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Type 2 diabetes: not 1 type of disease, not 1 type of treatment

Blogger: Suzan Wopereis

15 October 2018 • 3 min reading time

Today, a fairly simple examination is all that is needed for doctors to reach a diagnosis of type 2 diabetes. They measure ‘fasting glucose levels’ to find out whether a person is suffering from impaired sugar regulation. If that is indeed the case, the patient is initially given general lifestyle advice (eat healthier food and take more exercise). Despite this, however, many have to start taking medication within three months. But if you believe medication is the ultimate answer to the growing problem of type 2 diabetes, then you are living in yesterday’s world. If you believe there is just one type of type 2 diabetes, then you are living in today’s world. Only when you can offer people with type 2 diabetes the opportunity to reverse their disease, by means of personalized lifestyle advice, are you truly a healthcare professional of the future.

Yesterday and today: treating symptoms with medication

Given the current diagnosis and medication-driven treatment, it seems to be a relatively simple matter to keep type 2 diabetes (also known as age-related diabetes or DM2) under control. After all, sugar regulation can be effectively managed with today’s medications. Many believe that the problem has been solved. Yet, in the Netherlands alone, more than 900,000 people are currently suffering from DM2. Moreover, scientific studies have shown that – in many cases – these people’s medication is repeatedly modified and the dose increased. This goes on until, at a given point, doctors turn to insulin injections as a last resort.

Tomorrow: using lifestyle interventions to reverse type 2 diabetes

Surely things will be done differently in the future? Indeed they will, in fact we can get started tomorrow. The best way to understand how we can do things differently tomorrow is to learn more about how DM2 develops. We associate DM2 with ‘impaired sugar regulation’, but it can have a variety of causes. DM2 basically results from the interaction between an individual’s genetic predisposition and their way of life. In genetically susceptible individuals, a poor lifestyle (unhealthy eating habits, little exercise, a lot of stress, little sleep) can disrupt metabolic processes. This can trigger a low-grade, chronic inflammatory process that disrupts the action of insulin, causing blood glucose levels to rise. This, in turn, results in high blood insulin levels. Unless DM2 patients make the necessary lifestyle changes, this inflammation will persist.

“Unless type 2 diabetes patients make the necessary lifestyle changes, this inflammation will persist”

Cause and intervention are personal

However, the only really effective way to reverse DM2 tomorrow is to examine the cause in even greater detail. Here’s why. An unhealthy lifestyle causes the growth of fatty tissue, especially around organs. As a result, inflammatory reactions can easily be triggered around these organs. In liver cells and muscle cells, this can disrupt glucose absorption, resulting in insulin resistance. It can also affect the pancreas, disrupting insulin production. So three different organs (liver, muscle and pancreas) can disrupt sugar regulation. As you will probably have guessed, lifestyle interventions are a particularly effective way of restoring normal sugar regulation.

Successful trial involving targeted lifestyle interventions

This brings us to a general practice at Hillegom, in the Netherlands, where we have been testing this new way of tackling DM2. We gave people who had only recently been diagnosed with DM2 an oral glucose tolerance test. This shows how their bodies are processing glucose, i.e. how much insulin the pancreas is still producing and the extent of insulin resistance in liver and muscle cells. Patients whose insulin resistance was mainly related to their liver were placed on a very low calorie diet, under the supervision of a dietitian. Those with insulin resistant muscles did weight training several times a week, under the supervision of a physiotherapist. Our findings showed that these targeted lifestyle interventions were more effective than the standard treatment for DM2. We are now working to further refine this approach.

“Our findings showed that these targeted lifestyle interventions were more effective than the standard treatment for type 2 diabetes”

Tomorrow starts today!

People often say “Everything will be alright tomorrow”. Let’s make this happen for those suffering from DM2 and other diseases where an underlying inflammatory process can be identified. This helps us understand how a disease develops, so we can leave yesterday behind and leap ahead to the day after tomorrow. Then, by identifying the underlying problem in each individual patient, we will know which specific intervention is needed to treat that particular case. As far as we are concerned, the future started yesterday, in Hillegom. Will you be joining us tomorrow?

This TNO project supports the following Sustainable Development Goal

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Do you have any questions? Please contact Suzan Wopereis.

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