The Lancet recently published a Viewpoint piece challenging the very legitimacy of the term "Type 2 Diabetes." For a summary of the piece, see here. For an interview with the author, see this link.
Here on TuD, Natalie and others refer to Type 2 diabetes as a "garbage can diagnosis." In other words, it's not Type 1, it's not MODY (both defined by very specific testing), so let's throw it in the "garbage can" of Type 2 diabetes.
And let's not forget that no one with T2 is ever misdiagnosed as MODY or T1, but many, many people are misdiagnosed as T2. (Some people with MODY are also misdiagnosed as T1, but it doesn't happen very often.)
There are 54 genes involved in T2. I think they're up to 12 different disorders that fit into this one diagnosis.
I totally agree with Professor Gale. Type 2 is not a specific diagnosis. It is a "diagnosis by exclusion." If you carefully read the diagnosis guidelines from the AACE and the ADA. In fact, the AACE defines both T2 and Gestational Diabetes as being diagnosed by exclusion. And as acidrock often points out, the respected researcher Ralph Defronzo identifies 8 separate defects involved with the "spectrum" of T2.
So what is really sad is that diabetes diagnosis is really not done. If you walk into the ER with sudden onset of DKA, you will get an immediate T1 diagnosis. Only recently do they even start to bother with antibody testing. And if you walk into your GP with elevated blood sugar, you are diagnosed with "diabetes" simply based on high blood sugar. And since 90-95% of diabetes is dumped into a big T2 bin, everybody gets a T2 diagnosis. And unfortunately, this means that a significant number,perhaps even the majority of T1 patients get misdiagnosed because of this "cognitive dissonance." After all, you are T2 unless you are diagnosed with another form and if you don't attempt to test and diagnose any other form, then T2 fits. So we have a huge mess. The name doesn't matter, it is the diagnostic approach.
I have struggled for years to get better diagnostically guided treatment, but with overall failure. As a T2, I've been showered with all kinds of drugs which supposedly help my "insulin resistance," but they all fail. Apparently, my problem isn't really insulin resistance, it is some range of other defects which cause my fasting blood sugars to be chronically elevated.
I have to agree. We started with type 1 which as best as I can tell is specific.
For all other riots we assigned the type 2 moniker. There is not incorrect argument/comment here.
In fact for us type 2's what is the failure - liver, kidneys, reduced insulin generation due to aging/genes, environmental factors, thyroid issues, failing other hormones gpp5 glp1 etc. the reason we have had so many diagnostic failures is the clinging to type 1 specific thinking that all riots trace to - not enough insulin and if only we could throw more of that on the fire. (not)
The most successful drug metformin acts on the liver to stop excess liver glucose release when it should be fasting!
A most thought provoking discussion. Special thanks again brian (bsc) and David dns.
I also agree with Professor Gale - especially after my doctor ordered a test to see how much insulin I produce. Results? Normal insulin production. So.....why is my BG high? My doctor's only answer, "Insulin resistance."
I asked him why I'm always hungry & feel jittery & shaky most of the time. His answer: "Well, you're too thin." I'm NOT too thin; I'm 5'11" & 168 lbs. He may see me as too thin because he's too fat.
Sometimes I think doctors don't want to say "I don't know," so they make up an answer to sound intelligent & knowledgeable.