Is Type 2 Diabetes an Autoimmune Disease?

From verywellhealth.com

Type 2 diabetes is not an autoimmune condition, while type 1 diabetes is. Though new research suggests the immune system may be involved in type 2 diabetes, its causes are more closely linked to other factors such as family history and lifestyle habits.

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How Type 2 Diabetes Differs From Type 1 

Diabetes is a disease characterized by high blood glucose (sugar) levels. Blood sugar is regulated by insulin, a hormone produced by the pancreas. Though they share some characteristics, type 1 diabetes and type 2 diabetes are not the same. They have different causes and the treatment plans are often very different, as well.

Type 1 Diabetes

• Onset usually in childhood, adolescence, or young adulthood

• Can come on suddenly

• Insulin required for survival (body no longer produces insulin)

• Autoimmune disease; pancreatic cells damaged

• Risk factors that include family history, genetics, potential environmental triggers, and being young

Type 2 Diabetes

• Onset typically in adulthood
  

• Usually develops gradually over time

• Treatments that can include lifestyle changes, oral medication, or injectable medication (including insulin)

• Not an autoimmune disease; may be delayed or prevented with lifestyle changes

• Risk factors that include family history, ethnicity, overweight/obesity, lack of physical activity, age

Type 1 Diabetes

Type 1 diabetes is an autoimmune condition. It is usually diagnosed in children, adolescents, and young adults, though people of any age can develop it.

In type 1 diabetes, the body mistakenly attacks cells in the pancreas that produce insulin. Because of this, people with type 1 diabetes produce very little or no insulin, thus requiring insulin for survival.

This reaction is due to autoantibodies, which are proteins produced by the immune system that are mistakenly directed to healthy cells in the pancreas that produce insulin as foreign.

Risk factors for type 1 diabetes include:

• Genetics or having a family history of type 1 diabetes
• Being young
• Potential environmental triggers, such as a virus

There is no cure for type 1 diabetes, though it can be treated.

Type 2 Diabetes

Type 2 diabetes is when the body doesn’t respond to or cannot properly use insulin (insulin resistance).  It is usually diagnosed in adults, but people of any age, including children, can be diagnosed with type 2 diabetes. Type 2 diabetes usually develops gradually over time.

Risk factors include:

• Having a family history of type 2 diabetes
• Being overweight
• Being over 45 years of age
• Being physically inactive

U.S. populations with a higher prevalence of type 2 diabetes are:

• African American
• Latinx
• Native American
• Alaska Native
• Pacific Islander
• Asian American

Lifestyle interventions, such as losing weight, participating in regular physical activity, and following a healthy diet, can prevent or delay type 2 diabetes.

Along with self-monitoring of blood glucose, treatment may include lifestyle changes, oral (by mouth) medication, and/or injectable medication.

Research on Immune System Involvement

While some research suggests potential immune system involvement in type 2 diabetes, it is not considered a classic autoimmune disease in which the body attacks its own cells (as is seen with type 1 diabetes). Type 2 diabetes is considered a multifactorial disease (having many contributing factors).

Researchers have documented that type 2 diabetes is characterized by chronic (long-term) low-grade inflammation.

Inflammation occurs as a result of the immune response to high blood glucose levels and the presence of inflammatory mediators (chemicals) produced by adipocytes (cells that store energy as fat) and macrophages (white blood cells that play an important role in the immune system). 

A 2019 study found that some people with type 2 diabetes have altered immune cells, which cause inflammation that is attributable to an autoimmune response. The study revealed that reactive autoantibodies against insulin-producing cells could be detected in some people.

The researchers also noted that upcoming data suggest a modified function of regulatory T cells (a type of white blood cell involved in the immune system) in some people. Experts hypothesize that unhealthy lifestyle choices and advanced age may act as possible “triggers” for these inflammatory responses.

What Is an Autoimmune Disorder?

An autoimmune disorder or disease, is a condition in which the body mistakes its own healthy cells, tissues, or organs as foreign substances and attacks them.

Normally, the immune system is able to tell the difference between your cells and foreign substances. A flaw in the immune system can make the body unable to tell the difference between the two.

When this happens, the body mistakenly makes autoantibodies that attack the body’s normal cells, tissues, or organs. Simultaneously, regulatory T cells fail to keep the immune system functioning properly.

Autoimmune diseases can affect any part of the body. Experts know of more than 80 autoimmune diseases. Some common autoimmune diseases are type 1 diabetes, multiple sclerosis (MS), lupus, and rheumatoid arthritis (RA).

Studies suggest these diseases may be caused by interactions between certain genes and the environment. Risk factors for developing an autoimmune disease include sex, race, and certain ethnic characteristics.

Immunosuppressant Medications

Researchers have developed medications called immunosuppressants to help treat such conditions as autoimmune diseases. These drugs weaken the immune system response in an effort to reduce the body's reaction to substances it mistakes as harmful.

For example, a specific class of immunosuppressants called anti-CD20 antibodies is designed to target and destroy the immune cells that are attacking healthy tissue. These drugs treat some autoimmune diseases, such as RA and MS.

Some research indicates that immunosuppressive medications may benefit people with type 2 diabetes. More studies are needed before immunosuppressant drugs are used in the treatment of type 2 diabetes, but early research is encouraging.

Reasons for Lower Immunity With Type 2 Diabetes

Chronic low-grade inflammation, as described earlier, damages the cells in the pancreas that produce insulin. This leads to lower insulin production, which causes high blood glucose levels. High blood glucose levels in diabetes are thought to disrupt the immune system. 

When the immune system is altered, it is not able to properly ward off invading pathogens (disease-causing "germs"). Because of this, people with diabetes—especially those with poorly managed blood glucose levels—are known to be more susceptible to infections. 

Ways to Boost Immune Health

A healthy lifestyle can strengthen your immune system. The following healthy lifestyle habits  can help boost your immune system naturally:

• Follow a healthy eating pattern, including plenty of fruits and vegetables.
• Engage in regular physical activity.
• Maintain a healthy weight.
• Get seven to nine hours of quality sleep each night.
• Don’t smoke.
• Limit alcohol consumption.
• Reduce stress.
• Practice good hygiene and safe food handling practices.

How to Reduce Inflammation and Support Insulin Sensitivity

Inflammation is a very complicated process affecting many different inflammatory cells and pathways. Chronic low-grade inflammation has been shown to contribute to insulin resistance.

Several animal studies have demonstrated the benefit of reducing inflammation for obesity-linked insulin resistance and metabolic disease (conditions that affect the body's ability to process and use energy from food). However, human clinical studies testing specific therapies targeting inflammation and their impact on metabolic disease have had promising but substandard results.

 Nevertheless, reducing inflammation in the body has been shown to maintain or improve insulin sensitivity. There are several ways to help reduce inflammation, such as using using complementary therapies and healthy lifestyle habits. These include:

• Following an anti-inflammatory diet that includes fruits, leafy green vegetables (e.g., kale, spinach, romaine lettuce), fatty fish (e.g., salmon and tuna), whole grains, nuts, and olive oil
• Cooking with herbs and spices, such as clove, coriander, garlic, ginger, onion, pepper, and turmeric
• Reducing stress
• Avoiding or quitting smoking
• Limiting alcohol consumption
• Exercising regularly
• Getting enough sleep
• Drinking green tea or coffee

When to See a Provider

Contact a healthcare provider if you experience symptoms of diabetes or high blood glucose, such as:

• Blurred vision
• Fatigue or weakness
• Increased thirst
• Increased hunger
• Numbness or tingling in hands or feet
• Sores that heal slowly
• Urinating (peeing) often

Summary

Type 2 diabetes is not considered an autoimmune disease, while type 1 diabetes is. An autoimmune disease is when the body mistakes its own healthy cells, tissues, or organs for foreign substances and attacks them.

People with type 1 diabetes make little to no insulin because their bodies mistakenly attack cells in the pancreas that produce insulin. People with type 2 diabetes may still produce insulin, but their bodies don’t respond to or use it properly. 

Type 2 diabetes is considered a multifactorial disease. Chronic low-grade inflammation damages pancreatic cells that produce insulin, lowering insulin production and causing high blood glucose levels.

High blood glucose levels in diabetes are thought to disrupt the immune system. Experts hypothesize that unhealthy lifestyle choices and advanced age may act as possible “triggers” for these inflammatory responses.

https://www.verywellhealth.com/is-type-2-diabetes-an-autoimmune-disease-11694524