Talk:Diabetes mellitus type 2

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Etiology

Hello, Robert,

I wanted to add an etiology section, but I wondered where to place it and whether it should be named Causes or something similar. How would you proceed?

Pierre-Alain Gouanvic 00:26, 10 January 2008 (CST)

Sounds great. I suggest following the outline at WikiPedia: Template for medical conditions. At some point, I think CZ needs a recommended standard organization for medical articles. - Robert Badgett 10:20, 23 January 2008 (CST)

I took an extra "s" out of the word "occasion", but then the diff said, if I'm reading it right, that I also added an "s" to a web address, which I most certainly didn't. So I'm not sure what's the situation there: line 151.Jeffrey Scott Bernstein 17:53, 9 April 2008 (CDT)

Your opinion on linked articles here, and possibly other templates

What do you think of a separate article on insulin resistance, or should that be expanded in here -- maybe a tab? My immediate reason is that I am working on a set of articles dealing with understanding its mechanism and ways of overcoming it. My immediate plan is the article on Peroxisome proliferator-activated receptors (PPARs) in my sandbox, then to create articles on fibrates and TZDs, then go back and discuss the potential synergistic effect on TZD side effects of using those two families, which activate at different PPAR subreceptors. I suspect insulin resistance may deserve its own article.

Incidentally, I wrote initial articles on Coxiella burnetii and Q fever, as an experiment in working out how to pair articles on pathogens and the disease they cause. The outlines from which I worked are in my sandbox User:Howard C. Berkowitz/PathogenPage and User:Howard C. Berkowitz/DiseasePage; I haven't yet modified them to reflect the experience with the preceding two mainspace articles. Comments on structure are more than welcome. Howard C. Berkowitz 10:44, 3 June 2008 (CDT)

Added prevalence section

Robert, I added a prevalence section with a table and double-graph from NIH website. Probably needs nesting in text, and better way to do caption refs.

I Also expanded the Intro with a blockquote.

I added note under banner re wiki-links, now that red is dead. --Anthony.Sebastian 21:16, 25 June 2008 (CDT)

remission - doesn't exist

Robert, you and I know that there is no such thing as remission. They just go from Frank DM2, back to undetectable Pre-diabetic for a short window until they slip down the insulin resistance ladder again. Yes, exercise and lifestyle can theoritically knock you back from frank DM2 back to prediabetic, but the pathophys of insulin resistance still remains. I think this should be explained more clearly. A huge section should be on prediabetes. It is undetectable. A usc researcher has a great graph that I wish I could post on here. It shows where diabetes is diagnosed and treated and where the disease probably actually starts. With this concept in mind, I would argue there is no such thing as remission. And it's not like those papers can prove it either. And remission for how long? maybe a few years of "remission." Tom Kelly 18:44, 29 March 2009 (UTC)

But the goal of treatment is to get out of the frank DM2 and back to this prediabetic state, which you call remission. So it is still worth mentioning. I would probably argue that intensive insulin in a new DM2 is detrimental however and the remission section may encourage people to go on insulin. I think that is not the best way of approaching it. They would just be cranking up their insulin levels against high insulin resistance when they should be doing things like diet and exercise and some oral drugs that may reduce their insulin resistance. Going on to insulin is a sign that the disease is really progressing quickly. I know there are new studies with tight insulin control in postCABG patients but I think this cannot be applied outside the ICU setting. I know this is all over the place but I am just posting to say that remission rubs me the wrong way. Tom Kelly 18:50, 29 March 2009 (UTC)

Speaking myself as a Type II diabetic with no particular hopes of remission, I would still say that it's not out of the question. Now, gastric bypass is not a scalable means of treatment, but there's a strong case that it has led to remissions. No one is seriously suggesting it's the weight loss, but a change in gut-secreted hormones.

As I say, I'm not holding my breath waiting for remission, and no, even though I'm working on rebuilding my gym today, I don't expect exercise to do it. What I do think is possible, however, is that much better means of treatment, and turning it into an essentially asymptomatic disease, are coming. My control is excellent, but on a combination of insulin and pioglitazone that cause far too much weight gain and fluid retention. Right now, there's no clean way to migrate to some of the perhaps marginally improved regulatory substances, and I see much more promising things in clinical trial.

My physician and I agreed to back away from 5-times-a-day monitoring and insulin tight control, because we really are unconvinced it will be significantly better than twice daily. What we'd look at much more closely is a continuous monitor and pump, which would likely avoid the hunger surges of even small short-acting insulin boluses. Even then, we'd still look to better hormone- and hormone-like substances than insulin. Howard C. Berkowitz 19:27, 29 March 2009 (UTC)