I do have one straight forward question. In 1960 what was the criteria to diagnose t2? It seems that A1cs and portable meters were not around.
Just curious I have not seen much info about it.
This may sound ridiculous, but the main criterion was . . . . age. If you were a child, you were T1. If an adult, T2 until proven (dramatically or even catastrophically) otherwise.
Exception: if diabetes was caused by actual damage to the pancreas due to disease or injury, they usually got it right. Usually.
I donât believe the distinction between Type 1 and Type 2 was even known back in the 1960s, beyond the fact that children tended to be diagnosed with extremely high blood sugar and ketones and would die without insulin, while adults tended to be diagnosed with lower blood sugar and no ketones and could survive for years. Diabetes was just diabetes, âjuvenileâ if you were diagnosed as a kid, âadult onsetâ if you were diagnosed as an adult. I donât think whether you took insulin or not played into the labelling at all, and I donât think adults were denied insulin if their blood sugar was extremely high. It was only when they discovered that âjuvenileâ diabetes was actually caused by autoimmunity that the labelling became an issue. When I was diagnosed in 1991, my diabetes was called âinsulin dependent diabetes mellitusâ (since autoimmunity meant needing insulin for survival) and the other type was ânon-insulin dependent diabetes mellitusâ. Then at some point in the '90s âType 1â and âType 2â came along, since so many adults were using insulin but didnât have autoimmunity as the underlying causeâŚ
@mary 37 I totally agree. Which is why it is important to understand how others define prevent so that we are speaking the same language.
@Mary37 a clinician posed the question. As a fellow clinician I was seeking to share the perspective of clinicians since this is whom most people living with disease interact with. I thought it might be a good idea to share the perspective of a clinician to facilitate understanding when you (in general) interact with other clinicians.
I thank you for the reminder that that is the preferred language is nonclinical. Please know going forward I will limit the clinical perspective and stick to opinion.
@Mary37 thank you for your perspective. It is my opinion that the manner in which the DPP is used as an example is rather out of context and narrow. The study, unfortunately was not conducted nor were the findings written for an audience that has not received academic preparation on research methodology. Contextual factors must be taken into consideration when one makes blanket statements as has been posed in this thread.
As a critically thinking person, as you all are, and having read all the responses here, I am moved to wonder whether the manner in which âpreventâ âpreventionâ âpreventingâ is (dare I say) operationalized within the context of this thread, mirrors the definition as it has been operationalized in the research hypotheses of the DPP.
The conversation in my opinion is rather lopsided as no one is offering any opinion on the efficacy of metformin or placebo in âpreventingâ or âdelayingâ the progression of pre diabetes to T2DM. No_** one is using the _statistically significant_ findings that measured the extent to which any of the interventions used in the study (dare I say) âpreventedâ prediabetes progressing to T2DM_._ I understand that part doesnât matter in this conversation, so we wonât discuss it.
If one is going to use the DPP as the litmus test to answer whether "lifestyle modification prevents"⌠then one should be equally prepared to argue their position pertaining to whether "metformin prevents" or "placebo prevents" the progression of pre diabetes to T2DM critically within the context of the study.
Once again, thank you for your response.
This is beginning to remind me of Bill Clintonâs dissertation on the meaning of âisâ. 
3 Likes
Exactly my thought!!!
Seems to me @Mary and @Jojeegirl are WAY over thinking the original question.
Itâs just a guess on my part but the HUGE majority of users here are not clinicians and will interpret the word âpreventâ and itâs forms in common language usage.
I also believe the OP asked for opinions and not a theorectical discussion of word meanings in slang, common language or technical contexts.
My personal thought (opinion) on the topic is that manifestation of T2 symptoms is probably âpreventableâ and may be reversible in a subset of people who would otherwise experience them. The âpreventionâ can be accomplished by living a ânon-sedentaryâ life style and controlling food intake. I hesitate to place restrictions on the food type because I believe a lot of the âdataâ weâre given today related to âhealthyâ foods is nothing but advertising.
As for âcuringâ T2, itâs currently not possible but may be someday assuming we can identify and âfixâ the associated genetic component(s).
This is just my âopinionâ, itâs based on anecdotal âdataâ and extrapolation from personal experience.
BTW: Iâm T1 LADA.
Wheelman
1 Like
Nice to see you, Wheelman. Been a while. 
@mary37. It is possible that I have misunderstood the discussion question. I was under the impression the question pertained to the prevention of type 2 diabetes in populations who donât have type 2 diabetes which doesnât require any anti hyperglycemic.
Yeah, I pop in and out from time to time but havenât posted much.
I couldnât resist this thread though, the tangent it took caught my attention, I just had to participate. 
@jojeegirl. The thread topic and original post include forms of the words âpreventionâ, âreversalâ and âcureâ implying a discussion of âanti-hyperglycemicsâ is valid due to an assumption that a reversal or cure requires a manifestation.
Wheelman
1 Like
@wheelman The OP stated:
âMy purpose in starting this topic is to open a conversation surrounding the belief that diabetes, particularly Type 2, can somehow be prevented from developing in the first place, by following a âhealthy lifestyleâ (the meaning of which is an entirely separate and contentious topic on its own).â
Either I am as ignorant as a bag of rocks or the original poster was referring to populations who have not received a diagnosis of type 2 diabetes or have glucose levels indicative of impaired fasting glucose or impaired glucose tolerance. I, as well as the OP, am included in that descriptionâthe description being "_ diabetes, particularly Type 2 can somehow be prevented from developing in the first place."_ .
From my perspective it is clear that the OP was referring to folks w/o T2DM when she stated in writing, ""can somehow be prevented from developing in the first place."
From what I understand from what the OP has shared with the support group sheâs a parent of a child with T1DM. Itâs not necessary for me to explain the differences between T1DM and T2DM. You all understand the differences. I understand the inclusion of antihyperglycemics in the context of individuals diagnosed with type 1 diabetes. But individuals who have no diagnosis whatsoever of any type of diabetes? Where do antihyperglycemics fit?
@Wheelman, I close my response to you by highlighting the many public service announcements that are on television lately concerning Zika virus prevention. I donât know whether or not I will be bitten by a mosquito carrying the virus. What I do know is that I will use mosquito repellant to reduce my risk or the likelihood of being bit by any mosquito. I will do it as a form of prevention. I would not be so dogmatic to say that I will not get bitten by a Zika virus carrying mosquito, but I am surely going to reduce my risk of being bitten by any mosquito.
Thanks so much for the interchange.
@rgcainmd I am now very curious to know the perspective of an MD as to what advice do you give your patients who have not yet been diagnosed with T2DM as you describe in your original posting but have impaired fasting glucose or impaired glucose tolerance?
a) metformin
b) lifestyle modification
c) placebo
d) continue to do as you are doing
I include the link that details the standard followed by the American Association of Clinical Endocrinologists as it pertains to âprediabetesâ and diabetes.
https://www.aace.com/publications/algorithm
In advance, I thank you for your response.
Iâm not exactly sure how I would know if a patient of mine was going to be diagnosed with diabetes. I received two capital letters after my last name plus a ginormous amount of debt when I graduated from med school, not a crystal ballâŚ
I am of the belief that there are two kinds of people in this world: those who have diabetes (in one of many types) and those who do not have diabetes.
1 Like
@rgmainmd I thank you for honest response. 8))
I would add
- those who are at elevated risk for developing type 2 diabetes. And like many conditions, risk factors can be to some extent moderated (if weâre willing to acknowledge that they exist)
There is a difference between 100% prevention and moderating risk. Is that the sticking point that people are protesting? Iâm not sure anymoreâŚ
Jojeegirl,
I read the entire first post, considering the opening paragraph included statements referring to rgcainmdâs opinion regarding âcureâ and âreversalâ of T2D I, as I assume many others would, inferred those ideas were fair game in the discussion. I did not intend to insinuate you were âas ignorant as a bag of rocksâ, please afford me the same courtesy.
I assume your second message to me above is meant to instruct me in the idea that taking preventive measures will not guarantee a positive outcome but may improve the chances of such and cannot hurt. If this is true I didnât need the example as I fully understand the principle.
Iâm out!
Wheelman
1 Like
@Wheelman I apologize for having offended you. That certainly was not my intention. Be well.
Actually, you could just wave your hand over their head and proclaim the chance of being diagnosed with diabetes as one in three. Since the majority of people diagnosed with prediabetes move on to diabetes no matter what intervention is done and one third of the US has diabetes or prediabetes the chances that some random patient is going to be diagnosed with diabetes is one in three.
Given that the doctors have an average diagnostic accuracy of about 70%, the waving of the hands technique seems to have a ânot too shabbyâ accuracy.
ps. An I believe all humans contain at least some of the defects that make us vulnerable to diabetes, but some of us are able to evade those defects manifesting before we die.
3 Likes
in my stepdad´s family, there were ten children. they had a family history of T2 and my stepfather did lots of exercise and ate healthy for the most part, died young, so who knows. but one of his sisters is hypervigilant. she is basically carb free, walks about 10 km a day. she has great bloodwork. she does it all to make sure she avoids the D. she is the oldest, about 75 now.
two other siblings died from complications of D. another sister is determined not to get it and checks her blood sugar and does lots of jumping jacks when she sees a high number. but she sees the high numbers. when she gains weight she turns straight into a little barrel. at age 70, she has spectacular legs-her shorts are shorted than mine-and sitting on top of those two fab pins is a little round weeble-that typical type 2 shape.
so anecdotally, in my stepdad´s family, one of the siblings has been able to prevent it through a lot of work. another is working not as hard and seeing the high numbers at times. the two that died, well, my aunt theresa´s favourite thing was crumbcake.
i think to prevent it if you are predisposed, youve got to be so vigilant and give up a lot. and thats really hard when your bloods are normal!