As a medical student and health care professional, if there is one disease that continually comes up in daily discussion, it’s diabetes. As a disease, diabetes is one that I would not wish on anyone, not that I ever wish disease on anybody to begin, but I wouldn’t wish it on my worst enemy. As a disease diabetes my initially seem fairly tame, but it has the potential to eventually affect just about every organ system in the body.
As I begin to plan my career as a future Family Medicine Physician, I know that I will be dealing with diabetes on a regular basis. Any opportunity I have to learn more about the risk factors to look out for in order to help people avoid it, or to better manage it is one I need to take. So I am following up on a previous post regarding the frequency of the 230Cys allele found in Native American groups as a potential adaptation to feast or famine and storage of energy in the form of fat to hold out during harsh conditions.
How is this relevant to diabetes? Well, first of all, a little background. Diabetes is a disease that has a huge global burden. Currently, around 285 million people worldwide are affected and that number could potentially climb to 430 million by the year 2030. Diabetes also accounts for 12% of all health care expenditure. It is also a highly genetically associated disease, at least Type 2 Diabetes. Now, in type 2 diabetes the individual will have high levels of circulating insulin. Insulin is a key regulator of fat storage. It is released following meals in response to glucose from the meal and stimulates the uptake of that glucose into liver, muscle and fat. It also acts to antagonize other hormones that would breakdown and use the stored glucose as energy. So, this is where I got to thinking, if there is a gene that is linked evolutionarily to helping survive famine, is there a potential link between such genes and diabetes.