The Internet is abuzz with discussion of a recent study that showed that overweight people with type 2 diabetes lived longer than those who were normal weight.
The researchers had several theories for the effect.
First, doctors may treat normal-weight patients less aggressively than overweight patients, not pushing them as hard to modify their diets and get more exercise. And the patients themselves might not be as careful with their diet and exercise because they “may have a false sense of protection because they are not overweight or obese,” as stated in an editorial accompanying the article.
Second, many doctors don’t suspect type 2 diabetes in people who aren’t overweight, so the normal-weight patients might be diagnosed at later stages of the disease when it’s harder to control. One patient wrote that he suspected he had diabetes and begged his doctor for testing but the doctor just laughed at him because he wasn’t overweight.
Another factor, which I pointed out in the comments section of the Times article, is that the “type 2 patients” being studied might not all have been type 2 after all. Most of us know there are types of diabetes that aren’t type 1 or type 2, which is defined by having insulin resistance. They include LADA (latent autoimmune diabetes of adults), a slower moving form of type 1 diabetes found in older patients; MODY (maturity-onset diabetes of the young), a monogenic disease (meaning it’s caused by a mutation in just one gene, whereas type 2 is polygenic) that often appears in young people but sometimes is first found when they’re older; and “Flatbush diabetes,” also called ketosis-prone diabetes or diabetes type 1b, primarily found in people of sub-Saharan African descent but also sometimes found in other ethnic groups. There are other rarer types of diabetes and there may be types too that simply haven’t been discovered yet.
If someone has LADA and is treated with oral drugs for several years and the oral drugs don’t work, it means they’ve spent several more years with higher blood glucose levels than someone with real type 2, in which the orals usually help. I know someone whose A1c’s kept going up and up, and she begged to go on insulin, but the nurse practitioner she was assigned to kept telling her she was producing plenty of insulin but her body just wasn’t able to use it. She finally got to see an endocrinologist, who diagnosed type 1 and put her on insulin, and her A1c’s came down.
So too, so few medical people are familiar with MODY and Flatbush diabetes that they may not know the best way to treat them.
As I noted in the Times comments, being overweight may also trigger type 2 at a younger age, so you seem to live longer after diagnosis, just as early detection of an incurable form of cancer sometimes seems to show that people live longer with early detection even though they die at the same age as someone diagnosed at a later stage. There’s just a longer time between diagnosis and death.
What is upsetting is that so few people, including some medical professionals, seem to be aware of non-type 1 diabetes in non-fat people. Coincidentally, the Wall Street Journal recently had an article about misdiagnosing type 1 diabetes as type 2 when the patients are adult. It’s not uncommon. But again, the possibility that some of these patients weren’t really either type 1 or type 2 was not brought up, except in comments by patients who were better informed than the reporter.
It’s sad when patients have to beg for testing or for insulin and just get laughed at. It’s time that diabetes education among health care professionals be revamped so that atypical patients can get the same care as typical type 1 or type 2 patients. It’s time the news media stops blathering about the obesity epidemic causing an epidemic of diabetes so that brainwashed health care people think that only fat people get diabetes. It’s time we figure out what’s really causing the current upsurge in diabetes, both type 1 and type 2.
With so much misinformation out there, even among medical professionals, we must take charge of our health, learn what we can, and work with our health care people to find the best treatment for us as individuals. At least we patients have online sites like Health Central to help us understand this complex disease.
Published On: August 10, 2012