experience:
-Persistent, random "bone pain" or "deep bruising" sensation, even though there is no outward evidence of injury. Mostly in the radius and ulna of the arm, and in the tibia of the leg.
-Extreme muscle weakness and loss of endurance.
-Syncopy/near-syncopy with minor exertion
-increased ocurance and severity of boils in the upper legs and lower torso
-Strange rashes and lesions at random times in the scalp and sides of face (no correlation to soap or shampoo, as I've tested it). however, this particular symptom has gone down a lot compared to say a year ago.
-Vitamiin D deficiency
-Calcium excess
-Iron normal
-Iron feritin serum (or whatever it is) more than twice above maximum.

-most recently, extreme pain in right side of neck while mowing grass, resulting not in incapacitation, but dire urgent feeling of "stop now".

Sep 07, 2014
I am concerned that I may have experienced some sort of heat stroke, or the passing of a clot. I was cutting early in the morning to avoid the heat of the day, but even still I was sweating bullets, so it's possible it was heat stroke, I don't know.

anyway, I'm no expert on biology, but it occurs to me that anything related to Glucose would also be related to mitochondria, ATP, NAD/H. Why not test for the ratios of Glucose to those two chemicals in the blood? And if blood isn't a reliable enough tissue to sample, maybe try a small muscle tissue biopsy (from some standardized location).

It stands to reason to me that if Glucose, an energy carrier, isn't being processed properly by the body, then maybe one of these other molecules isn't being processed properly either, and perhaps, since those are recycled whilst glucose mainly comes from food and fat, they would be better markers.

Since they are supposed to be recycled, then if they are out of balance it would be a better marker.

Sep 07, 2014
I don't know what is the underlying cause of the symptoms I have, but I'd be willing to participate in any study of "possibly misdiagnosed Type 2 Diabetes candidates" or whatever.

I don't think it's Diabetes though, because I know and meet them all the time, and what I experience is more wide spread and more painful than what they describe. They typically describe the pain in their feet or hands.

The first time I experienced the symptoms it was in the crown of my head, and over the years it worked it's way down my entire body to the feet, with the worst "Jabbing needles" symptoms being in the eyes, the left cheek, left tricep, groin, BACKS of the hand, yes the feet, and finally those weird, deep bone pains, and the wide-spread prickly sensation which can be anywhere and everywhere at the same time.

Either I have a worse case of the same thing, or I have something else entirely which is just plain worse.

Sep 07, 2014
Oh yeah, I have bought a blood glucose test kit and have used it during the worst pain episodes a few times, and got normal glucose readings in the 80's each time.

I have, on several occasions, considered taking locks of my hair, and a collection of finger and toe nail clippings to a forensic crime lab (at LSU) to see if they could analyze them for any potential evidence of toxins which wouldn't be found by ordinary medical tests. I've always been ashamed to do it though, because I guess that suggests you know, if it was to come back positive, that someone might be doing this to me on purpose.

Controlling the pain is not enough. That's just treating symptoms.

Somebody has to be able to figure out the real cause so they can actually treat the disease. I'm on 6 times as much pain medicine as at the start.

Sep 07, 2014
Who cares?

Sep 07, 2014
Who cares?

He'll be caring if the people at the institute read physorg and realize they let him out too soon. He is not ready yet.

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