¶ … Diabetes The pathophysiology of Type 2 diabetes is found in the way the body's relationship with insulin. Either the body produces too little of it to meet the body's own needs or else there is a resistance to the insulin that the body has developed (which makes the insulin unable to do what it should -- thus there could be enough insulin in the body, it is just that cells in the body do not respond to it). The cause is due to "a combination of genetic factors related to impaired insulin secretion and insulin resistance" and impacts from external factors "such as obesity," inadequate exercise, aging, etc. (Kaku, 2010, p. 41).

Wilmot and Idris (2014) show that there is an age continuum risk associated with separating Type 2 diabetes diagnosis onsets into two separate categories -- pediatric (under 20 years of age) and adult (over 20). They assert that such a division only serves a practical or serviceable purpose and does nothing to address the issue of development of Type 2 diabetes in later years or in elderly persons. This negligence is important for a number of reasons: first, it fails to note the association of Type 2 diabetes in patients under 45 with the x10+ rate of developing "myocardial infarct" (Wilmot, Idris, 2014, p. 235). Another reason the age continuum is important is because at around 45 years of age, women can still bear children and if they have Type 2 diabetes, certain preparations and considerations need to be made. Thus, a generic cutoff in the continuum between pediatric and adult is not fair to adults who must deal with the issue over myriad different stages of development for a considerably longer duration.

The genomic issues inherent in the disease process of Type 2 diabetes indicate "novel pathways, pointed toward fundamental biology" including the "role of ?-cell dysfunction" (Billings, Florez, 2010, p. 59). The actual genetic heritability of Type 2 diabetes remains unclear, though the causal regions have been identified through genome-wide mapping -- namely in the location of the ?-cell. Nonetheless, there is little evidence of causality between the gene whose name denotes the region and the actual disease (Billings, Florez, 2010). As Billings and Florez (2010) note, genome-wide mapping has uncovered "38 SNPs associated with T2D" and more than 24 SNPs that bear some relation to "glycemic traits" -- yet the causal variant remains elusive (p. 60). Thus, while the exploration of genetic pathways that might shed light on how genes impact the onset of diabetes, discoveries (though informative) still have yet to isolate a single identifiable causative genetic agent. Therefore, what is known is the region in the genomic sequence where diabetes is first seen; what is not known is how, why or whether this region plays a causative role in the onset.

A review of the literature on Type 2 diabetes reveals that it is a very highly studied and important subject for researchers, judging by the number of scholarly articles produced on it year-over-year and the amount of articles written that highlight new developments towards the better understanding of the disease. Not only is understanding how and why it originates a concern and focus for researchers but also finding a treatment and establishing a method for controlling it. This focus has also received much attention from academic researchers and served as the subject for various essays attempting to locate a positive formula for controlling and/or mitigating the risk of diabetes because of the scourge-like proportions now associated with it in both developed and developing worlds.

Tabish (2010) for example asks whether diabetes is the largest epidemic of the 21st century in his study published in the International Journal of Health Sciences. This study was found using the keyword search "epidemic" and "diabetes," which was utilized after reading various reports of the size of the problem of diabetes in different countries around the world, including reports on the national diabetes statistics from the Centers for Disease and Control, as well as from the World Health Organization. Liu, Li, Gong et al. (2013) also contribute to this subject by providing an assessment of how Type 2 diabetes is impacted by and impacts a local economy in developing nations. This study was of particular interest because it found that developing nations in Central and South America were importing the dietary habits of developed worlds where obesity and diabetes were already a problem. The researchers found that as developing nations imported these habits, they also began to develop the same diseases -- namely Type 2 diabetes. Thus, this study explicitly linked a cultural and economic phenomenon such as progressivism to the relationship...

The databases that stored these articles were typically medical databases like NCBI and PubMed. Several studies were read and common keywords noted in each and used in later keyword searches to help generate even more studies, as "diabetes developing world," and "diabetes obesity third world" -- in short, studies that might show how the disease was spreading across the globe as a result of the importation of developed world practices. In this manner, the following study was located -- one by Davis (2012) in which the research conducted an experiment in the Marshall Islands to test whether the native populace, affected by Type 2 diabetes after importing a Westernized diet based on pre-packaged foods, could cause their diabetes to go into remission by altering their diet back to natural substances locally found and produced in the Islands. The experiment showed that by doing just this, the people were able not only to combat diabetes but to completely eliminate it -- simply by changing their diet to a natural, organic one that the community had used for years (without any incidence of diabetes) and by embracing the exercise and physical activity that correlated to the maintaining of this diet (working the land, fishing, etc.). This study by Davis (2009) showed that diabetes can be treated (at least in the third world) by promoting a healthy, organic, natural diet that focuses on particular foods which have been staples in the region for years prior to the introduction of the importation of mass-produced food items into the culture.
Likewise, the study by Cunninghamm-Myrie, Theall, Younger et al. (2015) examined the relationship between Type 2 diabetes and socio-environmental factors, such as neighborhood effects, lack of exercise, the onset of obesity, and the collective mental state (perspective) of a community on dietary issues. This study supports the finding of Davis (2012) by showing a causal relationship between the variants noted and the onset and spread of diabetes. It also gives an overview of the basics of the disease, how the pancreatic hormone insulin is rejected by cells, causing the regulation of glucose in the body to fall. Since insulin is what helps cell tissue to absorb glucose for energy, if cells cannot absorb it for energy (because either the pancreas is not producing it or the body is simply not accepting it) they begin to use fat/protein for energy, which causes damage to organs and even the nervous system. The studies utilized in this literature review identified these basic issues and offered possible treatments geared towards regulating exercise and diet. These treatments, as Davis (2012) shows, have been effective.

The International Diabetes Federation published a clinical Global Guideline for Type 2 Diabetes in 2012 but Holmer, Ogden, Burda and Norris (2013) have stated that clinical practice guidelines for treating Type 2 diabetes differ in their approach around the world and that caution and consideration should be exercised before adopting any specific method.

Controlling glucose levels is the most common clinical approach to treating diabetes (International Diabetes Federation, 2012, p. 38). Lowering HbA to under 7%/53mmol/mol is suggested in order to reduce the risk of complication, though a higher level is tolerated when co-morbidities exist. "Oral glucose lowering medications" are suggested as are "lifestyle measures" along with the use of metformin in order to begin therapy (International Diabetes Federation, 2012, p. 55). Insulin therapy is also suggested as an alternate therapeutic approach.

While these approaches are standard within the medical community and staples of any clinical guidelines, the results of the study by Davis (2012) and Cunningham-Myrie at al. (2015) show that diabetes can not only be controlled but defeated by addressing the environmental factors of diet and exercise. Thus the approach that this paper defends is the approach of strictly adhering to an organic, healthy, natural diet and exercising daily.

Follow-up treatment of diabetes, if following the clinical guideline, includes monitoring glucose levels and continuing with therapeutic interventions. For the suggested treatment in this study, follow-up would simply be to maintain the healthy dietary practices and continue the daily physical exercise regimen suggest by Davis as essential in addressing the disease. The study by Davis is an excellent referral.