Is Type 2 Diabetes An Autoimmune Disease

What Can We Conclude From All This

Obviously not every person with an autoimmune disease has obesity or Type 2 Diabetes Celiac Disease, for example, can cause malabsorption of calories and nutrients in the gut, so patients with untreated Celiac often need to gain weight, not lose it. But obesity and other metabolic diseases may also have an autoimmune component related to inflammation and insulin resistance . What does that mean for Paleo specifically?

Well, for one thing its a new perspective on the perfect storm of overabundant, gut-irritating junk food that we all live in: refined carb overload doesnt just cause metabolic disease and gut irritants dont just contribute to autoimmunity its all connected.

The potential for a vicious cycle also poses another problem for the idea of calorie reduction as the solution to obesity and related metabolic diseases. Regardless of the reason why someone has an autoimmune disease, if they now have autoimmune problems that are contributing to their disease, then suppressing their weight with calorie restriction may be possible, but it might not actually do anything to fix the underlying problem, and it may also be unnecessarily difficult.

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What Types Of Diabetes Require Insulin

People with Type 1 diabetes need insulin to live. If you have Type 1 diabetes, your body has attacked your pancreas, destroying the cells that make insulin. If you have Type 2 diabetes, your pancreas makes insulin, but it doesnt work as it should. In some people with Type 2 diabetes, insulin may be needed to help glucose move from your bloodstream to your bodys cells where its needed for energy. You may or may not need insulin if you have gestational diabetes. If you are pregnant or have Type 2 diabetes, your healthcare provider will check your blood glucose level, assess other risk factors and determine a treatment approach which may include a combination of lifestyle changes, oral medications and insulin. Each person is unique and so is your treatment plan.

How Is Diabetes Treated

Treatments for diabetes depend on your type of diabetes, how well controlled your blood glucose level is and your other existing health conditions.

• Type 1 diabetes: If you have this type, you must take insulin every day. Your pancreas no longer makes insulin.
• Type 2 diabetes: If you have this type, your treatments can include medications , insulin and lifestyle changes such as losing weight, making healthy food choices and being more physically active.
• Prediabetes: If you have prediabetes, the goal is to keep you from progressing to diabetes. Treatments are focused on treatable risk factors, such as losing weight by eating a healthy diet and exercising . Many of the strategies used to prevent diabetes are the same as those recommended to treat diabetes .
• Gestational diabetes: If you have this type and your glucose level is not too high, your initial treatment might be modifying your diet and getting regular exercise. If the target goal is still not met or your glucose level is very high, your healthcare team may start medication or insulin.

Oral medications and insulin work in one of these ways to treat your diabetes:

• Stimulates your pancreas to make and release more insulin.
• Slows down the release of glucose from your liver .
• Blocks the breakdown of carbohydrates in your stomach or intestines so that your tissues are more sensitive to insulin.
• Helps rid your body of glucose through increased urination.

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The Role Of A Gluten Free Diet In Preventing Celiac Disease And Glandular Autoimmunity

A large prospective study demonstrated that in infants at genetic risk for CeD and T1D a careful early introduction of 100 mg gluten per day in the diet from month 56 did not prevent celiac autoimmunity compared to placebo . Moreover, the introduction of gluten at 12 instead of 6 months of age only delayed the onset of CeD, with similar prevalences at age 5 years . However, a retrospective study indicated that patients on a long-term gluten free diet developed 50% fewer autoimmune diseases in up to 15 years of follow up . The studies that examined the effect of a gluten free versus gluten containing diet on the development and severity of T1D and AITD remain controversial . Interestingly, T1D appears to precede the development of CeD, as determined by IgA-TG2 Ab positivity, which would assign a less important role to the gluten free diet in the prevention of glandular autoimmunity .

What Is Continuous Glucose Monitoring

Advancements in technology have given us another way to monitor glucose levels. Continuous glucose monitoring uses a tiny sensor inserted under your skin. You don’t need to prick your finger. Instead, the sensor measures your glucose and can display results anytime during the day or night. Ask your healthcare provider about continuous glucose monitors to see if this is an option for you.

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Adaptive Immune Responses In Other Tissues

In obesity, inflammation occurs in several tissues and evidence suggests that adaptive immune cells are also present. HFD feedinginduced hepatic inflammation is associated with a drop in Treg numbers and an increase in macrophage and CD8+ T-cell infiltration , and genetic deficiency in the B7 costimulatory pathway, which diminishes Treg development, exacerbates obesity-induced liver inflammation . Increased T-cell infiltration has also been documented in the skeletal muscle after 12 weeks of HFD feeding . Furthermore, hypothalamic inflammation characterized by microglia accumulation has been shown to contribute to insulin resistance . While adaptive immune cells have not been seen infiltrating the brain during HFD feeding, a recent report demonstrated that HFD exposure can induce IgG antibody deposition in the hypothalamus of rodents . Whether these responses are tissue specific and driven by local antigens and how they contribute to systemic insulin resistance require further characterization.

Latent Autoimmune Diabetes Of Adulthood

The largest subgroup is that with diabetes of autoimmune origin, commonly calledlatent autoimmune diabetes of adulthood or adult-onset type 1 diabetes. This group comprises up to 12% of patients diagnosed with diabetes after age 20.259,260 Such individuals may have rapid deterioration of glycemic control prior to diagnosis, sometimes accompanied by prominent symptoms of hyperglycemia and weight loss, but these tend to progress less rapidly than in youth-onset T1DM. They frequently are not obese and may have other autoimmune disorders or a family history of these. Laboratory support can be provided by detection of antiglutamic acid decarboxylase antibodies or anti-islet cell antibodies, although lack of antibodies does not exclude an autoimmune process. Both family history and genetic markers are likely to be more consistent with T1DM, but there is heterogeneity and uncertainty in classifying individual cases.261,262 Insulin has been considered the main therapy from the outset, but other therapies may be possible in those with slow progression. There is some evidence that early use of insulin may prolong beta-cell function and prevent a period of sustained hyperglycemia that could initiate chronic complications.

Helen E. Smith PhD, Bradi L. Frei PharmD, BCOP, BCPS, in, 2019

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Autoimmune Activation In T2dm

Depending on the immunological model one adheres to, autoimmunity occurs due to defects in self-tolerance or the persistence of danger signals stemming from chronic inflammation and tissue destruction . The latter model, elaborated by Matzinger , would favour the concept of autoimmune activation in T2DM, as plenty of pathological alterations characteristic of this disease – such as obesity-associated chronic adipose tissue inflammation and -cell stress induced by gluco- and lipotoxicity – continuously provide danger signals which cause an activation of both innate and adaptive immunity. Danger signals can include any molecules resulting from cellular distress which binds to pattern recognition receptors, such as toll-like receptors and nucleotide-binding oligomerization domain receptors and cause a local or generalized immune response . This response consists in the assembly of a cytosolic protein complex composed of nucleotide-binding and leuchine-rich repeat containing proteins and caspase 1 which, once activated, triggers IL-1 production .

Fig. 1

Can You Be Born With Diabetes Is It Genetic

You arent born with diabetes, but Type 1 diabetes usually appears in childhood. Prediabetes and diabetes develop slowly over time years. Gestational diabetes occurs during pregnancy.Scientists do believe that genetics may play a role or contribute to the development of Type 1 diabetes. Something in the environment or a virus may trigger its development. If you have a family history of Type 1 diabetes, you are at higher risk of developing Type 1 diabetes. If you have a family history of prediabetes, Type 2 diabetes or gestational diabetes, youre at increased risk of developing prediabetes, Type 2 diabetes or gestational diabetes.

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What The Research Says

Early research suggests that the two types of diabetes may have more in common than previously believed. In the last decade, researchers have tested the idea that type 2 diabetes is an autoimmune disease, similar to type 1 diabetes.

Researchers have found evidence that insulin resistance may be the result of immune system cells attacking the bodys tissues. These cells are designed to produce the antibodies that fight invading bacteria, germs, and viruses.

In people with type 2 diabetes, these cells may mistakenly attack healthy tissue.

If type 2 diabetes is an autoimmune disease, the discovery may have big implications on our understanding of obesity. Itll also affect the way obesity-induced type 2 diabetes is treated.

Doctors currently treat type 2 diabetes with two traditional approaches.

The first focuses on a healthy lifestyle. A healthy diet and frequent exercise are the pillars of this treatment.

Doctors then typically prescribe oral medications that work in different ways to increase your bodys ability to use insulin, to make less glucose, and to perform other actions.

If medications dont work, you may need to use insulin. Injections of insulin can help your cells absorb glucose and generate energy.

Some people with diabetes may be able to postpone insulin injections with healthy lifestyle changes and medications. Others may need them right away.

Treatment Implications For Type 2 Diabetes

Currently, to treat autoimmune disorders, patients will use a range of different methods. They take anti-inflammatory drugs, immunosuppressive medication, and pain relievers. Many opt for physical therapy, hormone replacement, and blood transfusion if necessary.

For type 2 diabetes, eating balanced meals and doing physical activity can help manage the disease. The current treatment goal is to alleviate the symptoms and control the disease, especially when the patient has flare-ups.

Whereas 1 diabetes often requires adequate medication and insulin injections. When diabetes is paired with another disease, like autoimmune hypothyroidism, doctors may suggest immunosuppressant medication.

But, the recent statistics could pave the way for a more impactful treatment.

Experts believe that it might be possible to develop a vaccine for type 2 diabetes in the future. A product that will stimulate the protective immune responses instead of the harmful ones. If they can determine the panel of antibodies that defends the system from insulin resistance.

Further animal trials also supported the theory. Some researchers are strongly suggesting that immune modulation could be deemed as a possible human therapy. But, until they can prove these effects on large-scale human studies, it is difficult to determine its real impact.

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What Are The Symptoms Of Diabetes

Symptoms of diabetes include:

• In women: Dry and itchy skin, and frequent yeast infections or urinary tract infections.
• In men: Decreased sex drive, erectile dysfunction, decreased muscle strength.

Type 1 diabetes symptoms: Symptoms can develop quickly over a few weeks or months. Symptoms begin when youre young as a child, teen or young adult. Additional symptoms include nausea, vomiting or stomach pains and yeast infections or urinary tract infections.

Type 2 diabetes and prediabetes symptoms: You may not have any symptoms at all or may not notice them since they develop slowly over several years. Symptoms usually begin to develop when youre an adult, but prediabetes and Type 2 diabetes is on the rise in all age groups.

Gestational diabetes: You typically will not notice symptoms. Your obstetrician will test you for gestational diabetes between 24 and 28 weeks of your pregnancy.

Can Diabetes Cause Hearing Loss

Scientists dont have firm answers yet but there appears to be a correlation between hearing loss and diabetes. According to the American Diabetes Association, a recent study found that hearing loss was twice as common in people with diabetes versus those who didnt have diabetes. Also, the rate of hearing loss in people with prediabetes was 30% higher compared with those who had normal blood glucose levels. Scientists think diabetes damages the blood vessels in the inner ear, but more research is needed.

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Autoimmunity In Obesity And Type 2 Diabetes

A recent study pointed out that obesity is associated with all kinds of autoimmune diseases. They connected obesity to

• Multiple sclerosis
• Crohns Disease and ulcerative colitis
• Hashimotos Thyroiditis
• Type 1 Diabetes

The authors explanation started out with the fact that fat cells dont just hang out on your body storing energy. Theyre metabolically active in their own right, and in particular, they control some powerful inflammatory messengers. The authors of the study suggested that inflammatory signals from fat cells affects the immune response, which makes obese people more prone to developing autoimmune reactions.

Other recent research has examined Type 2 Diabetes as a disease with an autoimmune component. Type 2 Diabetes is the type of diabetes usually blamed on lifestyle . This study summarized some of the evidence for an autoimmune component in Type 2:

• Insulin resistance in fat tissue is related to a type of immune cells called T cells. Obese mice with insulin resistance have low levels of regulatory T cells in their fat tissue, and introducing regulatory T cells improves their insulin sensitivity.
• Patients with Type 2 Diabetes have higher levels of inflammatory markers, and most people agree that inflammation contributes to the development of insulin resistance.
• Inflammation is a risk factor for autoimmunity, as is obesity .
• New evidence has shown that immune-mediated damage to the pancreas isnt just a feature of Type 1 Diabetes its also part of Type 2.

What Types Of Healthcare Professionals Might Be Part Of My Diabetes Treatment Team

Most people with diabetes see their primary healthcare provider first. Your provider might refer you to an endocrinologist/pediatric endocrinologist, a physician who specializes in diabetes care. Other members of your healthcare team may include an ophthalmologist , nephrologist , cardiologist , podiatrist , neurologist , gastroenterologist , registered dietician, nurse practitioners/physician assistants, diabetes educator, pharmacist, personal trainer, social worker, mental health professional, transplant team and others.

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What Does It Mean If Test Results Show I Have Protein In My Urine

This means your kidneys are allowing protein to be filtered through and now appear in your urine. This condition is called proteinuria. The continued presence of protein in your urine is a sign of kidney damage.

A note from Cleveland Clinic

Theres much you can do to prevent the development of diabetes . However, if you or your child or adolescent develop symptoms of diabetes, see your healthcare provider. The earlier diabetes is diagnosed, the sooner steps can be taken to treat and control it. The better you are able to control your blood sugar level, the more likely you are to live a long, healthy life.

Last reviewed by a Cleveland Clinic medical professional on 03/28/2021.

References

S For Antibody Assays

The Presence of ANA, AMA, ASMA, LKM,APCA

Antibodies ANA, AMA, ASMA, APCA andLMC were analyzed by IIF according to themanufacturers instructions – DakoCytomation,Glostrup, Denmark.

Confirmation of the Presence of ANAwith Hep-2

The study was performed according to themanufacturer Euroimmun, Germany.

The presence of Anti-GAD

The study was performed according to themanufacturer – EUROIMMUN, Germany. Thestatistical analysis involved descriptive statistics,and a part was compared with the Chi-squaretest.

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Type 2 Diabetes Risk Factors

• Family history of type 1 diabetes
• Childhood consumption of cows milk, often before 1 year of age
• Mycobacterium avium paratuberculosis in dairy and meat products
• Enterovirus infections

• Family history of type 2 diabetes
• Diet high in fats, processed foods, and artificial sweeteners
• Weight above ideal
• Previous diagnosis of gestational diabetes mellitus
• Sedentary lifestyle

Just like the causes, the risk factors of type 1 diabetes are primarily uncontrollable, while the risk factors of type 2 diabetes are primarily related to your lifestyle.

Who Gets Diabetes What Are The Risk Factors

Factors that increase your risk differ depending on the type of diabetes you ultimately develop.

Risk factors for Type 1 diabetes include:

• Having a family history of Type 1 diabetes.
• Injury to the pancreas .
• Presence of autoantibodies .
• Physical stress .
• Exposure to illnesses caused by viruses.

Risk factors for prediabetes and Type 2 diabetes include:

• Family history of prediabetes or Type 2 diabetes.
• Being African-American, Hispanic, Native American, Asian-American race or Pacific Islander.
• Being overweight.

Risk factors for gestational diabetes include:

• Family history of prediabetes or Type 2 diabetes.
• Being African-American, Hispanic, Native American or Asian-American.
• Being overweight before your pregnancy.
• Being over 25 years of age.

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Is Type 2 Diabetes An Autoimmune Disease What The Research Says

Overview

For decades, doctors and researchers believed that type 2 diabetes was a metabolic disorder. This type of disorder occurs when your bodys natural chemical processes dont work properly.

Recent research suggests that type 2 diabetes may actually be an autoimmune disease. If thats the case, new treatments and preventive measures may be developed to treat this condition.

Currently, there isnt enough evidence to fully support this idea. For now, doctors will continue to prevent and treat type 2 diabetes with lifestyle changes, medications, and injected insulin.

Read on to learn more about the research thats being done and the implications it may have on the treatment and prevention of type 2 diabetes.

Type 2 diabetes has historically been viewed as a different type of disease than type 1 diabetes, despite their similar names.