Diabetes: Have We Got It All Wrong?

Diabetes is prevalent and chronic (1). A meta-analysis of studies published between 1990 and 2006 showed that in adults, obesity prevalence increased from 13 to 32% between the 1960s and 2004. Currently, 66% of U.S. adults are overweight or obese. The incidence of diabetes is increasing and afflicting new populations including children and developing societies. Changes in obesity prevalence among children and teens tripled, from nearly 5% to approximately 15% since the 1960s (2). Type 2 diabetes mellitus (T2DM) is a global health problem. In particular, Asia is at the epicenter of the epidemic as these populations develop diabetes at younger ages and at lower BMI levels than people of European origin (3). Diabetes does not usually diminish over time despite standard treatment. It is a lifelong illness that generally worsens with time and often leads to debilitating complications including cardiovascular disease, neuropathy, retinopathy, and nephropathy (4). These realities indicate that both our understanding of the disease and our treatment of the disease are inadequate. Current approaches are not working. It is widely believed that overeating calorie-dense food, particularly a high-fat diet, together with an inactive lifestyle causes obesity. A consequence of obesity is increased circulating lipids and cytokines, indicators of inflammation and inducers of insulin resistance. Obesity and insulin resistance are believed to be the precursors of diabetes in about 20% of subjects. The current standard treatment for diabetes includes diet, exercise, and a biguanide together with agents that increase circulating insulin in an effort to overcome insulin resistance (5). The term Insulin Resistance Syndrome is used to describe the combination of insulin resistance and compensatory hyperinsulinemia (HI). It is assumed, without evidence, that insulin resistance precedes and causes HI. Insulin resistance purportedly stimulates increased insulin secretion, interpreted as the body’s attempt to overcome the resistance, …