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Development Of Type 2 Diabetes

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Do Artificial Sweeteners Increase Diabetes Risk

How type 2 diabetes develops

Artificial sweeteners are man-made, sweet-tasting substances that cannot be metabolized by humans for energy. As such, they provide sweetness without any calories.

Though artificial sweeteners dont spike blood sugar levels, they have still been linked to the development of insulin resistance and type 2 diabetes .

Drinking just one can of diet soda per day has been associated with a 2567% increased risk of type 2 diabetes, compared to drinking no diet soda at all .

Its unclear why artificial sweeteners increase diabetes risk, but there are a variety of theories.

One thought is that artificially sweetened products increase cravings for sweet-tasting foods, leading to higher sugar consumption and weight gain, which increases diabetes risk .

Another idea is that artificial sweeteners disrupt your bodys ability to properly compensate for calories consumed from sugar since your brain associates the sweet taste with zero calories .

Some research has found that artificial sweeteners can change the type and number of bacteria that live in your colon, which may contribute to glucose intolerance, weight gain and diabetes .

While there does appear to be a link between artificial sweeteners and diabetes, more research is needed to understand exactly how theyre related.

Disordered Fat Storage Enhances Development Of Type 2 Diabetes

Diabetes is a devastating, life-changing condition. Professor André Carpentier and his colleagues from Université de Sherbrooke are exploring how obesity increases the risk of type 2 diabetes. After all, abnormal fat storage can lead to insulin resistance, which endangers organ function. Through his and his teams research, Dr Carpentier aims to develop therapeutic measures which reverse detrimental pre-diabetic effects.

In 2015, diabetes mellitus was the sixth leading cause of death worldwide. This chronic metabolic disorder results in insufficient glucose uptake from the blood, due to abnormal insulin activity. Pancreatic cells secrete the hormone insulin into the blood where it triggers skeletal muscle, liver and fat cells to absorb and store glucose. Irregular insulin activity can lead to hyperglycaemia which in the long-term can cause kidney disease, cardiovascular complications, foot ulcers and eye damage.

Insufficient insulin activity arises from either:

  • an autoimmune response, leading to a loss of pancreatic cells and dangerously low insulin levels , or
  • cells that become insulin resistant and are unable to respond to insulin signals with an inability of pancreatic cells to compensate by secreting enough insulin to counter this insulin resistance .
  • Environmental factors such as obesity, smoking or a high, low-quality fat and carbohydrate diet all increase the risk of T2D development.

    Effects Of Position In The Social Status Hierarchy

    It is well established that living in poor economic circumstances affects people’s health, but it is only within the past few decades that we have come to recognize that there is a social gradient in health such that even middle-class people have more diseases and shorter life expectancies than do people just a step higher in the social hierarchy . is the most studied measure of social position in developed countries, it is typically measured as education, income, and/or occupational prestige.

    It has been shown that the prevalence of health-adverse behaviors increases with decreasing social position , and it has also been shown that the latter is associated with increasing exposure to stressors such as poor social circumstances and psychological challenges . For example, Canadian data have shown that self-reported chronic stressors ranging from marital issues to neighborhood, job, financial, and life stressors were all more common as income decreased . Monden and colleagues have also demonstrated that people with lower education reported significantly more stressful work factors .

    It has repeatedly been demonstrated in cross-sectional studies that T2D rates increase with decreasing socioeconomic position but it has also been argued, without clear evidence, that having T2D affects a person’s ability to maintain a high social standing. There is a need for longitudinal studies demonstrating that having T2D changes a person’s SES to support this view.

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    What Are The First Symptoms Of Type 2 Diabetes

    Many people with type 2 diabetes do not experience any symptoms at first and it may go undiagnosed for years. If they do have symptoms, these may include:

    • being very thirsty
    • having cuts that heal slowly

    Over time, diabetes can lead to complications, which can then cause other symptoms.

    Blood glucose testing is important for detecting pre-diabetes and type 2 diabetes before complications arise.

    These Are Some Of The Statistics:

    The different steps in the development of type 2 diabetes ...
    • 80-90% of people with Type 2 diabetes have other family members with diabetes.
    • 10-15% of children of a diabetic parent will develop diabetes.
    • If one identical twin has type 2 diabetes, there is up to a 75% chance that the other will also be diabetic.
    • There are many genetic or molecular causes of type 2 diabetes, all of which result in a high blood sugar.
    • As yet, there is no single genetic test to determine who is at risk for type 2 diabetes.
    • To develop type 2 diabetes, you must be born with the genetic traits for diabetes.
    • Because there is a wide range of genetic causes, there is also a wide range in how you will respond to treatment. You may be easily treated with just a change in diet or you may need multiple types of medication.

    The hallmark of type 2 diabetes is resistance to the action of insulin and insufficient insulin to overcome that resistance

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    Managing Type 2 Diabetes

    Managing type 2 diabetes requires teamwork. Youll need to work closely with your doctor, but a lot of the results depend on your choices.

    Your doctor may want to perform periodic blood tests to determine your blood glucose levels. This will help determine how well youre managing the condition. If you take medication, these tests will help gauge how well its working.

    Your doctor may also recommend a home monitoring system to test your own blood glucose levels between visits. Theyll explain to you how often you should use it and what your target range should be.

    Because diabetes can increase your risk of cardiovascular disease, your doctor may want to monitor your blood pressure and blood cholesterol levels. If you have symptoms of heart disease, you may need additional tests. These tests may include an electrocardiogram or a cardiac stress test.

    It may also be helpful to bring your family into the loop. Educating them about the warning signs of blood glucose levels that are too high or too low will allow them to help in an emergency.

    Summary Of Main Results

    We included 103 prospective cohort studies from many parts of the world evaluating people with IH, usually defined using the IFG5.6 or IFG6.1 threshold, IGT, combined IFG/IGT or elevated HbA1c. However, we did not identify studies involving black Africans or Eastern Europeans. Participants were of Australian, European or North American origin in 41 studies primarily of Latin American origin in 7 studies Asian or Middle Eastern origin in 50 studies American Indians in 3 studies Mauritians in 1 study and Nauruans in 1 study. Six studies included children, adolescents or both.

    Ninetythree studies contributed data to estimate the overall prognosis of people with IH, and 52 studies evaluated baseline glycaemic status as a prognostic factor by comparing an IH cohort with a normoglycaemic cohort.

    Cumulative incidence of T2DM for the IFG5.6 threshold, the IFG6.1 threshold, IGT, combined IFG/IGT and elevated HbA1c, showed increasing percentages over followup time however, there was no clear linear increase over time. Regression rates to normoglycaemia, though decreasing over followup, showed fluctuations and no clear linear decrease over time. The estimates of the prognostic effect of IH versus normoglycaemia were comparable when using HR, IRR or OR across the different definitions of IH. There was no clear pattern of risk differences between geographic regions.

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    Gregor Mendel: Father Of Genetics

    The idea of particulate inheritance of genes can be attributed to the monk who published his work on pea plants in 1865. However, his work was not widely known and was rediscovered in 1901. It was initially assumed that only accounted for large differences, such as those seen by Mendel in his pea plants and the idea of additive effect of genes was not realised until ‘s paper, “” Mendel’s overall contribution gave scientists a useful overview that traits were inheritable. His pea plant demonstration became the foundation of the study of Mendelian Traits. These traits can be traced on a single locus.

    Pharmacotherapy Therapy For Type 2 Diabetes Mellitus

    Understanding Type 2 Diabetes

    Current therapeutic agents available for type 2 diabetes mellitus include sulfonylureas and related compounds, biguanides, thiazolidenediones, -glucosidase inhibitors and insulin . In addition, several other classes of therapeutic agents will soon become available. A rational approach would be to begin with the agents particularly suited to the stage and nature of the disease, progressing, if necessary, to combination therapy. Pharmacological agents acting through different mechanisms of action should be chosen to improve glucose values while minimizing adverse effects.

    Repaglinide is a new agent that binds to pancreatic -cells and stimulates insulin release. It is structurally different from sulfonylureas and binds to a nonsulfonylurea receptor . The drug is taken preprandially and has a rapid onset and limited duration of action, which may decrease the incidence of weight gain and hypoglycemic episodes. Limited published clinical data demonstrate an efficacy similar to that of sulfonylureas as with sulfonylureas, repaglinide shows an added benefit when given with metformin .

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    Will I Need Medication Or Insulin For Type 2 Diabetes

    Some people take medication to manage diabetes, along with diet and exercise. Your healthcare provider may recommend oral diabetes medications. These are pills or liquids that you take by mouth. For example, a medicine called metformin helps control the amount of glucose your liver produces.

    You can also take insulin to help your body use sugar more efficiently. Insulin comes in the following forms:

    • Injectable insulin is a shot you give yourself. Most people inject insulin into a fleshy part of their body such as their belly. Injectable insulin is available in a vial or an insulin pen.
    • Inhaled insulin is inhaled through your mouth. It is only available in a rapid-acting form.
    • Insulin pumps deliver insulin continuously, similar to how a healthy pancreas would. Pumps release insulin into your body through a tiny cannula . Pumps connect to a computerized device that lets you control the dose and frequency of insulin.

    The Insulin Resistance Syndrome

    Individuals with type 2 diabetes are more likely to be diagnosed with other medical problems such as atherosclerosis, coronary artery disease, hypertension, obesity and dyslipidemia. Insulin resistance is thought to worsen and possibly directly cause these problems. The optimal medical care of type 2 diabetes includes not only controlling the blood glucose but also treating high blood pressure, high cholesterol or triglycerides, reducing excess weight and staying physically fit.

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    Industry Influence On Research

    In 2015, the New York Times published an article on the , a nonprofit founded in 2014 that advocated for people to focus on increasing exercise rather than reducing calorie intake to avoid obesity and to be healthy. The organization was founded with at least $1.5M in funding from the , and the company has provided $4M in research funding to the two founding scientists Gregory A. Hand and since 2008.

    Accuracy Of Diabetes Test Results

    Schematic representation of the development of Type 2 ...

    Depending on the test used, the level of blood glucose can be affected by many factors including:

    • eating or drinking
    • taking medications that are known to raise blood glucose levels, such as oral contraceptives, some diuretics and corticosteroids
    • physical illness or surgery that may temporarily alter blood glucose.

    If you think any of the above may have influenced your result, then it is important to discuss this further with your doctor.

    If you don’t have diabetes, but your glucose levels are higher than normal, this is called pre-diabetes and it includes one or both of:

    • impaired fasting glucose IFG
    • impaired glucose tolerance IGT .

    Diabetes can be delayed or prevented in some people with pre-diabetes by:

    • increasing physical activity
    • following a healthy eating plan developed by a dietitian
    • losing 510 per cent of their body weight, if they are overweight.

    Talk to your doctor about how you can reduce your risk of developing diabetes.

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    How Is Type 2 Diabetes Managed

    Theres no cure for Type 2 diabetes. But you can manage the condition by maintaining a healthy lifestyle and taking medication if needed. Work with your healthcare provider to manage your:

    • Blood sugar: A blood glucose meter or continuous glucose monitoring can help you meet your blood sugar target. Your healthcare provider may also recommend regular A1c tests, oral medications , insulin therapy or injectable non-insulin diabetes medications.
    • Blood pressure: Lower your blood pressure by not smoking, exercising regularly and eating a healthy diet. Your healthcare provider may recommend blood pressure medication such as beta blockers or ACE inhibitors.
    • Cholesterol: Follow a meal plan low in saturated fats, trans fat, salt and sugar. Your healthcare provider may recommend statins, which are a type of drug to lower cholesterol.

    How Can I Manage My Type 2 Diabetes

    Managing your blood glucose, blood pressure, and cholesterol, and quitting smoking if you smoke, are important ways to manage your type 2 diabetes. Lifestyle changes that include planning healthy meals, limiting calories if you are overweight, and being physically active are also part of managing your diabetes. So is taking any prescribed medicines. Work with your health care team to create a diabetes care plan that works for you.

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    Overview Of Complete Data Set And Certainty Of The Evidence

    provides a succinct overview of the overall prognosis of people with IH as well as regression from IH to normoglycaemia over 1 to 20 years of followup.

    provides a succinct overview of IH compared with normoglycaemia as a prognostic factor for developing T2DM according to geographic regions/special populations and type of outcome measurement.

    shows the overall prognosis of IH as measured by cumulative incidence over different followup periods and across all populations, as well as regression from IH to normoglycaemia.

    Overall prognosis of people with intermediate hyperglycaemia associated with measures of intermediate hyperglycaemiaHbA1c5.7/HbA1c6.0: glycosylated haemoglobin A1c 5.7%/6.0% threshold IFG5.6/6.1: impaired fasting glucose 5.6/6.1 mmol/L threshold IGT: impaired glucose tolerance

    shows IH versus normoglycaemia as a prognostic factor for developing T2DM measured by IRR, OR or HR across all populations.

    Intermediate hyperglycaemia versus normoglycaemia as a prognostic factor for developing type 2 diabetes HbA1c5.7/HbA1c6.0: glycosylated haemoglobin A1c 5.7%/6.0% threshold IFG5.6/6.1: impaired fasting glucose 5.6/6.1 mmol/L threshold IGT: impaired glucose tolerance IRR: incidence rate ratio OR: odds ratio HR: hazard ratio

    Genetics And Beta Cell Function

    Treatment and Management of Type 2 Diabetes

    Some individuals have a genetic predisposition to the development of type 2 diabetes. Typically, these patients have genetic mutations in various genes that regulate beta cell function. These individuals are often diagnosed early in life . However, it is believed that the genetic etiology of type 2 diabetes is minimal, with most patients developing the disease due to environmental factors.

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    Summary Of Findings 5

    Summary of findings: risk of intermediate hyperglycaemia versus normoglycaemia for developing T2DM

    Outcome: development of T2DMPrognostic factor: intermediate hyperglycaemia as measured by combined IFG and IGT
    No of studies No of participants with intermediate hyperglycaemia Geographic region/special population Overall certainty of the evidence a
    HR: 3 HR: 10.20 IRR: 11.20 OR: 6.99
    HR: 3.80 IRR: 13.92 OR: 20.95
    HR: 0
    HR: 6.90 IRR: 10.94 OR: 13.14
    CI: confidence interval HR: hazard ratio IFG: impaired fasting glucose IGT: impaired glucose tolerance IRR: incidence rate ratio NA: not applicable N/M: fewer than 3 studies or calculation of the 95% prediction interval did not provide a meaningful estimate OR: odds ratio T2DM: type 2 diabetes mellitus.
    GRADE Working Group grades of evidenceHigh quality: further research is very unlikely to change our confidence in the estimate of effect.Moderate quality: further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.Low quality: further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.Very low quality: we are very uncertain about the estimate.

    Limitations In The Review Process

    As described in the section, it was difficult to define a reliable search strategy, which probably holds true for many systematic reviews of prognostic studies. We noted that when checking other systematic reviews on the topic and the references of the included studies, around one third of our included studies were identified through reference checking. However, using PubMed’s ‘similar articles’ algorithm did not yield new studies but did help us identify 13 secondary publications of studies we had already included. The 103 prospective cohort studies included in this review represent by far the largest amount of data synthesised on the overall prognosis of IH and the impact of IH versus normoglycaemia as a prognostic factor for T2DM development. We did not contact study authors for additional information, mainly for logistical reasons but also because we anticipated poor response, since many studies were published long ago. Moreover, retrieval of additional information, often demanding recalculations, would have imposed a considerable burden on study authors.

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