"Type 1 and type 2 diabetes probably represent extremes on a range of diabetic disorders," the authors write, noting that many people suffering from the disease now exhibit characteristics of both forms. It was long thought that type 1 diabetes, an autoimmune disorder in which antibodies destroy pancreatic cells that control insulin production, afflicts only children and that type 2 diabetes, characterized by high blood sugar levels and obesity, afflicts adults only.
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However, over the past 30 years and in lockstep with the obesity epidemic, children as young as 10 now exhibit symptoms of type 2 diabetes, and adults have problems typically seen in children with type 1. "Now that our environment is changing and the population is less active at younger ages, we're now starting to see diabetes in younger people that doesn't match typical type 1 or typical type 2 diagnostic criteria," says Elizabeth Seaquist, MD, an endocrinologist and professor in the University of Minnesota department of medicine, and president-elect of Medicine and Science for the American Diabetes Association, who wasn't involved in the recent review.
The Lancet review identified various "hybrid" types of diabetes that share characteristics of both disorders yet are seen in a wider variety of age groups. One form, called latent autoimmune diabetes in adults and sometimes referred to as type 1½ diabetes, can befall adults over 35 who aren't necessarily overweight but do harbor the pancreas-damaging antibodies seen in children with type 1 diabetes. Another form of diabetes found more often in African American teenagers leads to high blood sugar levels (an identifying characteristic of type 2 diabetes) as well as ketoacidosis, a problem seen more often in type 1 diabetics when dangerously low insulin levels cause the body to burn too much fat, instead of sugars, for fuel.
What all this means, the authors write, is that diabetes is a far more complicated disease than previously thought, and with a disease that is strongly influenced by genetics, it now seems like people can be genetically predisposed to both the autoimmune forms of diabetes and the forms more influenced by lifestyle factors like diet and exercise.
The authors also allude to environmental factors that could be heavily influencing the progression of the disease. A growing body of research is finding associations between people with diabetes and exposures to high levels of hormone-disrupting chemicals, which interfere with how the body produces and manages hormones like insulin. "There's a lot of good epidemiological work coming out that shows an association between a variety of environmental risk factors and diabetes," says Dr. Seaquist. And although obesity and lack of exercise are the strongest risk factors, she adds, there could be something else in the environment playing a role, whether it's pollution that deters people from exercising or endocrine-disrupting chemicals that people absorb from everyday products. "We're really just at the beginning of understanding these variables," she says.
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The most important takeaway from this new science, she adds, is that "anyone who is genetically predisposed to the disease needs to recognize that they can modify that risk by behavioral factors: exercise and watching their diet." Modify those, and many at-risk people might just avoid diabetes types 1 to 100 or A to Z.