For decades, experts regarded type 2 diabetes solely as a metabolic condition. Because of the long list of triggers, such as unhealthy lifestyle choices, weight gain, age, and genetic predisposition, the body’s natural chemical processes are thrown off balance.
But, recent findings suggest that type 2 diabetes might actually be a more complex condition. One in which the immune system wrongly attacks the body instead of protecting it from viruses and bacteria. This has the exact same impact as an autoimmune disease.
Many people want to know is diabetes an autoimmune disease? Classifying type 2 and 1 diabetes mostly relies on insulin therapy. As well as the presence of immunologic abnormalities. But, no matter how different these diseases can be, they will often overlap.
Want to read more? Here is what the latest research has to say about this condition and its implications.
Is Diabetes an Autoimmune Disease?
Based on 2011 reports, scientists have redefined type 2 diabetes. Rather than just being a metabolic condition, it could also be an autoimmune illness. If that’s true, then preventive tactics and new treatments can help manage the condition.
According to Daniel A. Winer, one of the study leaders, these findings could inspire new diabetes treatments that target the immune system instead of just managing the blood sugar.
Scientists estimate that insulin resistance happens because the immune cells and B cells are attacking their own bodies’ tissues. With this study, endocrine pathologists are in the process of revamping the most widespread illness in America as an autoimmune disease.
If successful, the study can change people’s perceptions about obesity and diabetes. It will most likely affect future diabetes treatment. To really understand where this is coming from, it is important to look at both type 2 and type 1 diabetes individually.
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Type 1 Versus Type 2 Diabetes
Type 2 and type 1 diabetes have similar names, but they affect the body in different ways. These new results bring type 2 diabetes much closer to type 1.
Although it was established that type 1 diabetes causes autoimmune pancreatic B cell destruction, type 2 was considered a metabolic disease. Many mechanisms and inflammatory sources suggest there might be more to type 2 diabetes than it meets the eye.
Type 1 Diabetes
Type 1 diabetes mellitus is an autoimmune disease. The pancreas is unable to produce insulin because the immune system destroys and attacks the insulin-producing cells. The body interprets its own tissues as foreign cells and targets them.
This causes tissue damage and inflammation. Chronic pancreas inflammation damages the cells. In insulin-dependent patients, the pancreatic islets show signs of the disease. This type of response is known as an autoimmune reaction. Adolescents and children are prone to autoimmune difficulties that their diabetes may not cause.
Another form of type 1 diabetes is LADA (latent autoimmune diabetes). It can develop later in adulthood. It occurs more slowly than 1 diabetes and is very similar to type 2 diabetes. The reason people mistake autoimmune diabetes for type 2 diabetes is that it takes a long time to develop. Much longer than 1 diabetes. Whereas type 1 develops quickly, often in just a couple of days.
According to Eiji Kawasaki, the lead author of the Clinical Pediatric Endocrinology study, type 1 diabetes is often complicated with a different autoimmune illness. Anti-islet autoantibodies come before the clinical onset of the disease. Autoreactive t cells play a key role in autoimmune disorders. They can act as effector cells and regulatory cells.
The most typical coexisting autoimmune disease in T1D patients is autoimmune thyroid disease. Problems with the thyroid gland affect 90% of patients with T1D and autoimmune illnesses.
At the start, the prevalence of anti-thyroid antibodies in young patients with diabetes is 20%. People with anti-thyroid antibodies have an 18 times bigger risk of getting thyroid disease than those without the antibodies. That’s why early detection is critical.
The prevalence of another autoimmune condition can make the patient’s diabetes worse. An illness like celiac disease, Hashimoto’s thyroiditis, coeliac disease, Addison’s disease, and rheumatoid arthritis can become a serious problem.
In cases such as these, treatment is tailored towards managing the flare-ups and controlling the diabetes symptoms. Because of the lack of insulin, the body experiences insulin resistance, and the blood glucose increases. This type of diabetes can cause irritation, thirst, and frequent urination.
Type 2 Diabetes
Even though not everyone with type 2 diabetes is overweight, an inactive lifestyle and obesity are the most common causes for this condition. They are responsible for 90% to 95% of diabetes cases in the U.S.
This type of diabetes appears when the body develops insulin resistance or is incapable of producing its own insulin. The insulin is important for moving the glucose from the blood towards the cells, which is then converted into energy.
People can also develop islet autoimmunity. That means the body creates persistent autoantibodies to one or more insulin antigens, explains the American Diabetes Association.
Why is that important? Well, islet cell autoimmunity is a typical characteristic of type 1 diabetes. But, it also appears in 10% to 15% of subjects diagnosed with type 2 diabetes. This could be a predictor for future insulin problems.
When the body doesn’t get enough insulin, the cells can’t use the glucose. As a result, people experience diabetes symptoms. Such as frequent infections, fatigue, increased thirst, blurry vision, and more. If your blood glucose is too high and too often, the doctor might suggest insulin injections to get diabetes under control.
What Are the Risk Factors for Type 1 and Type 2 Diabetes Mellitus?
People are at risk of having type 2 diabetes if they:
- Have prediabetes (or an elevated blood glucose level)
- Lead a sedentary lifestyle
- Are obese or have excess body weight
- Had diabetes when pregnant (gestational diabetes)
- Are older than 45
- Have someone in their family who has diabetes
- Have PCOS (polycystic ovary syndrome)
The typical risk factors for 1 diabetes are:
- Hereditary: Having a sibling, parent, or anyone else in the family that has 1 diabetes.
- Location: Type 1 diabetes prevalence rate increases in people who live furthest from the equator.
- Genes: Being born with a specific gene puts them at risk of 1 diabetes, poor glucose control, and insulin secretion.
What Do Experts Have to Say?
According to researchers, these two diabetes types have a lot more in common than previously believed. They examined the theory that type 2 diabetes is an autoimmune disorder, quite like type 1 diabetes.
A couple of years ago, the study authors began thinking that an immune cell can cause fatty tissue inflammation. This inflammation can affect the internal organs. The immune cells that could trigger such a reaction are:
- B cell (mainly engaged in antibody responses)
- T cell (mostly engaged in cell-mediated immune responses)
Based on animal trials, mice that consumed high-calorie and high-fat diets developed this type of inflammation. Their fat cells grew quicker than their blood supply. Thus, the fat cells start to die, spilling their contents, and force the macrophages to clean up the immune system.
This immune reaction is the reason behind the chaos in the fatty tissue. When scientists took a closer look, they realized that it wasn’t just the macrophages that were involved, but the B cells and T cells as well. They gradually affected the way the body responds to insulin.
There is some evidence that insulin resistance could be caused by immune cells attacking the tissues. Where, in fact, these cells are meant to create antibodies to fight off viruses, germs, and bacteria. To confirm this theory, researchers kept the high-calorie and high-fat diet for a couple of weeks.
The mice experienced a spike in blood sugar levels and grew obese. But, when scientists blocked the T cells’ action, that’s when the immune system caused a response in the cells in tissue. The mice didn’t get diabetes.
Evidence suggests that B and T cell alterations occur due to the loss of insulin sensitivity in the adipose tissue. They also contribute to the general pro-inflammatory drift found in type 2 diabetes patients.
To test autoimmunity, scientists evaluated the interval from the onset of type 1 to the onset of Graves’ disease in APS3v patients (autoimmune polyendocrine syndrome type 3 variant).
There was a remarkable predominance of female patients with high levels of diabetes-associated antibodies known as an autoantibody. The numbers were much higher in APS3v patients than those with diabetes but without the type 3 variant.
Moreover, among the patients with diabetes and Graves’ disease, 60% developed Graves before the onset of diabetes. At the same time, 30% developed it after diabetes. Only 10% developed diabetes and Graves simultaneously.
To see if this would happen in humans, scientists studied 32 overweight individuals. They matched with weight and age but had a different insulin sensitivity. Based on the results, those with insulin resistance created antibodies against their own proteins.
While those who weren’t insulin resistant didn’t develop these antibodies, it is highly suggestive that humans who develop insulin resistance also have their bodies targeting their own proteins. It basically ties the concept of insulin resistance to autoimmunity.
What Makes the Immune System React This Way?
The actual cause of an autoimmune disorder is unknown. But, a couple of theories exist that might help explain the malfunction. They could be caused by:
- Drugs
- Chemical irritants
- Environmental factors
- Virus
- Bacteria
When the body’s natural defense system is thrown off balance, that’s when the immune response kicks in. Sometimes, the healthy tissues and cells get caught up in the process.
What we do know is that autoimmune disorders typically run in families, predominantly in the female population. Injury may also have a role to play. If a part of the body experiences high stress, it can trigger a response.
Since the autoimmune disorder is destroying healthy tissue, it can interfere with organ function and cause abnormal growth. Proper treatment can help restore normal organ function and control the disease.
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.
Immunosuppressant Meds
Autoimmunity is a known pathogenic component in type 1 diabetes. But it is also a very complex and multifactorial process. Many factors are involved in the process, which develops the disease. Such as the environment and genes.
Based on a 2014 report, meds that affect the immune system can benefit patients with type 2 diabetes. Immunosuppressants might prevent the immune system cells from attacking the healthy tissue. They are currently useful for treating arthritis and an autoimmune disorder.
These medications can get the autoimmunity back on track. The response to immunosuppression in autoimmune disease is seen in 60% to 70% of patients. The disease can progress, go into remission, or stop responding to treatment.
Rituximab (MabThera, Rituxan) is a common immunosuppressant. It belongs to the group of medicine called anti-CD20 antibodies. Anti-CD20 are approved treatments for an autoimmune disorder and blood cancer.
Winer’s research also found similar results. He explained that anti-CD20 stopped the development of type 2 diabetes in lab mice susceptible to the disease. It also kept their blood sugar at a healthy level. This antibody can target and remove the mature Beta-cell in the human system.
But, there isn’t enough research to see whether it will work for autoimmune diabetes in humans. Even though the results seem promising, using these medications for diabetes is a long way off. So far, it does seem like a viable strategy.
How to Test for Autoimmune Disease?
Do you have type 1 diabetes or type 2, but believe you may also have an autoimmune disorder? Then you need a proper diagnosis. There isn’t just one test that can diagnose all autoimmune disorders. The doctor will need to combine multiple tests to analyze your symptoms and health state.
To diagnose the disease, your doctor will need to identify the amount of antibody production and release that’s attacking the healthy tissue. These tests include:
- CRP (C-reactive protein) – measuring the antibodies can help detect the inflammation that’s affecting the system.
- Antinuclear antibodies – these tests try to locate any antibodies that might be attacking the nuclei of cells.
- ESR (Erythrocyte sedimentation rate) – this test can measure the inflammation level indirectly. It can help identify the disease and show you what’s happening in the system.
- Urinalysis (urine testing) – by examining the concentration, look, and content of your urine, the doctor, can help identify the problem. These tests give them a perfect look at what is happening in the body and the best way to manage the problem.
Even though you can’t actually prevent an autoimmune disorder and 1 diabetes, you can still manage them properly. A doctor can help you find the best treatment strategy.
Conclusion
Researchers and doctors believed that type 2 diabetes was merely a metabolic illness. But, new statistics suggest that the illness might be an autoimmune disease. If the research produces viable evidence, it could create new preventive and treatment measures for diabetes. Right now, the evidence is limited and more studies are necessary to confirm this claim. So, doctors will continue to treat and prevent diabetes with insulin, meds, and lifestyle changes. Now that you know the ins and outs of the recent research on type 2 and 1 diabetes, you may have a better perspective of what to expect in the future.
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