Talk:Type 2 diabetes/Archive 1

Type 1/2, what's the big deal? Confusion on the ground

What is the 'big' difference between type 1 and 2? i understand most of it is because of the insulin intake but i'm very confused@

In brief: Type I results from an inability to produce insulin. Type II results from an insensitivity of cells to whatever insulin is produced. - Nunh-huh 22:08, 8 Mar 2004 (UTC)

Old topic but I thought I'd weigh in anyways. Type 1 is mostly genetic and type 2 is mostly acquired through unhealthy living/just being old. There are exceptions for each case but that's the norm. Ball of pain 00:34, 18 August 2007 (UTC)

Actually, type 2 is very strongly inherited, though it is less likely to be expressed in an environmnet of considerable exercise and reduced calorie intake. Type 1, on the other hand, is not inherited. A susceptibility to it is, but it iw usually the result of an enviromental insult, for instance an infection of any of several types. The difference between them is substantial. Treatment is quite different as well. ww 06:38, 18 August 2007 (UTC)

Maybe if you read the article, you may learn the differences, because they are in there. Wumbla (talk) 15:25, 11 March 2009 (UTC)

history of this refactoring

the following are extracted from the diabetes talk page

Sometimes I wonder how the Diabetes pages should be organised. I'm in favour of separate pages for Type I and Type II, because they're hugely different diseases.

• Diabetes (disambiguation)
• Diabetes Mellitus (disambiguation)
• Diabetes Mellitus Type 1
• Diabetes Mellitus Type 2
• Complications of diabetes
  • Diabetic nephropathy
  • Diabetic retinopathy
  • Diabetic neuropathy
  • Atherosclerosis in diabetes
  • Diabetic encephalopathy
• Diabetology and Diabetologist

Any ideas? Jfdwolff 10:35, 9 Mar 2004 (UTC)

I'm still thinking about it, and still looking at what has been done so far. At the moment, all I can be reasonably certain of, is that Types 1 and 2 should be split off in a fashion similar to what has been done with Gestational Diabetes. As such I have already merged that material in the general article into this one. Possibly sometime in July, the middle paragraph of the Type 2 section of the general Diabetes article could be deleted, and a link similar to the one for Gestational_diabetes could be put in. I just want to get the thoughts of others before actually doing anything on it. If it works well enough, I can do the same thing for Type 1 as well.

--Coro 03:01, 25 Jun 2005 (UTC)

with regret, I told you so

It's an unpleasant thing to point out and I regret doing so, but I feel so strongly about it that I'm willing to be a bit impolite.

The very first comment on this new article's talk page illustrates the point I have made (see diabetes talk page at "whench diabetes" and sporadically earlier). DM is itself a mess, most layfolk are thoroughly confused about it (eg, "it's some kind of sugar problem", ...) and its seriousness (eg, "You mean I could go into a coma and die from this?!!!"), about differences between the two most common types (eg, "Will I have to use needles for insulin? Yuck!"), about complications (eg, "I can really go BLIND??!!"), about the (current) chronic and unremitting quality of living with any variety, ... The breakout of Type 2 from the diabetes article has made worse WP's attempt to address these confusions, and this first comment is an especially apt illustration of the issue. I left an extended comment at diabetes talk (@rerefactoring needed).

This article, as it currently stands, is inadequate and requires major work. The is no coverage of complications, of typical treatment, of the studies which demonstrate that getting as close as possible to normal glucose values is hugely beneficial in reducing complications, etc. Much work is needed. ww 18:03, 14 December 2005 (UTC)

Clarification

This is a more complex problem than type 1, but is sometimes easier to treat, since insulin is still produced, especially in the initial years.

Insulin continues to be produced in the later years, right? If so, this sentence, and the sentence on the Diabetes page, should be reworded as such (at the least--it's still not a great sentence): This is a more complex problem than type 1, but since insulin is still produced, it is sometimes easier to treat, especially in the initial years.

In fact, a substantial portion of Type 2s eventually lose (all or nearly all) insulin production and become insulin dependent. They are thus, Type 1+2 or Type 3 or Type 2ID or any of a collection of ad hoc shorthand terms, most of which have little wide use. Poor phrasing, is one of those things about which most anyone can Be Bold! and correct. The technical stuff is a somewhat harder; being bold is good, but getting the facts right is perhaps better. In such cases, perhaps one should Be Bold!, But Accurate? ww 18:07, 21 December 2005 (UTC)

Why was my reference to hydrogenated oils removed?

My wife removed hydrogenated oils from her diet and went into remission of type II as verified by th Loma Linda VA. I gave research references. What was the perceived problem with my edit? Is it so surprising that a dietary change could reverse an illness? Above posted by User:71.104.11.155 22:00, 12 May 2006

The relationship between diet and type 2 diabetes is not understood to the degree necessary to make statements like that. I recommend that your wife continue her hydrogenated oil free diet while monitoring for a possible relapse with her doctor. I hope it stays in remission. Pasado 07:57, 29 May 2006 (UTC)

Research link removed

I have removed the following link, as this is speculation that it may develop into a future treatment. There are many promising leads in research for diabetes, not all of which result in changes to existing treatment methods. Wikipedia is not a news service and so should not be reporting on each "latest research". To do so (when not yet developed into a tried and tested treatment) is speculation and so, to me, seems in breach of the Nor Original Research policy (WP:NOR). Of course if the findings are creating widespread comment from other scientists, then it would have notability and deserve inclusion (but one news story on a single research paper does not constitute accepted change in clinical practice)

• Chemical in Gardenia Fruit Raises Hopes for Type 2 Diabetes Treatment

David Ruben ^Talk 12:39, 7 June 2006

Perhaps Wikinews would be a better placement for this link.

—Preceding unsigned comment added by 71.137.192.41 (talk • contribs) 17:53, 6 July 2006

Diabetes Type II is curable

The second sentence of the article (as I write this) is misleading. It says Diabetes Type II is not curable. There are different meanings for the word 'curable'. The authors seem to care only about the narrow (typically drug-oriented) meaning in which 'curable' means that people with the disease can take a potion and have the disease go away without attention to lifestyle. The other, more useful meaning for 'curable' is that the disease can be driven into a durable remission by whatever means, including by adhering to a wise lifestyle (mainly diet).

Under the more useful meaning of the word 'cure', Diabetes Type II is definitely curable, by which we mean that the person's blood sugar is always within a healthy range, and there is no insulin resistance. This is achieved by adopting a major, permanent shift in diet, often with the help of some orthomolecular supplementation.

Also, the authors do not mention the theory that the most important mechanism of the disease is the fact that the kidneys, in their attempt to dump excess sugar from the blood, also allow excess elimination of minerals and other micronutrients, and that it is the resulting chronic deficiencies in these micronutrients which cause much of the severe damage from the disease.

For a fascinating and humorous talk on curing Diabetes Type II through diet and supplementaion, in other words, through Orthomolecular Medicine, see this talk video by Julian Whitaker, M.D.

--Dave Yost 20:34, 31 July 2006 (UTC)

Even supposing for one moment that I accepted Orthomolecular Medicine, which I don't, it does not claim to be a perminant cure but an (alternative) method of controlling or managing the condition. Even in those patients with excellent control of their sugar levels (diet, weight loss, medication), there is still an increased risk of macro & micro vascular complications (good control reduces but does not entirely eliminate the risks). So no, conventional view, is that one does not cure either the diabetes or its indirect morbidity/mortality effects, just manage the issues. A successful islet cell transplantation in a type I diabetic might effect a true cure, but that's speclation/development for now.David Ruben ^Talk 01:01, 1 August 2006 (UTC)

Concur with DR on this. Cure implies -- after treatment -- that the condition is gone. Useful or not useful won't apply to actual cures, whatever the mechanism. Not currently possible, though I'm fascinated by Yost's claim that insulin resistance can be normalized. Would love to hear more. ww 03:39, 1 August 2006 (UTC)

I get the impression it's well-established that insulin resistance can be reversed with diet and exercise. Type 2 diabetes is a threshhold by which insulin resistance has become a pressing health concern, as determined by fasting glucose, glucose response, circulating insulin, or whatever other means is used to evaluate the condition. Presumably, wouldn't returning to normal levels of these indicate that the condition has disappeared? Sure, insulin resistance could return, and perhaps some people are more *prone* to insulin resistance than others, and certainly perhaps some permanent damage from the higher circulating glucose may remain. But, if the condition we define as Type 2 diabetes itself is no longer observable, has it not been cured? Frankg 20:58, 16 November 2006 (UTC)

Only if the underlying reasons for the condition have been removed is a cure truly effected. It isn't enough to control the symptoms, as Diet & Exercise does. A true cure would eliminate the need for further control. --Coro 19:51, 19 November 2006 (UTC)

But as far as I know, diet and exercise operate under the same mechanisms in type-2 diabetics as they do in people who have never exhibited impaired glucose control. Virutally everyone will exhibit health problems sooner or later if they don't exercise or attend to their diet appropriately. It seems like under this philosophy, type-2 diabetes will not be "cured" until we find a way to allow everyone to "let themselves go" without detrimental effects. :) Or is there some other factor at play here? Frankg 20:07, 19 November 2006 (UTC)

With non-diabetics there is no insulin resistance to be reversed. That means that non-diabetics are tangibly less vulnerable to loss of eyesight, or the need for amputation, both of which are long-term effects of uncontrolled glucose levels in Type 2 Diabetes. With Type 2, the penalties for having a sub-optimal lifestyle tend to be more severe. --Coro 21:46, 20 November 2006 (UTC)

I was under the impression that insulin resistance had a spectrum of severity, of which every individual has a different magnitude. Once an individual has crossed a given threshhold of insulin resistance, they would be considered a type-2 diabetic. Is there such thing as an individual that is immune to any change in insulin sensitivity? Frankg 17:33, 21 November 2006 (UTC)

Clinically, this is exactly so. Some people are able to conrol their insulin resistance with diet, exercise, and weight loss. That it's controlled does not mean the insulin resistnace has vanished. Letting go of the diet, exercise, weight loss business will cause it to return. Others have more severe cases of insulin resistance and require drugs to get into some kind of control. Still others... But you get the picture. Why this range of clinical behavior is seen is not at all clear. There is observed a strong heretible component to Type 2 which suggests genetics as the underlying cause; this remains obsucre as well. But if genetics (in some combination -- several genes have been found) is the underlying cause, cure would seem to be out of bounds entirely. At least in some sense. When we add in variations is susceptibilty to diabetic complications, the clinical picture is still further confused and still less predictable. Cure is misleading and wrong-footed terminology in the current context. Those who use the term will be thought either 1) lacking understanding or 2) peddling unsupportable promises (regardless of their details) to the desperate and vulnerable. The term should be avoided in favor of control, which better captures the situation. Anyway, in the current context, cure is not appropriate for this article. ww 06:40, 20 March 2007 (UTC)

I'm seeing some article edits pertaining to whether the condition is curable or not; I'm wondering if anyone else wants to chime in. Frankg 04:06, 20 March 2007 (UTC)

See above. And let's have a go at the left margin, eh?

What is the percent of recovery for Type 2 Diabetes. Soccerman111 (talk) 18:35, 7 January 2008 (UTC) b

A friend of me, has this desease since more than 50 years ago.He is an old, but productive man.With correct treatment, this health problem can be controled. Agre22 (talk) 22:37, 13 July 2008 (UTC)agre22

Cure discussion, part II

Per the margin comment, I'm continuing on here. Regarding insulin resistance, what about individuals whose glycemic control has returned to normal after a period of diet and exercise? Likewise, what about individuals whose diabetic symptoms do not return even after returning to old bad habits? While some diabetics may have genetics to blame, it seems like nobody is immune to the potential for insulin resistance, and, likewise, many are able to correct the situtation. I understand your point about salesmen of false quick-fix cures, but I feel like claiming insulin resistance is entirely uncurable implies that there is no hope for those with this kind of condition. Frankg 10:38, 20 March 2007 (UTC)

The normal condition is that, regardless of diet / exercise / weight, the insulin/glucose system operates so as to keep glucse within rather tight bounds. And in so doing, the many other effects of insulin are also appropriate. Someone who has increased glucose uptake in the relevant cells by exercise, and kept the glucose load down by diet, has made no change in the underlying situation. Cells which were resistant are still resistant, but their environment is being deliberately manipulated so dodge round the problem somewhat. No improvement in other problems such as insuficient response to insluin in its other effects. There is no difference in principle between this and alteration of environment by use of drugs; there is just a more natural alteration of environment than with drugs. But this is a philosophical distinction, not in a sense a real one.

As for your comment about no hope, you are quite wrong. We now know, with great confidence, after many large and extensive studies, that the rate and risk of complications (eg, blindness, kidney failure, infection, amputation, etc) go to normal levels if glucose is kept close to or at normal values. Perhaps this means that glucose toxicity is the key issue, or perhaps not, but which is the case is irrelevant in this instance. Tight control of glucose levels typically requires more and closer attention than many diabetics can manage while coping with the rest of life's issues.

We now have a wide variety of treatments, from drugs to diet and exercise protocols which have considerable efect. None of these is perfect or alwasy effective in every patient, and there is any case very often a progression of severity (or at least response to assorted treatemnts) in Type 2 diabetics, which complicates things quite a bit. Nonetheless, there is considerable hope. More than in many cases of poorly healed broken ankles or dietary issues post gall bladder removal, or cases of persistent infection and reinfection from which some people suffer. ww 14:06, 20 March 2007 (UTC)

"Cells which were resistant are still resistant"...isn't overall sensitivity restored over time, assuming steady control of glucose levels, and absent some kind of genetic disorder? Cellular turnover, etc. Frankg 14:17, 20 March 2007 (UTC)

Sensitivity most definitely does return over time, if one is following a reasonable diet and/or exercise program. Even just fasting one day a week will increase insulin sensitivity by 60% on average. I guess the real question here is should one be capable of eating a poor diet which will eventually cause insulin resistance? I would say no, therefore insulin resistance is curable... —Preceding unsigned comment added by PowerSam (talk • contribs) 23:52, 6 December 2007 (UTC)

Cause of improvement in the case of modest weight loss

The article currently states: Type 2 is initially treated by adjustment in diet and exercise, and by weight loss, especially in obese patients. The amount of weight loss which improves the clinical picture is sometimes modest (5 - 10 lb); this is almost certainly due to currently poorly understood aspects of fat tissue chemical signalling (especially in visceral fat tissue in and around abdominal organs). In many cases, such initial efforts can substantially restore insulin sensitivity.

I am concerned by the "almost certainly due to...": Is there a reference for this? What reason is there to believe that the improvement is not because the increased physical activity and improved diet that typically going along with the weight loss results in reduction of insulin resistance and thus improvement in diabetes symptoms? Chartreuse green 03:08, 16 August 2006 (UTC)

At the moment, there is very littel which is known with certainty about Type 2 and its correct treatment. Patinets vary widely in their response to treatment, there appear to be several sifferent 'strains' of Type 2 in the sense that the clinical course can be (sort of) classified into assorted groups (though this may be another variation of the previouse point about different patient response). And so on.

Weasel word comments like this are about as good as anyone can actually do, though there are many who make much stronger claims for various reasons, ranging from "I've got something to sell" to "I think I understnad this stuff and I'm willing to stride confidently out onto the plank". It's a mess, and caution is learned early by those without an ax to grind. ww 21:33, 18 October 2006 (UTC)

(This has not always worked.)

I am looking for the typical presentation of type 2 diabetes. How is it usually diagnosed? What brings the patient to the doctor?

   * No early symptoms - many people have Type 2 diabetes without knowing it
   * Early mild symptoms - from moderate blood sugars (which are still dangerous and lead to serious complications):
         o Skin rashes
         o Skin infections
         o Athlete's foot
         o Poor skin healing
         o Urinary tract infections
         o Candida
         o Thrush
         o Dry itchy skin
         o Flaky skin
         o Skin ulcers
         o Peripheral neuropathy
         o Paresthesias
         o Foot tingling
         o Foot numbness
         o Hand tingling
         o Hand numbness
         o Blurred vision
         o Sexual problems
         o Erectile failure
         o Unusual vaginal dryness
         o Premature menopause
         o Absent periods
         o Poor healing - any type of difficulty healing of minor infections, injury or after surgery.
         o Weight loss
         o Weight gain
         o Drowsiness
         o Malaise 
   * Later more extreme symptoms when blood sugars get higher:
         o Excessive thirst
         o Excessive urination
         o Dehydration
         o Bed wetting - in children
         o Excessive hunger
         o Tiredness
         o Weight loss
         o Severe blurred vision
         o Muscle cramps
         o Muscle aches
         o Headaches
         o Irritability
         o Tiredness
         o Fatigue
         o Muscle weakness
         o Acne - often worsens from diabetes and improves once sugars controlled
         o Sexual problems
               + Erectile failure
               + Unusual vaginal dryness 
         o Absent menstrual periods
         o Persistent fungal skin infections
               + Athlete's foot
               + Tinea
               + Thrush (Candida) 
   * Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) - a very severe life-threatening complication of high blood sugars
   * Diabetic Ketoacidosis (DKA) - a very severe life-threatening complication of high blood sugars, requiring emergency treatment, which has very severe symptoms:
         o Nausea
         o Vomiting
         o Sweet-smelling fruity acetone breath
         o Breathing difficulty
         o Rapid Pulse
         o Abdominal pain - usually in children

http://www.wrongdiagnosis.com/d/diab2/symptoms.htm#symptom_list

(this comment left 18 October 2006 by user:74.60.79.208 and moved to the correct position by ww the same day)

What percentage are fat?

The article says most diagnosed are obese but I couldn't find that in the sources. Half the people I know who have were never fat they are just old. Is there any really facts on who gets it?

Clinical observation for generations indicated so close a connection (if not invariable) with obesity, that a former name for Type 2 was obesity-related diabetes. Another, of course, was adult-onset diabetes. Or non insulin-dependent diabetes. Which pretty much illustrates the confusing picture it presents. The most important issues are probably that heredity matters in Type 2 (very substantially) and that excess weight -- apparently most importantly fat in and around abdominal organs, not merely subcutaneous fat) is hormonally active in a way not previously understood, and that that activity has a close connection (as far as can be told now) with the development of insulin resistance.

There is also a connection with diet, almost certainly, and it's not just getting fat from not eating enough shoots and leaves. Perhaps it's white bread, or too much table sugar, or sugar in foods, or supersized portions as a marketing tool, something, but it may be both diet and a sedentary life, for Type 2 rates in the developed world seem to have begun to shoot up only in the last few decades, and lots of sugar, fat, and white bread was common before that. Or perhaps we are only noticing the statistical hangover of events from decades ago come to clinical attention with a diagnosis. The epidemiological research on such things is very difficult. ww 19:01, 5 March 2007 (UTC)

1/3 of US children remark.

At the end of the intro someone very clearly stated "One-third of children in the USA have type 2 diabetes. [1]" I can find no such article on the irish examiner's online archives, and did not really expect to. The statement is absurd. According to the NIH (http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.htm) in 2005 for all ages there were 20.8 million cases of diabetes. If all of those were children it would still be under 1/3 (assuming a roughly 80 million children in the US). I assume this is simply a misquote of a comment on obesity in America and how 1/3 of children are at risk for type 2 diabetes. As I am new to Wikipedia I am holding off on doing edits until I better understand the community and its guidelines, I'll check back in a few days and delete if necessary. Vytrox 05:48, 5 March 2007 (UTC)

Hadn't noticed that, and I agree with your speculation as to how it came to be. Projections are often misunderstood. As for WP, there is a policy here to be bold. So jump in and correct it. The water's fine, if surprising now and then. Welcome aboard... ww 19:03, 5 March 2007 (UTC)

It is a misquote of the ADA statement that "1 in 3 Americans born in 2000 will develop diabetes in their lifetime if nothing is done to stem the tide". http://www.diabetes.org/I-decide-campaign.jsp Bollar 19:15, 8 March 2007 (UTC)

Discovery of Genes Conferring Type 2 Risk

The article currently states that Type 2 Diabetes is of unknown etiology. A recent Nature paper, authored by Dr. Rob Sladek of Mc Gill University) has identified four genes which explain a substantial portion of the disease risk (approx. 70%)

This wiki article should probably be updated to reference this information: The abstract for the Nature article is here: http://www.nature.com/nature/journal/v445/n7130/abs/nature05616.html

A press release from Genome Quebec is here: http://www.genomequebec.com/GQmedia/communiques/natureFev2007.asp?l=e&

A new study led by researchers at the McGill University Health Centre (MUHC) has identified four genes that increase the risk of developing type 2 diabetes

“Of the four genes we have identified, two are involved in the development or function of insulin-secreting cells and one plays a role in the transport of zinc, an important mineral required for the production of insulin,” says Sladek.

http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20070212/diabetes_genes_070212?s_name=&no_ads=

Sladek said the findings will help identify people who risk developing Type 2 diabetes, since the gene variations might account for 70 per cent of the genetic risk associated with the disease.

—The preceding unsigned comment was added by 74.12.88.196 (talk) 22:32, 22 March 2007 (UTC).

April 29, 2007: Apparently researchers working on a US-lead study have found additional genetic regions and confirmed three of the genetic regions mentioned in the above above-mentioned Canadian-led study:

Ten genetic variants associated with type 2 diabetes, a disease which impacts more than 170 million people worldwide, have been identified or confirmed by a U.S.-Finnish team led by scientists at the University of Michigan School of Public Health.

The discoveries could lead to the development of new drugs for diabetes, permit more effective targeting of drug and behavioral therapies, and help scientists and physicians better predict who will develop diabetes, said Michael Boehnke, the Richard G. Cornell Collegiate Professor of Biostatistics at the U-M School of Public Health. ...

The groups identified at least four new genetic factors associated with increased risk of diabetes and confirmed the existence of another six. The findings of the three groups, published simultaneously today in the online edition of the journal Science, boost to at least 10 the number of genes confidently associated with increased susceptibility to type 2 diabetes.

http://www.news-medical.net/?id=24315

Someone check out and include the possible new treatment by cutting part of the intestine!

- above title added to top of page by Marcelino 5 Sept 07; there was no actual comment and no signature - moved here by ww 07:08, 6 September 2007 (UTC)

Question: where to place discussion of selecting anti-diabetic drugs?

The new insulin randomized controlled trial in NEJM (doi:10.1056/NEJMoa075392) raises the important point of where to discuss the trials that guide selecting a treatment regimen for diabetes? This discussion could legitimately go under Diabetes mellitus type 2, Anti-diabetic drug, or insulin. So we do not grow parallel content that is difficult to harmonize, I propose this content only go in one of these places with the other two places noting the discussion and linking to it. I would like to clarify this now before adding doi:10.1056/NEJMoa075392.

I propose this discussion go under Diabetes mellitus type 1 and Diabetes mellitus type 2, which is where most of the discussion is currently. Is this ok?

I have posted this question on the talk pages of all three articles.
Badgettrg 20:22, 23 September 2007 (UTC)

There's a problem with at least one variety of this sort of thing. WP is not in the business of dispensing clinical advice to readers. Aside from any liability issues, there is a severe problem with adapting any advice to the quite variable clinical situations of especially Type 2 diabetics. So I think there are some clear limitations as to the advice we can offer here. As an example of the wrong sort of thing to do, consider the most recent issue of Consumer Reports, in which an article gives advice on generic or less expensive drugs which are equivalent to more expensive newer drugs. Amongst the recommendations are, for Type 2 diabetics, a flat recommendation of metformin in preference to Actos and other diabetic drugs. While this may be a perfectly sensible choice for some diabetics, but it will not be sensible for others. Possibly wildly and unfortunately so. ww (talk) 19:09, 7 January 2008 (UTC)

Mortality risk score

Risk score developed in Hong Kong: http://archinte.ama-assn.org/cgi/content/abstract/168/5/451

Now is this generalisable to Western populations? JFW | T@lk 06:22, 8 May 2008 (UTC)

The inability to control for variables makes me dubious about all such studies. So application to Western or Eastern or vertical populations strikes me as equally inapposite. It's a short term study. It's of a population with different cultural practices than many others, including much of the West. It's a population with different culinary habits as well. I surely can't demonstrate the existence of hidden variables affecting the study which invalidate it for any population, but my inability doesn't show there is none. Suspicions remain... ww (talk) 19:49, 8 May 2008 (UTC)

"ketosis-prone DM-2" ...

... is associated with HHV-8, whatever ketosis-prone means, according to [1]. So, yet another brick in the autoimmunity wall. --Ayacop (talk) 08:52, 19 June 2008 (UTC)

Has nothing about phytotherapy

I know that there's efective(and cheap) medicines, for diabetes type 2, but there's some people that uses herbs for this health problem, in early state.The article has nothing about herbs used in this problem.Agre22 (talk) 22:40, 13 July 2008 (UTC)agre22

Commercial links removed

In line with Wikipedia:External links I have removed the following external links:

• Diabetes Section of The Hormone Foundation
• Type II Diabetes type 2-specific information
• Change your life now live longer, go bariatric
• Diabetes mellitus Type 2 at Epocrates Online

If you feel that some of these are valid links then please include a rationale on this talk page before adding them back.—Ashleyvh (talk) 08:56, 12 August 2008 (UTC)

removed section

I have removed the following section. It is contentious the standard medicine vs alternative medicin sense. It appears to be commercial in part and makes claims which are not accepted in the medical community (eg, persistent implication that anti-oxidants in diet are effective treatment). The citations made are less than distinguished.

===Possible alternatives or additions to a prescription medicine regime===

Diabatrol is an all-natural nutraceutical designed to combat insulin resistance in Type 2 Diabetics. Clinical trials in patients treated with antioxidants have demonstrated improved insulin sensitivity in cases of insulin resistance. Diabatrol is high in natural antioxidants and can be integral in maintaining healthy glucose metabolism. Clinical studies report a dramatic decrease in fasting glucose levels and approximately 31% reduction in A1c levels after 60 days of usage .

Carnitine has been shown to increase insulin sensitivity and glucose storage in humans. . It is important to note that this was with a constant blood infusion, not an oral dose, and that the clinical significance of this result is in practice unclear. Studies have shown that carnitine may increase blood clotting in Type 1 (and assumedly Type 2) diabetics with recent hyperglycemia (high blood sugar) due to higher platelet ATP:ADP ratios

Taurine has also shown significant improvement in insulin sensitivity and hyperlipidemia in rats.

Neither of these have shown permanent positive effects, nor a complete restoration to pre-diabetes conditions, only improvement. Their clinical importance in humans remains unclear.

Chromium (Chromium Picolinate, CrPic) is has been showed with increasing evidence to have significant positive effect to patients with type 2 diabetes.

Vinegar has been shown to reduce glucose spikes at mealtimes. :

I invite discussion of whether this content, this type of content, or such claims, belong in this article. Perhaps another on alternative approaches to DM management? ww (talk) 01:05, 26 October 2008 (UTC)

There is medical evidence on chromium being used to helping obese people avoid diabetes *[2]Chromium May Help Obese People Avoid Diabetes as well as USDA Reports *[3] Chromiuam Supplements mayb be beneficial for Diabetics. If you search online you can find more of these reports WSNRFN (talk) 22:22, 3 November 2008 (UTC)WSNRFN

Moving some content form main DM page

Treatment

Type 2 diabetes is usually first treated by increasing physical activity, decreasing saturated fat and carbohydrate intake, and losing weight. These can restore insulin sensitivity even when the weight loss is modest, for example around 5 kg (10 to 15 lb), most especially when it is in abdominal fat deposits. It is sometimes possible to achieve long-term, satisfactory glucose control with these measures alone. However, the underlying tendency to insulin resistance is not lost, and so attention to diet, exercise, and weight loss must continue. The usual next step, if necessary, is treatment with oral antidiabetic drugs. Insulin production is initially only moderately impaired in type 2 diabetes, so oral medication (often used in various combinations) can be used to improve insulin production (e.g., sulfonylureas), to regulate inappropriate release of glucose by the liver and attenuate insulin resistance to some extent (e.g., metformin), and to substantially attenuate insulin resistance (e.g., thiazolidinediones). According to one study, overweight patients treated with metformin compared with diet alone, had relative risk reductions of 32% for any diabetes endpoint, 42% for diabetes related death and 36% for all cause mortality and stroke. Oral medication may eventually fail due to further impairment of beta cell insulin secretion. At this point, insulin therapy is necessary to maintain normal or near normal glucose levels. Doc James (talk · contribs · email) 20:20, 3 November 2009 (UTC)

References

drive by fact tags

Sometime in July 2009, someone added numerous fact tags to the article. Nobody bothered with them, including me, as touching them often sets off touchy folks who like to do this. Late in January, an anon editor, helpfully deleted content which the fact tagger had sprayed with fact tags. In the process (his 2nd try if I read the edit summaries correctly) deleting actual content of value to readers. He also left an ominous edit summary admonishing another editor who seems to have had the same reaction as I to his deletions. I will repeat what that editor said, namely deleted tagged stuff you think is wrong, if you're doing a sweep.

I will review each of the July 2009 tags and remove those for which there is no problem in the medical world. Perhaps this will satisfy the anon deleter? ww (talk) 00:37, 10 February 2010 (UTC)

Merger proposal

The following discussion is closed. Please do not modify it. Subsequent comments should be made in a new section.

• Merge. Apparently an editor, not liking his edits removed, decided to start a forked article elsewhere that belongs here. It is Prevention of diabetes mellitis type 2. There appears to be no size reason or anything for being separated from the main article. It was not discussed. A nuisance that now has to be "discussed." There is only one link, from this article, of course. There are typos. It definitely needs wider editor exposure. Student7 (talk) 02:16, 27 December 2010 (UTC)

Or you could ask said editor :-) The main article is to be just an overview thus this is a subarticle rather than a fork. Other section could probably also be split off as some are currently too detailed. But what this article really needs is to be based on review articles rather than the large amount of primary research.--Doc James (talk · contribs · email) 02:29, 27 December 2010 (UTC)

So far, agree with Doc James, but will watch. SandyGeorgia (Talk) 14:53, 29 December 2010 (UTC)

Upon closer examination, that article has existed for a long time, and there is no reason for it not to exist (per Summary style), so I oppose the merge. It does need some cleanup of sourcing to conform with WP:MEDRS, but so does this article. SandyGeorgia (Talk) 15:19, 29 December 2010 (UTC)

• Merge, but ideally only when all the primary sources have been replaced by a couple good secondary ones. JFW | T@lk 21:42, 29 December 2010 (UTC)

The main reason I move this is that most of it is based on primary sources. I have summarized it with secondary source in the main article. I guess the question is should I have just outright deleted this content here... Doc James (talk · contribs · email) 22:10, 29 December 2010 (UTC)

• Merge. Its a short enough article that could be tidied up, re-referenced with good review articles and texts and included in the T2DM article. Mattopaedia ^{Say G'Day!} 03:25, 30 December 2010 (UTC)

I am happy to have it remerged after someone rewrites it based on review articles. Moved it here to do that. Doc James (talk · contribs · email) 03:43, 30 December 2010 (UTC)

You may continue to change this in your sandbox if you wish. The proposal is to merge whatever is here back into the main article for scrutiny by the editors there. Student7 (talk) 14:03, 1 January 2011 (UTC)

Thanks for bringing it to our attention but we will not have any trouble to keep an eye on it wherever it may end up. Richiez (talk) 23:08, 1 January 2011 (UTC)

• Against or delay. Diabetes mellitus type 2 is already long enough and some sections of it need substantial improvement. While the small prevention article is relatively easy to fix the main article seems difficult to keep actual and well balanced in the many aspects it touches. Independet of technicalities it is a distinct subject frequently mentioned by mainstream media. Richiez (talk) 22:55, 1 January 2011 (UTC)
  • Comment. It was 67kb on 12/24 prior to the article being forked without discussion. This is not "too long." Nor was size given as a factor in moving. Nor was any reason given.Student7 (talk) 21:41, 3 January 2011 (UTC)
• Against Rather than argue about what should happen this page should be first improved. Doc James (talk · contribs · email) 23:01, 4 January 2011 (UTC)
  • Comment. It appeared to me that the editors in the main article were critiquing this severely before it was moved out to avoid just that type of scrutiny that it appears to need. Moving it back would gain it more scrutiny, not less. Student7 (talk) 23:14, 6 January 2011 (UTC)
    • Could you provide difs of this critique? Doc James (talk · contribs · email) 23:48, 6 January 2011 (UTC)
      • Comment. This won't be as smooth an answer as it should be. I'm experiencing very slow downloads. Try Here a lot of stuff is added. Revert war starts with knowledgeable, but unregistered editor who had been editing the article. This never played out before it was moved. If the dates don't square, my apologies. The new article started on 12/23 a minute or two after my first pointer. It may not have been in response to anything, but doesn't seem like a good idea. Student7 (talk) 22:00, 8 January 2011 (UTC)
        • Yes a revert with no discussion on talk and no comment in the edit summary. Doc James (talk · contribs · email) 22:13, 8 January 2011 (UTC)

---

The above discussion is preserved as an archive. Please do not modify it. Subsequent comments should be made in a new section.

Testosterone

Testosterone deficiency (hypogonadism) can easily results in diabetes mellitus, therefore testosterone replacement therapy is proven to be very effective against diabetes mellitus type 2 because it reduces insulin resistance.

The ref does not support this text. Doc James (talk · contribs · email) 08:45, 7 February 2011 (UTC)

The refs are referring to associations. There is no long term studies to support mortality benefit or improved prognosis. Thus not suitable for the main DM page.Doc James (talk · contribs · email) 09:19, 8 February 2011 (UTC)

References

Reviews

• Ripsin CM, Kang H, Urban RJ (2009). "Management of blood glucose in type 2 diabetes mellitus". Am Fam Physician. 79 (1): 29–36. PMID 19145963. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
• Wareham, NJ (2009 Dec). "Epidemiology of type 2 diabetes". Endocrinologia y nutricion : organo de la Sociedad Espanola de Endocrinologia y Nutricion. 56 Suppl 4: 60–2. PMID 20629236. {{cite journal}}: Check date values in: |date= (help)

Doc James (talk · contribs · email) 17:53, 9 January 2011 (UTC)

Glycosylated hemoglobin section is obviously incorrect (misquoted?)

"In this study, 177 of 1061 patients with glycosylated hemoglobin value less than 6% became diabetic within 5 years compared to 282 of 26281 patients with a glycosylated hemoglobin value of 6.0% or more. This equates to a glycosylated hemoglobin value of 6.0% or more having:" 16.68% of people with < 6% become sick 1.07% of people with >6% became sick. therefore >6% means an increased chance of becoming sick? I imagine the cohorts are reversed. —Preceding unsigned comment added by 64.71.2.189 (talk) 01:33, 10 February 2011 (UTC)

Reviews

• Herder, C (2011 Jun). "Genetics of type 2 diabetes: pathophysiologic and clinical relevance". European journal of clinical investigation. 41 (6): 679–92. PMID 21198561. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
• Williams textbook of endocrinology (12th ed. ed.). Philadelphia: Elsevier/Saunders. pp. 1371–1435. ISBN 978-1437703245. {{cite book}}: |edition= has extra text (help)
• Vijan, S (2010 Mar 2). "Type 2 diabetes". Annals of internal medicine. 152 (5): ITC31-15, quiz ITC316. PMID 20194231. {{cite journal}}: Check date values in: |date= (help)

--Doc James (talk · contribs · email) 03:42, 5 January 2012 (UTC)

• Another review article http://www.annals.org/content/156/3/218.full.pdf+html --Doc James (talk · contribs · email) 06:10, 12 February 2012 (UTC)

GA1

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

GA Review

This review is transcluded from Talk:Diabetes mellitus type 2/GA1. The edit link for this section can be used to add comments to the review.

Reviewer: Aircorn (talk · contribs) 11:37, 15 January 2012 (UTC)

I will review this over the next few days. I must say that many of the sections look a bit sparse from my initial glance. AIRcorn (talk) 11:37, 15 January 2012 (UTC)

Thanks. It is a succinct overview. Let me know what further you think deserves being discussed.Doc James (talk · contribs · email) 09:39, 16 January 2012 (UTC)

Got about halfway through last night. Will have some comments for you tonight. AIRcorn (talk) 22:44, 16 January 2012 (UTC)

Finished my first read through. Fixed what I considered obvious errors[4], and noted some that I wasn't comfortable touching below. I am far from being an expert in this field, although I had a few lectures on diabetes at university, so I hope the comments are constructive. I also see this as a collaborative process, so feel free to disagree with any comment below.

Criteria

GA review (see here for what the criteria are, and here for what they are not)

1. It is reasonably well written.

   a (prose): b (MoS for lead, layout, word choice, fiction, and lists):

   Just a few minor points on prose below. Should be really easy to clean up. On the whole I liked the technical level, most people should be able to read this and understand it.

2. It is factually accurate and verifiable.

   a (references): b (citations to reliable sources): c (OR):

   I usually check these on my second read through when the prose and content is sorted. Don't foresee any problems looking at the quality of the references.

3. It is broad in its coverage.

   a (major aspects): b (focused):

   I understand that this is an overview article, but still feel it skips over details too much. I have posed some questions below that came to my mind when reading. Don't feel that an answer is needed in each case, I was more hoping you could use some of them to flesh out sections.

4. It follows the neutral point of view policy.

   Fair representation without bias:

5. It is stable.

   No edit wars, etc.:

6. It is illustrated by images, where possible and appropriate.

   a (images are tagged and non-free images have fair use rationales): b (appropriate use with suitable captions):

   Could the diagram of the person under signs and symptoms be enlarged slightly, I can't easily read the text.

7. Overall:

   Pass/Fail:

   Hold for now.

Comments

Some of these are questions that might help expand the article, others are parts that I didn't understand or thought could use clarification. Prose issues are also included. All of them are negotiable and I won't be offended if you disagree. However, purely to make it easier for me to keep track of the review, it would be appreciated if you could respond under each one (even if it is just to say fixed).

• Would be good to know early on how this differs from Type1.

Sure added to the lead.--Doc James (talk · contribs · email) 05:35, 31 March 2012 (UTC)

• It mentions the United States a few times in the text, but no other nations. Are there some stats for other nations? Not a biggy as i consider the map enough to cover world view as far s GA is concerned.

Have added a few others in the epidemiology section. --Doc James (talk · contribs · email) 05:38, 31 March 2012 (UTC)

• What are the other (non-classical) signs and symptoms? The ones in the diagram?

Added some --Doc James (talk · contribs · email) 06:51, 31 March 2012 (UTC)

• Can more information be given on how lack of sleep is causative and in general what is the fetus lacking?

Sure --Doc James (talk · contribs · email) 07:06, 31 March 2012 (UTC)

• Lifestyle causes is overly short. Could more detail on this be added? I would be interested to know the thinking behind urbanization being a factor (pollution?). What fats (long chain, short chain?). Should it be "lack of physical activity"? If not, that could be explained. Is smoking a factor?

Urbanization leads to more food and less excise. --Doc James (talk · contribs · email) 07:06, 31 March 2012 (UTC)

• Diet playing a role is mentioned twice. Maybe reword the last sentence.

Fixed I think --Doc James (talk · contribs · email) 07:12, 31 March 2012 (UTC)

• Gender and age are mentioned as causes, but not how. Are men more susceptible? What ages are at the most risk? Other demographic information could also be included (ethnicity and income levels spring to mind). I see now that I have read to the end that some of this is mentioned in Screening and Epidermology. At the risk of repeating I feel it would still be worth mentioning, very briefly, here. Another approach could be to remove age and gender. Would they not fall more under risk factors than actual causes. In fact maybe this section should be renamed as genetics and even obesity really just increase the risk. I am not sure what the best approach would be.

Clarified --Doc James (talk · contribs · email) 07:15, 31 March 2012 (UTC)

• Type 2 diabetes is due to .... Starts both the Cause and Pathopysiology section. I am not sure this is wrong, but it reads funny to me. Would "the development of type 2 diabetes is caused by ..." be better for Causes? I think the Pathopysiology on is alright

Sure Doc James (talk · contribs · email) 18:54, 20 January 2012 (UTC)

• Most cases of diabetes involved many genes contributing small amount to the overall condition - Grammar, clarify

Fixed --Doc James (talk · contribs · email) 07:16, 31 March 2012 (UTC)

• Are there a few genes we could name that predispose more than the others? Are these generally genes that predispose to obesity or are some expressed in the pancreas? Are any insulin receptors?

Added details --Doc James (talk · contribs · email) 07:12, 31 March 2012 (UTC)

• Would you consider moving Pathophysiology above signs and symptoms? I feel it would be good to know what it is before finding out what causes it.

Articles are ordered per WP:MEDMOS for consistency. Thus people know in what part of the article to look for what type of information. Doc James (talk · contribs · email) 18:54, 20 January 2012 (UTC)

• Could a little bit more on insulin resistance be added. Is it partial or full? The second sentence could be expanded too. When is the glucose released from the liver (in response to low glucose levels in the blood)? Why does this release increase when you have Diabetes type 2?

Clarified --Doc James (talk · contribs · email) 19:11, 31 March 2012 (UTC)

• Does the Diagnosis section apply to both types? If so how is type 2 diagnosed from type 1.

Clarified --Doc James (talk · contribs · email) 08:15, 31 March 2012 (UTC)

• In those with impaired glucose tolerance, diet and exercise and/or metformin or acarbose may decrease the risk of developing diabetes This is unclear. What decreases the risk? I am assuming everything except the impaired glucose tolerance, but it could easily read that acrabose works for those with an impaired diet or a number of other permutations. Also I read somewhere not to use "and/or". It doesn't overly bother me, but if it can be written without the forward slash too that would improve the sentence.

Reworded. --Doc James (talk · contribs · email) 08:29, 31 March 2012 (UTC)

• Managing other cardiovascular risk factors including hypertension, high cholesterol, and microalbuminuria improves a person's life expectancy. Parenthesis need to be applied here for the "including ..." or maybe it could be rewritten?

Fixed I hope --Doc James (talk · contribs · email) 08:15, 31 March 2012 (UTC)

• What is intensive blood sugar lowering involve and how is it accomplished? How is standard and intensive quantified?

Clarified --Doc James (talk · contribs · email) 08:27, 31 March 2012 (UTC)

• If lifestyle measures in those with mildly elevated blood sugars have not resulted in an improvement within six weeks medications should than be considered How do you measure lifestyle?

Fixed --Doc James (talk · contribs · email) 07:35, 31 March 2012 (UTC)

• Metforin is mentioned a few times, maybe a short description of its action would be appropriate?

I typically leave mechanism of action to the pharmacology articles.Doc James (talk · contribs · email) 07:31, 31 March 2012 (UTC)

• When insulin is used, a long-acting formulation is typically added initially at night, while oral medications are continued. Could this be rearranged so intially at night fits in better. Is it needed?

Attempted Doc James (talk · contribs · email) 07:31, 31 March 2012 (UTC)

• Doses are than increased to effect Is this supposed to be then inceased to effect? What does effect mean? until an effect is seen?

Clarified Doc James (talk · contribs · email) 07:28, 31 March 2012 (UTC)

• The long acting insulins, glargine and detemir, do not appear much better than NPH but have a significantly greater cost making them as of 2010 not cost effective What is NPH? The as of 2010 doesn't sit right where it is. Could it be removed or re-written? There is a similar one in Epidermology, but it works much better there (although some commas around it would improve it in my opinion).

Clarified NPH by a link. Cost effectiveness is very time dependent as it depends on if something is on or off patent.Doc James (talk · contribs · email) 07:28, 31 March 2012 (UTC)

Sorry for the delay and getting to this...Doc James (talk · contribs · email) 06:26, 31 January 2012 (UTC)

Don't worry, I'm not going anywhere. Might pay to ping me on my talk page when you are ready for me to have another look. AIRcorn (talk) 05:54, 3 February 2012 (UTC)

Additional comments

I hope its ok to chip into the review process. A couple of comments for now as I don't have a lot of time at present and I had to scan through. Anyway, I will try and contribute as much as I can.

• I think you should include fatigue in the list of sign and symptoms. I know its a vague and ill-defined symptom, but it is a common manifestation of endocrine dysfunction, including diabetes.

Done --Doc James (talk · contribs · email) 07:17, 31 March 2012 (UTC)

• I think it's no longer correct to say that diabetes is the commonest cause of blindness (in complications), I believe its been overtaken by age-related macular degeneration. However I think diabetes is the commonest cause of blindness in people of working age. Sorry I dont have a reference to hand but I think I could find one if you needed it.

This is supported by a 2009 review. Do you have something more recent? --Doc James (talk · contribs · email) 08:17, 31 March 2012 (UTC)

The review is inaccurate - the source it cites (National Diabetes Fact Sheet United States, 2005 http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2005.pdf) actually says that 'Diabetes is the leading cause of new cases of blindness among adults aged 20 - 74 years.' - the review seemed to overlook the qualification regarding age (hence my comment about working age people above). A better source is the WHO (RESNIKOFF, Serge et al. Global data on visual impairment in the year 2002. Bull World Health Organ [online]. 2004, vol.82, n.11 [cited 2012-04-13], pp. 844-851 . Available from: <http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862004001100009&lng=en&nrm=iso>. ISSN 0042-9686. http://dx.doi.org/10.1590/S0042-96862004001100009.) and this is consistent with more recent data in the UK (Bunce C, Xing W, Wormald R (2010). "Causes of blind and partial sight certifications in England and Wales: April 2007-March 2008". Eye (Lond). 24 (11): 1692–9. doi:10.1038/eye.2010.122. PMID 20847749. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)). Of course I agree that diabetes is a very important and treatable cause of blindness and visual impairment. Adh (talk) 19:55, 13 April 2012 (UTC)

• The most recent recommendation of the International Expert Committee Report on the Role of the A1C Assay in the Diagnosis of Diabetes proposed that the diagnosis of diabetes is made if the A1C level is ≥6.5% (as you say). However they advocate that diagnosis should be confirmed with a repeat A1C test unless there are clinical symptoms and glucose levels are >200 mg/dl (>11.1 mmol/l). (International Expert Committee Report on the Role of the A1C Assay in the Diagnosis of Diabetes. Diabetes Care July 2009 32:1327-1334; published ahead of print June 5, 2009, doi:10.2337/dc09-9033) My impression from colleagues in the diabetes field (I'm not a diabetologist) is that most people who have access to A1C will move to that assay routinely, since it doesn't involve fasting or an oral glucose load , so it may be worth amending the text here.

Added --Doc James (talk · contribs · email) 08:16, 31 March 2012 (UTC)

• It would probably be good to mention retinal screening. In uk everyone over 11 with diabetes gets screened annually (at least in theory) and screening is also recommended in the US, although probably only half of eligible people receive it (Lee PP, Feldman ZW, Ostermann J, Brown DS, Sloan FA: Longitudinal rates of annual eye examinations of persons with diabetes and chronic eye diseases. Ophthalmology 110:1952–1959, 200).

Found a ref that recommends screening in everyone with the diagnosis. --Doc James (talk · contribs · email) 07:45, 31 March 2012 (UTC)

Overall I thought the article was good, although I agree with the other reviewer that a few sections might benefit from some expansion. Hope the comments were helpful Adh (talk) 21:50, 4 February 2012 (UTC)

You are more than welcome to comment and can stick around for as long as you wish. AIRcorn (talk) 22:43, 4 February 2012 (UTC)

Thanks. Another comment on re-reading the article - the statement regarding beta-agonists and type 2 diabetes in Medical conditions might need some revision - beta-agonists do cause hyperglycemia and can worsen control of established diabetes but I am not aware of evidence that their chronic use (e.g. in asthma) is associated with incresed risk of type 2 diabetes. Perhaps a more nuanced statement is needed here. In contrast, beta-blockers (beta-adrenoceptor antagonists) are associated with an increase in new onset diabetes, (Elliott WJ, Meyer PM. Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis. Lancet. 2007 Jan 20;369(9557):201-7.) particularly when combined with thiazides.(Manrique C, Johnson M, Sowers JR. Thiazide diuretics alone or with beta-blockers impair glucose metabolism in hypertensive patients with abdominal obesity. Hypertension. 2010 Jan;55(1):15-7.). Both hypo and hyperthyroidism are associated with diabetes but I think its not clear whether the link is causal except in type 1 diabetes with autoantibodies (LH Duntas, J Orgiazzi, G Brabant. The interface between thyroid and diabetes mellitus. Clinical Endocrinology 2011; 75: 1–9). Psychotropic drugs such as phenothiazines, levodopa/dopa, chlordiazepoxide, lithium, are also associated with hyperglycaemia and diabetes (Izzadine et al., Expert Opin Drug Saf 2005; 4:1097-1109) - this reference has a long list but I have focused on commonly used drugs. In this context statins should probably also be listed since recent data does suggest that they have a modest effect on new onset diabetes (Sampson UK, Linton MF, Fazio S. Are statins diabetogenic? Curr Opin Cardiol. 2011 Jul;26(4):342-7.)Adh (talk) 23:43, 5 February 2012 (UTC)

Good refs. Have updated. --Doc James (talk · contribs · email) 19:27, 31 March 2012 (UTC)

I am away for the next 4 weeks. Will take thus up again in mid march. Doc James (talk · contribs · email) 06:11, 12 February 2012 (UTC)

Will fail this as the main contributor is away for a month and most of the recent changes are minor. There is some good advice here and it should not take much more effort to get it to GA standard. AIRcorn (talk) 05:15, 17 February 2012 (UTC)

Under Epidemiology, wrong information is presented about Type 2 diabetes: the article states that Type 2 diabetes is 90% of all cases of diabetes, but that is an old statistic that includes slow-onset Type 1 diabetes (latent autoimmune diabetes of adults or LADA) in the Type 2 stats. Quite consistently worldwide, in many many peer-reviewed studies, about 10% or more of "Type 2 diabetics" are found to be autoantibody positive (GADA, ICA, IA-2, ZnT8), are misdiagnosed, and in fact have Type 1 autoimmune diabetes. The advent of antibody testing more than 30 years ago demonstrated about 10% of people who had been diagnosed with Type 2 diabetes were antibody positive. Although this population has Type 1 diabetes, and its presence is increasingly acknowledged, this population of Type 1 diabetics is still included in the statistics and information on Type 2 diabetes (a fundamentally different disease not only clinically but genetically). If people with LADA are removed from the Type 2 diabetes statistics and correctly included in the statistics for Type 1 diabetes, Type 2 diabetes represents about 75-85% of all diabetes and Type 1 represents about 15-25%. See DIABETES CARE, VOLUME 36, APRIL 2013 (Adult-Onset Autoimmune Diabetes in Europe Is Prevalent With a Broad Clinical Phenotype: Action LADA 7). Redyoga (talk) 03:40, 9 June 2013 (UTC)

New meds

A review of DPP http://www.bmj.com/content/344/bmj.e1369 Doc James (talk · contribs · email) 01:43, 18 March 2012 (UTC)

Clinics

2010 review [5] --Doc James (talk · contribs · email) 10:39, 1 April 2012 (UTC)

---

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Aircorn (talk · contribs) 11:37, 15 January 2012 (UTC)

Epidemiology: image only marginally supports text

Prevalence of diabetes worldwide in 2000 (per 1000 inhabitants). World average was 2.8%.

  no data

  ≤ 7.5

  7.5–15

  15–22.5

  22.5–30

  30–37.5

  37.5–45

  45–52.5

  52.5–60

  60–67.5

  67.5–75

  75–82.5

  ≥ 82.5

This image only marginally illustrates the text in the Epidemiology section where it appears, in that it generally shows higher rates in developed and developing countries, as the text states. There is mention in the text of the five most affected countries by numbers of cases (which is not illustrated in any image):

The five countries with the greatest number of people with diabetes as of 2000 are India having 31.7 million, China 20.8 million, the United States 17.7 million, Indonesia 8.4 million, and Japan 6.8 million.

But there is no mention in the text of the most affected countries by rate of occurrence (which this image illustrates). Someone who has access to the data should add a similar statement giving the five (or more) most affected countries by percentage of population.

For example, the 20.8 million with the disease in China – although a larger number – is a less significant statistic than the 17.7 million in the US; and Canada is the same color as the US in the image, indicating a similarly high rate of occurrence, but it doesn't even appear in the list of countries by total number of cases.

Even if a reader tries to extract that information from the image, it's hard to distinguish adjacent colors. Are the US and Canada in the 60–67.5 group, the 67.5–75 group or the 75–82.5 group? I can't tell. They may even be in one of the below-60 groups. And what countries are in the ≥ 82.5 group? Those countries must be quite small geographically and therefore hard to find on the map.

We should make it easier for readers to get that information, at least for the countries with the very highest rates of occurrence. It would be interesting to know, for example, where the epidemic is even worse than it is in Canada and the US; but that's hard to find in the image, and it's nowhere in the text.--Jim10701 (talk) 00:47, 23 November 2012 (UTC)

GA2

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

GA Review

This review is transcluded from Talk:Diabetes mellitus type 2/GA2. The edit link for this section can be used to add comments to the review.

Reviewer: Aircorn (talk · contribs) 13:24, 4 April 2012 (UTC)

I failed the previous review as the nominator was unable to edit for a month due to real world commitments and I was unsure of my time availability when he returned. Now that he has returned I am happy that all the issues raised in my first review (along with comments by ADH) have been adequately addressed. I will pass this as a Good Article. Congratulations. AIRcorn (talk) 11:13, 13 April 2012 (UTC)

GA review (see here for what the criteria are, and here for what they are not)

1. It is reasonably well written.

   a (prose): b (MoS for lead, layout, word choice, fiction, and lists):

2. It is factually accurate and verifiable.

   a (references): b (citations to reliable sources): c (OR):

3. It is broad in its coverage.

   a (major aspects): b (focused):

4. It follows the neutral point of view policy.

   Fair representation without bias:

5. It is stable.

   No edit wars, etc.:

6. It is illustrated by images, where possible and appropriate.

   a (images are tagged and non-free images have fair use rationales): b (appropriate use with suitable captions):

7. Overall:

   Pass/Fail:

New review calling into question metformin

• Boussageon, R (2012 Apr). "Reappraisal of metformin efficacy in the treatment of type 2 diabetes: a meta-analysis of randomised controlled trials". PLoS medicine. 9 (4): e1001204. PMID 22509138. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help) Doc James (talk · contribs · email) 10:03, 22 April 2012 (UTC)

---

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Aircorn (talk · contribs) 13:24, 4 April 2012 (UTC)

History

Perhaps the egyptian manuscript shouldn't be stated as fact:

Diabetes is one of the first diseases described[62] with an Egyptian manuscript from c. 1500 BCE mentioning "too great emptying of the urine."[63]

The source quoted says "a condition of 'too great emptying of the unrine' - perhaps, the reference to diabetes mellitus." — Preceding unsigned comment added by 124.127.68.85 (talk) 05:46, 5 September 2013 (UTC)