The Genetics of Type 2 Diabetes

1.Health.
Diabetes can be inherited. Type 1 diabetes is something that can develop in early adulthood, specifically adolescence. Symptoms for onset of the disease include excessive thirst, frequent urination, and blurred vision (Florez, 2016). The patient, Holly, is exhibiting signs of diabetes. According to her family history, she has a father with type 1 diabetes who has multiple family members with type 1 diabetes. Holly is 17 and falls within the time frame when people begin developing type 1 diabetes complications. While she may only have excessive thirst, frequent urination, and high blood sugar as symptoms, the initial diagnosis of type 1 diabetes may have been favored if the history of the mother did not show a potential type 2 diabetes diagnosis.
The mother’s history shows that on her side of the family there is morbid obesity with the mother and grandmother being morbidly obese and the grandmother suffering from type 2 diabetes. There are multiple relatives on the mother’s side of the family with high blood pressure and arthritis. This can be a concern for Holly as she herself is in the obese range with a BMI of 34. Holly could potentially cross over to the morbid obesity range. Such a high BMI could seriously impact quality of life, especially if she has family history of arthritis. One article states increased body weight leads to development of osteoarthritis.
Obesity is one of the risk factors for hip or knee osteoarthritis (OA), since mechanical overload on weight-bearing joints activates chondrocytes and accelerates cartilage degeneration. Surprisingly, obesity and overweight also contribute to hand OA due to a systemic effect involving the pro-inflammatory and -degenerative role of some adipokines, secreted by adipose tissue, as well as some joint cells (Sellam & Berenbaum, 2012, p. 621).
2.Prevention
If Holly has type 2 diabetes, it could have been prevented, the same with obesity-induced osteoarthritis and high blood pressure. These are consequences of poor lifestyle choices. The right lifestyle choices like a diet high in fruits and vegetables and lean meats and organ meats can lead to positive health outcomes that promote a nutritionally sound foundation for the rest of someone’s life. Additionally, cardiovascular exercise and a healthy BMI decreases the likelihood that a person will experience osteoarthritis and high blood pressure due to less weight on certain joints (hip joint) and improved stamina (heart).
Doctors the world over have noted the importance of a healthy BMI through exercise and nutrition. Nutrition plays a key role in preventing many chronic illnesses, especially related to obesity. Those with a family history of diabetes need to be especially concerned with eating less simple carbohydrates and opting for complex carbohydrates that have fiber and micro-nutrients. Such positive lifestyle options are the cornerstone of any healthy body.
3.Screening
Holly noted she has been obese since the age of 5. Therefore, even though type 2 diabetes is often asymptomatic, because she has lived with poor lifestyle choices for years, it is important to screen for both. Furthermore, it is important to perform a genetic screening for the risk of type 2 diabetes. A 2013 study noted the incidence and prevalence of type 2 diabetes. A whopping 90% of all cases of diabetes are type 2 (Lyssenko & Laakso, 2013). With type 2 diabetes being a complex disorder stemming from the interaction of environment with genes, it is important to screen for the likelihood of type 2 diabetes development, especially with type 1 diabetes development on one side of the family and one incidence of type 2 on the mother’s side.
Lyssenko & Laakso (2013) stated several risk factors can lead to an increased chance of developing type 2 diabetes. “age, sex, obesity and central obesity, low physical activity, smoking, diet including low amount of fiber and high amount of saturated fat, ethnicity, family history, history of gestational diabetes mellitus, history of the nondiabetic elevation of fasting or 2-h glucose, elevated blood pressure, dyslipidemia, and different drug treatments” (Lyssenko & Laakso, 2013, p. S120). Moreover, evidence of a strong genetic background further supports the need to screen for type 2 diabetes. With such information suggesting the need to screen for these things, there should be a genetic screening for type 2 diabetes.
4.Diagnostics
With the information obtained and both the family histories, the initial diagnosis is type 2 diabetes. This comes from Holly’s lifestyle choices, her high BMI, and her diet. Why type 2 and not type 1 diabetes as a diagnosis? Type 1 diabetes is an autoimmune disease (Levy, 2016). Meaning, a person’s immune system attacks pancreatic cells that produce insulin. Type 2 diabetes however, is when people inherit genes that increase susceptibility to type 2, when combined with poor lifestyle choices, leads to development of the disease. Because the autoantibody test came back negative, the diagnosis is type 2 diabetes.
5.Prognostics
Because the diagnosis is type 2 diabetes, the prognosis is favorable for recovery if Holly maintains adoption of healthy eating choices. Some evidence suggests type 2 diabetes can be reversed if people affected, adopt healthier lifestyle choices and exercise at least three times a week. This can lead to weight loss and weight loss has been shown to reverse type 2 diabetes brought on by obesity. “Extremely obese diabetic adolescents experience significant weight loss and remission of type 2 diabetes mellitus after gastric bypass. Improvements in insulin resistance, ?-cell function, and cardiovascular risk factors support gastric bypass as an intervention improves the health of these adolescents” (Inge et al., 2009, p. 214).
6.Selection of treatment
Treatment will be multi-step. The first step is pharmacological in the form of a metformin prescription. Metformin is often the first choice of treatment for those with type 2 diabetes (Florez, 2016). It helps treat high blood sugar and promotes some weight loss in the patient. The second part is promotion of wellness. Patient education on healthy food choices, healthy lifestyle choices and referral to a nutritionist. A nutritionist can perform a series of blood tests to see what Holly may be lacking regarding important vitamins and minerals and designate a tailored eating plan. The next step is to refer her to an endocrinologist to see any hormones are out of balance to further promote weight loss as the desired BMI would be 23 to ensure she has improved health and potential reversal of type 2 diabetes.
7.Monitoring of treatment effectiveness
The advice would be monthly appointments with a weight goal set of 8 pounds per month for the first 6 months and then a goal of 6 pounds a month for an additional 6 months. Each month blood pressure will be measured to see if an additional intervention of blood pressure medication is necessary. After 3 months, an A1C test will performed to measure average levels blood glucose (Florez, 2016). If her levels are higher, increase the dose. If her levels are lower decrease the dose. If her levels are too low, stop medication. Some people can stop metformin if they have a healthy lifestyle and demonstrate no need for it.
The weight loss will be a measure of effectiveness of treatment plan. Holly is 200 pounds and measures 5ft 4 inches. She has a total BMI of 34.3. She needs to lose 65 pounds to get to a healthy BMI of 23.2. If she loses 8 pounds each month the first 6 months, that is 48 pounds. Then, if she loses 6 pounds a month for the remainder, that is a total of 36 pounds or 19.9 BMI.

















References
Florez, J. C. (2016). The Genetics of Type 2 Diabetes and Related Traits: Biology, Physiology and Translation. Cham: Springer International Publishing.
Inge, T. H., Miyano, G., Bean, J., Helmrath, M., Courcoulas, A., Harmon, C. M., … Dolan, L. M. (2009). Reversal of Type 2 Diabetes Mellitus and Improvements in Cardiovascular Risk Factors After Surgical Weight Loss in Adolescents. PEDIATRICS, 123(1), 214-222. doi:10.1542/peds.2008-0522
Levy, D. (2016). Type 1 diabetes. Oxford University Press.
Lyssenko, V., & Laakso, M. (2013). Genetic Screening for the Risk of Type 2 Diabetes: Worthless or valuable? Diabetes Care, 36(Supplement_2), S120-S126. doi:10.2337/dcs13-2009
Sellam, J., & Berenbaum, F. (2012). Osteoarthritis and obesity. La Revue du Praticien, 62(5), 621-624.