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[IP] RE: prevalence of Type 1 diabetes in adults and children



While there is no denying that all patients with Type 1 require insulin
for survival, I am not aware of ANY scientific journal that has
documented that expediting the speed by which they are placed on
exogenous insulin does ANYTHING to prevent further destruction of
residual beta cells.  If that were true, then maintaining glycemic
control would be relatively easy because patients could be maintained in
a perpetual honeymoon period indefinitely, making glycemic control
infintely easier as well as providing additional counterregulatory
function to protect from hypoglycemia.  Obviously, that does not happen,
even among those who were diagnosed at a very young age.  Also, the
possibility of diabetes complications being reduced from putting someone
on exogenous insulin quickly is most unlikely, as the consensus is that
nothing short of sustained eyglycemia will eliminate the possibility of
complications.  Recent studies have shown that C-peptide plays a role in
reducing the incidence of complications.  Studies have shown systemic
administration of C-peptide improved vascular, neural, and renal
dysfunction in NOD diabetic rats, decreases glomerular filtration, and
increases renal plasma flow in type 1 diabetic patients, and at present,
no form of exogenous insulin contains C-peptide, so having a fantastic
A1C is no guarantee of a complication-free life, sorry to say.

I believe the issue misunderstanding the scope of type 1 diabetes lies
primarily in medical community, not JDRF.  After all, most doctors
mistakenly assume that just because someone is older they must have the
far-more-common type 2 diabetes.  That is due to inherent prejudice among
many doctors, (many of whom have not had any continuing medical education
or CME credits on diabetes in decades).  Virtually all research funded by
JDRF benefits adults as well as children with type 1 diabetes (and the
roughly 1/3 of the dollars spent on complications also benefit patients
with type 2).  One of the criticisms I've been seeing is the focus on
children and newly diagnosed patients, but there are often valid research
reasons for this.  Most notably, the ability to arrest autoimmunity while
a patient is still in the honeymoon period that can be easily measured
with a C-peptide test that can be done in labs across the country.  If
you've had type 1 for 30 years and now have a negative C-peptide, how
would any scientist be able to determine if their intervention had
actually halted the autoimmune attack on the beta cells -- esp. if you
have no beta cells left?  For this reason, many studies focus on newly
diagnosed patients because they can measure if interventions are working,
and they have "clean slates" to understand how their interventions impact
patients.

A number of the key execs with JDRF (including Larry Soler, head of
government relations) have type 1 themselves.  However, as an
organization, the reality is that children make far more compelling
fundraisers and lobbyists than adults which helps the organization fund
more towards type 1 research than even the NIH/NIDDK -- close to $100
million per year on type 1.  Think about it, are a bunch of old people
petitioning Congress for funding going to accomplish more than a group of
cute little kids?!  Highly unlikely.  In 2002, JDRF was able to secure
$750 million in supplemental funding for juvenile diabetes research at
the NIH on top of regularly appropriated funds, and type 1 diabetes is
the ONLY disease to get research funding from the government in this
unique manner.

In terms of the statistics cited, it is true that the CDC's figures are
estimates only.   The only difference between LADA and type 1A diabetes
is that in LADA, the beta cell destruction has occurred over years to
decades instead of days or months, and for this reason, these patients
are often mistakenly diagnosed as having insulin resistant type 2
diabetes.  However, they have the same autoimmunity markers as juvenile
type 1A.  Type 1B (or idiopathic, meaning the cause is not known) is the
only genuine rarity among type 1s, and as a result, it is even more
poorly understood.  It is also true that the need for insulin among type
1B's can be absolute at one moment in time, then disappear just as
suddenly only to re-appear later.  The exact mechanisms behind type 1B
remains unknown, but it has been theorized that a chromosomal abnormality
or a viral infection may be possible triggers -- but again, these are
only theories.  Type 1B diabetes is extremely rare in caucasians. 
Individuals of African, Hispanic, or Asian decent are more likely to
develop type 1B diabetes if they have any form of type 1, but even among
them, the incidence of type 2 is far more common, at something like 95%
to 5%.

The bottom line is that diabetes is the most inappropriately named
disease around.  The fact is that is that it is a common set of symptoms
with very dissimilar causes.  I can't help but feeling that we would all
be better served with different names rather than trying to "force" us
all under the same umbrella, but the medical establishment won't hear of
it.   The ADA thinks its definitions actually helped clarify the
distinctions among types, and everyone from endocrinologists to CMEs
think the current naming conventions are adequate, even though countless
doctors routinely misdiagnose patients.  By comparison, patients with
Chrohn's Disease and Ulcerative Colitis have distinct names, even though
both are effectively Inflammatory Bowel Diseases (IBD) caused by
autoimmunity.

 

 

Date: Wed, 12 Jan 2005 18:31:37 +0000
From: email @ redacted
Subject: [IP] prevalence of Type 1 diabetes in adults and children

"ALL people who acquire Type 1 diabetes should be put on exogenous
insulin as early as possible, to control glucose levels, prevent further
destruction of residual beta cells, and reduce the possibility of
diabetic complications."
.
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