There is certainly a need for a new category beyond "Type I" and "Type II".
Estimates are that of Type II Diabetics who are overweight or obese, 85% of them would be asymptomatic if they simply reduced their weight to a healthy one, and didn't consume more calories than they burned each day.
Obese people with "Type II" should be reclassified as "Type F Diabetes". This will help our healthcare system allocate funds and resources better. Why spend money on a population who has a free, safe, and natural remedy (eating less) available to them?
It would be lovely to live in a world in which telling obese people they should "just eat less" reliably allowed more than a tiny percentage of them to drop to a "normal" weight range and stay there for >5 years, but alas, that is not the world we do live in.
> It would be lovely to live in a world in which telling obese people they should "just eat less"
Why would it matter? Telling cigarette smokers to just smoke less didn't work either, but it's just as prescriptive. People rather fail than change, so there's really no reason to lump the funding (type I vs type II) together.
I welcome the discerning scrutiny in research, described which should properly aim the funding.
> Telling cigarette smokers to just smoke less didn't work either, but it's just as prescriptive.
Hang on - by what measurement are you claiming telling people to smoke less didn't work?
People are smoking less, both as individuals and collectively. People who want to smoke less or to stop smoking entirely do manage to successfully do that with a decent success rate. Suggesting a smoker become a nonsmoker by smoking less isn't anywhere near so useless as telling an obese person to stop being obese by eating less.
(This even shows up in population level stats: the percentage of Americans who smoke has dropped in half since the 1970s whereas the percentage of Americans who are obese has more than doubled since the 1970s. Stopping smoking actually works - there is advice that works and there are treatments that work and people can just do it on their own. Whereas regarding obesity we just don't know what the hell is going on; most of the advice given is useless at best and counterproductive at worst.)
> It would be lovely to live in a world in which telling obese people they should "just eat less"
vs
> Telling cigarette smokers to just smoke less didn't work either, but it's just as prescriptive.
"Work" is a weasel word being used here to describe the initial axiomatic assumption about "fat people". The assumption is there is a measure of conversion not being met by medical advice. The warning about the dangers of cigarettes are the template for such advice, so it's reasonable to equate the two. If you don't think telling people to eat less "works", then telling people to smoke less didn't "work" either. No other lever was applied and people continued to suffer the consequences.
I thought it was obvious, how I was making a correlation to highlight the absurdity of the initial axiomatic statement. I was not trying to revise history.
> If you don't think telling people to eat less "works", then telling people to smoke less didn't "work" either.
I think my metric for whether advice "works" is whether people attempting to seriously follow the advice have at least, say, a 1-in-20 chance of success. By that metric "smoke less" does work and "eat less" does not.
When people follow the advice "eat less" it seems to have about a 1% chance of success 5 years later, whereas "smoke less" has at least a 10% chance of success. If only one of those numbers is meaningfully positive, only one of those sets of advice "works".
It seems to be that a lot of this "just eat less" is more of result of hate and wish to punish those people. It is not an attempt to describe what heatly eating looks like.
Obesity should be taxed, but indirectly. Taxing people with an eating disorder seems mean. Let's nudge them in the right direction by adding a massive federal healthcare tax to sugars at the wholesale level. Let's see how many Oreos you eat when they go from $2 to $20 per box.
This is politically challenging because people hate taxes and farmers & processed food companies like money and they're organized. That said, we managed to tax cigarettes despite tens of millions of smokers and plenty of tobacco farmers and even RJR Nabisco.
Insane taxes that increase the cost of the product 10 times is a form of prohibition. It doesn't even matter what you call it, you just created a black market with 900% margins.
...and has a well-recognised problem with binge-drinking, likely as a direct result.
The high cost of alcohol has minimised or removed the 'social' aspect from drinking culture for many people - rather, people get hammered on cheap booze at weekends.
> ...and has a well-recognised problem with binge-drinking
Norway? I've worked for a Norwegian company for over 15 years, and I've spent a lot of time there over those years.
And I've never seen bing-drinking or heard of it as a "well-recognised problem" there.
> rather, people get hammered on cheap booze at weekends
Sorry, what cheap booze?
IME, what you state is just not the case. Alcohol always seems to be a social thing, more of an event even, likely because of the price. Norwegians tend to be more like connoisseurs of good quality alcoholic drinks - because so much of the cost is tax, you can buy high quality aquavit, whisky and craft beers for the same price as what would be considered 'pish' here in the UK.
I assume that this is just for ethanol to drink, right? Bio-ethanol as fuel wouldn't work if it weren't separated. How do they keep the ethanol-as-fuel out of ethanol-as-commestable apart? Also - at that tax-level - do they attempt to keep people from home-distillary?
In the short run, we could even use some of the taxes to compensate producers and induce them to switch to producing healthy food. That should help take some objection away from agribusiness.
For consumers, the taxes should be earmarked to subsidize healthy food and thus increase demand for it. Therefore, consumers do not pay more taxes in aggregate and that should reduce objection from fiscal conservatives.
The problem is that some climates are massively more efficient at producing one crop over another. Switching corn subsidies to vegetable subsidies would reduce the value of farms in Iowa and increase the value of farms in California. Explicitly regional subsidies might work (CA farmers get $0.01 per carrot while IA gets $0.05). Some people will decry this as another market distortion, but that's the point.
People with eating disorder have themselves to blame so it would be entirely fair to tax them just like we tax smokers since they are at elevated risks of various diseases as well.
While I agree in principle, I have my trouble with politicians deciding what's healthy and what's not. With sugar it seems to be a clear cut case by now. But just imagine your policy implemented in the 90s. They would have heavily taxed fat and eggs. The obesity epidemic would have been even worse, because poor people would have substituted with carbs.
Nutritional "science" is less science than advice. And it's often wrong.
Just look at the number of bs studies on chocolate is healthy, wine is healthy etc. They're famous because everybody likes chocolate and wine. My best guess is that having a glass of wine in the evening is correlated with people who are a) more well-off, b) cook at home and c) have enough moderation not to drink a whole bottle of wine. Having moderation is generally good for you. People who eat dark chocolate? Well they probably aren't people with such a sweet tooth (otherwise they'd eat milk chocolate), and that is in general a healthy thing to have.
Nutritional science is 99% bunk, and filtering through that noise is nigh impossible. I'm wary of politicians calling shots on this basis.
Or we could just stop massively subsidising sugar (in the form of HFCS). Crazy, I know.
Why does everyone think that politicians are clueless numpties when they're deciding what to tax, but omniscient geniuses whenever they're deciding what to subsidise?
Earmarks and subsidies are some of the most criticized aspects of the legislative process. Those who benefit directly from the subsidies of course are in favor of them, others simply feel powerless to do anything about them.
>Why does everyone think that politicians are clueless numpties when they're deciding what to tax, but omniscient geniuses whenever they're deciding what to subsidise?
I don't agree that everyone thinks that way. Most people like me are wary of both taxation and subsidies. IMHO there shouldn't be any subsidies on food for the same reason. We don't know enough about food to make smart decisions.
So I'm all for a complete cut of subsidies. But not for taxation to control buying behavior.
> With sugar it seems to be a clear cut case by now.
I'm not sure. It was quite recently, in 2014-2015, that Coca-Cola spent millions on the Global Energy Balance Network convincing people sugar isn't bad and doesn't cause obesity. There is so much money at stake I'm convinced we will never have 100% objective scientific research here.
This approach is super goofy because refined sugar and corn syrup are already heavily subsidized by the federal government. Instead of adding another layer of distortions to correct the first one we should start by looking at why the current regulations exist and what the consequences will be if we unwind them.
You know,.. I actually agree with you. For whatever reason, my below average weight wife has persistently elevated insulin, but normal blood sugar. Still, it was high enough for her doctor to wonder whether she had pancreatic cancer (she doesn’t, thankfully). Shes athletic and active and doctors can’t say she her body simply produces more insulin.
It’s really awful to be doing research and read over and over that those with high insulin should lose weight. If my wife loses 10 pounds she would actually be underweight. When she was pregnant last, she lost ten pounds and the doctors were starting to get worried.
The shittiest part is that my fat diabetic family try to give her diet advice while simultaneously having no discipline. We’ve tried diets to lose what weight she has left and bring her insulin down, but no dice. Meanwhile, my family says they’ll diet, eats trash, are fat, and have diabetes and act as if they and my wife have the same disease.
Ultimately focusing all our attention on people engaging in self destructing behaviors lessens the amount of time spent helping people who actually have a disease
A female (whose weight was already very much on the lower end of 'normal') was diagnosed as pre-diabetic a while ago, and was able to control/improve things with a fairly strict low-carb --verging on keto-- diet. Sounds similar, and a similar approach may be worth trying?
These diets cause weight loss. The person is already mildly underweight so they are doubly risky. Not to say these shouldn't be tried, but only under careful monitoring.
No export, but from what I've read, while they (slow/low-carb diets) are usually used for weight-loss, your caloric intake is still important while following the diet. Thus it's possible to follow a s/low-carb diet and maintain, rather than lose, weight.
This just shows how little we know about metabolic diseases. She might have one of the genetic insulin resistance variants - a few are already known.
As long as blood sugar is controlled (check with Hb1Ac test) and cancer is thoroughly excluded (not just pancreatic, other ones can cause this too), higher than typical insulin should be no real problem...
You're right... there shouldn't be any link. My wife and I are typically not really into treating things that don't cause issues. However, we'd been investigating any reason why we've lost seven pregnancies to stillbirth and miscarriage, and there's some studies indicating that lower insulin leads to better outcomes. That's why we had been trying to get it as low as possible. At this point, though, it's not clear whether or not that was even a factor.
Too bad this is just five "clusters" of characteristics that people with not-type-I diabetes can be grouped into. No clear underlying mechanism for the cause of each of the groups diabetes. Maybe more in the journal paper? Or now focused studies can be done on each group to find out the root cause? I hope so.
I was surprised to learn on reading this that the Type 1 classification always means "autoimmune disease". I was under the impression that the two type classifications were "1: unable to produce enough insulin", and "2: producing what ought to be normal amounts of insulin, but for some reason resistant to it"; naively, those seemed like much more natural classes for classifying a syndrome. Having a finer-grained analysis can't be a bad thing; for example, the paper identifies some increased risks for the individual clusters.
I had in my head that Type 1 was "unable to produce enough insulin, because of autoimmune problems with beta cells". I was surprised to read about Cluster 2 where they don't produce enough insulin and nobody knows why.
I would have also intuitively put Cluster 2 under Type 1 diabetes though, because it's the same effect.
AFAIK in type 1, most of the beta cells get destroyed, and it happens because of autoimmune processes. To me this means that immune-modulating medication or perhaps stem cell injections could help a great deal.
Immune-modulating medication maybe, but unless this is identified very early, they won't help. Once the beta cell destruction is complete, you are left without any. Even if the immune system stops attacking, at some point it no longer helps.
In fact, a long time ago some experimental treatment was tried, where active beta cells were transplanted into type 1 diabetes patients. They were very quickly destroyed by the patient's immune system.
The problem with those are that they're more complicated (even when perfected) than current treatment. Immune modulation would require either suppressing the entire system (or very large chunks of it) which is done with some other diseases but generally has super high costs, as it leaves you quite vulnerable. Or you're targetting only the handful of cells responsible (my DM I knowledge is rusty but I'm guessing b-cells?) in which case you're on your way to solving a bunch of different diseases.
Stem cells has a similar issue, in that once you made new beta cells your immune system will just react to those.
Current treatment is quite alright. There's ground to be gained in earlier prediction and treatment, and a ton (this should excite people here on HN) in bettering the treatment method—create a proper feedback loop with insulin/glucose readers that automatically push out insulin when needed instead of a huge shot of it when you're guessing you'll need it.
My doctor wants me to start thinking about a closed loop system on this year so I don't need to wake up every night for CGM alarms. One interesting project would be the open source pancreas, I've heard lots of good about it, of you have the right insulin pump and CGM.
Until there’s a dual (glucagon, insulin) pump released, you’ll still be waking up to deal with those low BG alarms. You may be dealing with fewer alarms because of the predictive suspend feature, sure.
Our 6 year old has had a Medtronic 530g which (you probably already know) suspends basal delivery when it reaches a low threshold. I’m pretty sure it’s saved his life a few times (at night) over the past 4 years. He’s due for a new pump and we were hoping the Beta Bionics dusk chambered pump would be ready by this time, but sadly it still looks to be a couple of years away. The Medtronic 670g is likely his next pump, which will add predictive suspend and IIRC will also auto increase his basal rates to account for highs.
OpenAPS looks interesting but for now I’m not willing to experiment with it on our son.
My doctor's colleague in US uses the 670G and when they met he showed her how now every night he has a straight 6.5 mmol/l line and no wake-ups anymore. My need for basal changes quite often and this feature would be nice.
I use xdrip which wakes me up before I got hypo or hyper. I'd prefer to have eight hours of sleep every now and then.
Yeah we use a Medtronic MySentry (basically think of a baby monitor with a screen that displays his BG level...and relays CGM/pump alarms, loud enough to wake the dead.)
xDrip / parakeet looks awesome, but that looks to be Dexcom-only as far as I can tell.
Our son carries a medtronic Minimed Connect (pump<->bluetooth adapter) and an iPhone (yeah a kindergartener with an iPhone) so it can relay his BG when he's in school using Nightscout.
Unfortunately neither the MySentry, nor the Minimed Connect are supported with the 670g so we're a little concerned that we won't be able to monitor him remotely (while he's sleeping or when he's at school...the two times he's most vulnerable.)
I'd love to switch him to a Dexcom, but there are currently no pumps that support predictive / suspend functionality at this time (though the T:Slim X2 is getting close to getting this type of update.)
There's an enormous amount of research into both understanding the autoimmune reaction and into safe insulin producing cells that could be introduced.
Turns out they are both really hard problems.
It's a reason to be pretty excited about medicine over the coming years. Doctors are starting to tease apart some of the specifics of the immune system.
It seems a remarkable number of comments seem to think that people with Type II diabetes resulting from Obesity should be compelled not to eat and should be denied healthcare in the interim, such as this one [dead] comment:
> Why spend money on a population who has a free, safe, and natural remedy (eating less) available to them?
Please study food addictions¹²³⁴. Addiction is a disease⁵. Going cold turkey may work for some, but for many, this option is infeasible with drugs. With food, it's infeasible for everyone.
Food addiction is especially difficult to combat without medical intervention⁶. Denying victims access to said care will only exacerbate the problem.
Alzheimer’s disease is informally referred to as Type 3 diabetes because of similarity; this informal name
Is prevalent enough that when a different form of type I was discovered (which may or may not be cluster 2 in this article) it was called type 4
The quality of this article is rather poor. It's almost beyond belief that they didn't consult with Prof. Andrew Hattersley, who is regarded as one of the world leading experts in this.
We have known for many many years about several other types of diabetes. It is what I research as my job.
Type 1 is caused by the autoimmune destruction of the beta cells in the pancreas that generate insulin, and the patient becomes dependent on injected insulin.
Type 2 is caused by a progression from the body becoming resistant to insulin due to being overweight, the beta cells generating more insulin to compensate, and then eventually the beta cells burning out. Along the way, treatment progresses from diet, to tablets such as metformin, and eventually to insulin injections. Many people think that you progress to type 1 when you become dependent on injected insulin, but that is not the case - it is still type 2.
There is gestational diabetes, where the huge changes in the body caused by pregnancy can trigger temporary diabetes (although sometimes it persists for a while after pregnancy). For this reason, we tend to test the blood sugar level of pregnant women.
Then we have MODY (Maturity Onset Diabetes of the Young), which is a form of monogenic diabetes. There are at least 10 types, caused by single gene defects in various genes. The treatment and prognosis depends on the gene which is defective. For instance, if you have one of your two copies of the GCK gene defective, then you get GCK MODY, which typically has few symptoms, but is usually detected when a woman is pregnant and has their blood sugar levels tested. The danger with GCK MODY is over-treatment - they do not need any treatment at all, but doctors may try to lower the blood sugar levels by giving insulin injections, which can be dangerous. Other forms of MODY do require insulin.
There is also Neonatal Diabetes (NDM), which has two broad types, being permanent and transient, and there are several different sub-types depending on the gene defect. In this case, you are generally diagnosed with diabetes under the age of six months, and sometimes as young as hours after birth. If both of your copies of the GCK gene are defective, you will get permanent neonatal diabetes, and require insulin injections for life, from birth. However, if you have neonatal diabetes caused by defects in the ABCC8 or KCNJ11 genes, treatment with sulfonylurea tablets is highly effective. It is important to obtain a genetic diagnosis in order to get the correct treatment.
There are other types of diabetes other than these. It is very weird for this article to be claiming the fact that there is more than just type 1 and type 2 to be news - it has been widely known for many years.
A lot of the recent work has been on trying to distinguish the different types of diabetes. Neonatal diabetes is easy to distinguish, because it has a severe early onset. It is possible to determine the genetic cause in about 80% of patients that have this condition, and we are confident that further searches will reveal a large proportion of the remainder. MODY is however too similar to type 1 diabetes, so of patients sent for genetic testing for MODY, a proportion of them will have type 1 instead, so the genetic test success rate is lower, around 30%. Genetic risk scores for the autoimmune type 1 diabetes response are used to try and distinguish the two, in order to try and perform gene discovery research on as pure a MODY cohort as possible.
"We did data-driven cluster analysis (k-means and hierarchical clustering) in patients with newly diagnosed diabetes (n=8980) from the Swedish All New Diabetics in Scania cohort. Clusters were based on six variables (glutamate decarboxylase antibodies, age at diagnosis, BMI, HbA1c, and homoeostatic model assessment 2 estimates of β-cell function and insulin resistance), and were related to prospective data from patient records on development of complications and prescription of medication. Replication was done in three independent cohorts: the Scania Diabetes Registry (n=1466), All New Diabetics in Uppsala (n=844), and Diabetes Registry Vaasa (n=3485). Cox regression and logistic regression were used to compare time to medication, time to reaching the treatment goal, and risk of diabetic complications and genetic associations"
k-means and hierarchical clustering are notoriously prone to producing false positive clusters.
k-means is just garbage, but hierarchical clustering can be good. The problem with hierarchical clustering is that you can produce whatever set of clusters you're biased towards by fiddling with the linkage function and the cut criterion.
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I was diagnosed with diabetes seven years ago, and I started getting complications such as renal failure. Someone suggested that I purchase diabetes herbal formula from BEST HEALTH HERBAL CENTRE which i did. I only used the diabetes herbal formula for 5 weeks only. Is three months now, no more renal failure and I have been free of diabetes .
62 comments
[ 3.0 ms ] story [ 98.5 ms ] threadEstimates are that of Type II Diabetics who are overweight or obese, 85% of them would be asymptomatic if they simply reduced their weight to a healthy one, and didn't consume more calories than they burned each day.
Obese people with "Type II" should be reclassified as "Type F Diabetes". This will help our healthcare system allocate funds and resources better. Why spend money on a population who has a free, safe, and natural remedy (eating less) available to them?
Why would it matter? Telling cigarette smokers to just smoke less didn't work either, but it's just as prescriptive. People rather fail than change, so there's really no reason to lump the funding (type I vs type II) together.
I welcome the discerning scrutiny in research, described which should properly aim the funding.
Hang on - by what measurement are you claiming telling people to smoke less didn't work?
People are smoking less, both as individuals and collectively. People who want to smoke less or to stop smoking entirely do manage to successfully do that with a decent success rate. Suggesting a smoker become a nonsmoker by smoking less isn't anywhere near so useless as telling an obese person to stop being obese by eating less.
(This even shows up in population level stats: the percentage of Americans who smoke has dropped in half since the 1970s whereas the percentage of Americans who are obese has more than doubled since the 1970s. Stopping smoking actually works - there is advice that works and there are treatments that work and people can just do it on their own. Whereas regarding obesity we just don't know what the hell is going on; most of the advice given is useless at best and counterproductive at worst.)
vs
> Telling cigarette smokers to just smoke less didn't work either, but it's just as prescriptive.
"Work" is a weasel word being used here to describe the initial axiomatic assumption about "fat people". The assumption is there is a measure of conversion not being met by medical advice. The warning about the dangers of cigarettes are the template for such advice, so it's reasonable to equate the two. If you don't think telling people to eat less "works", then telling people to smoke less didn't "work" either. No other lever was applied and people continued to suffer the consequences.
I thought it was obvious, how I was making a correlation to highlight the absurdity of the initial axiomatic statement. I was not trying to revise history.
I think my metric for whether advice "works" is whether people attempting to seriously follow the advice have at least, say, a 1-in-20 chance of success. By that metric "smoke less" does work and "eat less" does not.
When people follow the advice "eat less" it seems to have about a 1% chance of success 5 years later, whereas "smoke less" has at least a 10% chance of success. If only one of those numbers is meaningfully positive, only one of those sets of advice "works".
This is politically challenging because people hate taxes and farmers & processed food companies like money and they're organized. That said, we managed to tax cigarettes despite tens of millions of smokers and plenty of tobacco farmers and even RJR Nabisco.
Alcohol taxes are quite low in most states:
https://files.taxfoundation.org/legacy/docs/Spirits-Excise-T...
The comment above suggests a $18 tax on a tiny $2 pack, 14 Oz. That's very different from a few cents per bottle tax.
The world is bigger than the USA!
Look at Norway, for example, which has high alcohol taxes and even runs a state monopoly for alcohol over a certain strength (ftom memory, ~4%
The high cost of alcohol has minimised or removed the 'social' aspect from drinking culture for many people - rather, people get hammered on cheap booze at weekends.
Norway? I've worked for a Norwegian company for over 15 years, and I've spent a lot of time there over those years.
And I've never seen bing-drinking or heard of it as a "well-recognised problem" there.
> rather, people get hammered on cheap booze at weekends
Sorry, what cheap booze?
IME, what you state is just not the case. Alcohol always seems to be a social thing, more of an event even, likely because of the price. Norwegians tend to be more like connoisseurs of good quality alcoholic drinks - because so much of the cost is tax, you can buy high quality aquavit, whisky and craft beers for the same price as what would be considered 'pish' here in the UK.
I assume that this is just for ethanol to drink, right? Bio-ethanol as fuel wouldn't work if it weren't separated. How do they keep the ethanol-as-fuel out of ethanol-as-commestable apart? Also - at that tax-level - do they attempt to keep people from home-distillary?
For consumers, the taxes should be earmarked to subsidize healthy food and thus increase demand for it. Therefore, consumers do not pay more taxes in aggregate and that should reduce objection from fiscal conservatives.
Nutritional "science" is less science than advice. And it's often wrong.
Just look at the number of bs studies on chocolate is healthy, wine is healthy etc. They're famous because everybody likes chocolate and wine. My best guess is that having a glass of wine in the evening is correlated with people who are a) more well-off, b) cook at home and c) have enough moderation not to drink a whole bottle of wine. Having moderation is generally good for you. People who eat dark chocolate? Well they probably aren't people with such a sweet tooth (otherwise they'd eat milk chocolate), and that is in general a healthy thing to have.
Nutritional science is 99% bunk, and filtering through that noise is nigh impossible. I'm wary of politicians calling shots on this basis.
Why does everyone think that politicians are clueless numpties when they're deciding what to tax, but omniscient geniuses whenever they're deciding what to subsidise?
I don't agree that everyone thinks that way. Most people like me are wary of both taxation and subsidies. IMHO there shouldn't be any subsidies on food for the same reason. We don't know enough about food to make smart decisions.
So I'm all for a complete cut of subsidies. But not for taxation to control buying behavior.
I'm not sure. It was quite recently, in 2014-2015, that Coca-Cola spent millions on the Global Energy Balance Network convincing people sugar isn't bad and doesn't cause obesity. There is so much money at stake I'm convinced we will never have 100% objective scientific research here.
That's beneficial for producers but shows up as higher consumer prices.
It’s really awful to be doing research and read over and over that those with high insulin should lose weight. If my wife loses 10 pounds she would actually be underweight. When she was pregnant last, she lost ten pounds and the doctors were starting to get worried.
The shittiest part is that my fat diabetic family try to give her diet advice while simultaneously having no discipline. We’ve tried diets to lose what weight she has left and bring her insulin down, but no dice. Meanwhile, my family says they’ll diet, eats trash, are fat, and have diabetes and act as if they and my wife have the same disease.
Ultimately focusing all our attention on people engaging in self destructing behaviors lessens the amount of time spent helping people who actually have a disease
No export, but from what I've read, while they (slow/low-carb diets) are usually used for weight-loss, your caloric intake is still important while following the diet. Thus it's possible to follow a s/low-carb diet and maintain, rather than lose, weight.
As long as blood sugar is controlled (check with Hb1Ac test) and cancer is thoroughly excluded (not just pancreatic, other ones can cause this too), higher than typical insulin should be no real problem...
Not a licensed medical advice of course.
I would have also intuitively put Cluster 2 under Type 1 diabetes though, because it's the same effect.
Stem cells has a similar issue, in that once you made new beta cells your immune system will just react to those.
Current treatment is quite alright. There's ground to be gained in earlier prediction and treatment, and a ton (this should excite people here on HN) in bettering the treatment method—create a proper feedback loop with insulin/glucose readers that automatically push out insulin when needed instead of a huge shot of it when you're guessing you'll need it.
https://openaps.org/
Our 6 year old has had a Medtronic 530g which (you probably already know) suspends basal delivery when it reaches a low threshold. I’m pretty sure it’s saved his life a few times (at night) over the past 4 years. He’s due for a new pump and we were hoping the Beta Bionics dusk chambered pump would be ready by this time, but sadly it still looks to be a couple of years away. The Medtronic 670g is likely his next pump, which will add predictive suspend and IIRC will also auto increase his basal rates to account for highs.
OpenAPS looks interesting but for now I’m not willing to experiment with it on our son.
I use xdrip which wakes me up before I got hypo or hyper. I'd prefer to have eight hours of sleep every now and then.
xDrip / parakeet looks awesome, but that looks to be Dexcom-only as far as I can tell.
Our son carries a medtronic Minimed Connect (pump<->bluetooth adapter) and an iPhone (yeah a kindergartener with an iPhone) so it can relay his BG when he's in school using Nightscout.
Unfortunately neither the MySentry, nor the Minimed Connect are supported with the 670g so we're a little concerned that we won't be able to monitor him remotely (while he's sleeping or when he's at school...the two times he's most vulnerable.)
I'd love to switch him to a Dexcom, but there are currently no pumps that support predictive / suspend functionality at this time (though the T:Slim X2 is getting close to getting this type of update.)
Thanks for the heads up on xDrip!
Turns out they are both really hard problems.
It's a reason to be pretty excited about medicine over the coming years. Doctors are starting to tease apart some of the specifics of the immune system.
> Why spend money on a population who has a free, safe, and natural remedy (eating less) available to them?
Please study food addictions¹²³⁴. Addiction is a disease⁵. Going cold turkey may work for some, but for many, this option is infeasible with drugs. With food, it's infeasible for everyone.
Food addiction is especially difficult to combat without medical intervention⁶. Denying victims access to said care will only exacerbate the problem.
¹ https://www.webmd.com/mental-health/eating-disorders/binge-e...
² http://onlinelibrary.wiley.com/doi/10.1002/eat.20957/full
³ https://www.sciencedirect.com/science/article/pii/S019566631...
⁴ https://www.sciencedirect.com/science/article/pii/S019566631...
⁵ https://scholar.google.com/scholar?hl=en&as_sdt=0%2C47&q=add...
⁶ https://www.sciencedirect.com/science/article/pii/S019566631...
We have known for many many years about several other types of diabetes. It is what I research as my job.
Type 1 is caused by the autoimmune destruction of the beta cells in the pancreas that generate insulin, and the patient becomes dependent on injected insulin.
Type 2 is caused by a progression from the body becoming resistant to insulin due to being overweight, the beta cells generating more insulin to compensate, and then eventually the beta cells burning out. Along the way, treatment progresses from diet, to tablets such as metformin, and eventually to insulin injections. Many people think that you progress to type 1 when you become dependent on injected insulin, but that is not the case - it is still type 2.
There is gestational diabetes, where the huge changes in the body caused by pregnancy can trigger temporary diabetes (although sometimes it persists for a while after pregnancy). For this reason, we tend to test the blood sugar level of pregnant women.
Then we have MODY (Maturity Onset Diabetes of the Young), which is a form of monogenic diabetes. There are at least 10 types, caused by single gene defects in various genes. The treatment and prognosis depends on the gene which is defective. For instance, if you have one of your two copies of the GCK gene defective, then you get GCK MODY, which typically has few symptoms, but is usually detected when a woman is pregnant and has their blood sugar levels tested. The danger with GCK MODY is over-treatment - they do not need any treatment at all, but doctors may try to lower the blood sugar levels by giving insulin injections, which can be dangerous. Other forms of MODY do require insulin.
There is also Neonatal Diabetes (NDM), which has two broad types, being permanent and transient, and there are several different sub-types depending on the gene defect. In this case, you are generally diagnosed with diabetes under the age of six months, and sometimes as young as hours after birth. If both of your copies of the GCK gene are defective, you will get permanent neonatal diabetes, and require insulin injections for life, from birth. However, if you have neonatal diabetes caused by defects in the ABCC8 or KCNJ11 genes, treatment with sulfonylurea tablets is highly effective. It is important to obtain a genetic diagnosis in order to get the correct treatment.
There are other types of diabetes other than these. It is very weird for this article to be claiming the fact that there is more than just type 1 and type 2 to be news - it has been widely known for many years.
A lot of the recent work has been on trying to distinguish the different types of diabetes. Neonatal diabetes is easy to distinguish, because it has a severe early onset. It is possible to determine the genetic cause in about 80% of patients that have this condition, and we are confident that further searches will reveal a large proportion of the remainder. MODY is however too similar to type 1 diabetes, so of patients sent for genetic testing for MODY, a proportion of them will have type 1 instead, so the genetic test success rate is lower, around 30%. Genetic risk scores for the autoimmune type 1 diabetes response are used to try and distinguish the two, in order to try and perform gene discovery research on as pure a MODY cohort as possible.
So are you saying the research project didn't contribute any new knowledge at all? In that case, why the quotes from the experts that it did?
On the other hand, if you do think it contributed some new knowledge, you should have said that and mentioned some specifics.
k-means and hierarchical clustering are notoriously prone to producing false positive clusters.