Is Type 2 Diabetes an Autoimmune Disease?


Historically speaking, type 2 diabetes has always been recognized as a metabolic disorder, often triggered by lifestyle behaviors and genetics. 

As opposed to type 1 diabetes, which is an autoimmune disease (with no known prevention and no cure), prediabetes and type 2 diabetes were always viewed by researchers as something to “prevent”. 

But more research is coming out that type 2 diabetes may actually be an autoimmune disease, which could radically change the thought processes behind prevention and treatment. 

So, what does the research tell us? 

This article will investigate whether or not type 2 diabetes is indeed an autoimmune disease after all. 

What is type 2 diabetes? 

Type 2 diabetes is a condition where the body either doesn’t make enough insulin or has too high insulin resistance to properly process glucose from the bloodstream into the cells for energy. 

It is becoming extremely common in the United States, with more than 1 million new cases diagnosed each year. It affects nearly 1 in 10 US adults. 

Many people with type 2 diabetes can control their blood sugars with diet and exercise alone, but some people either require an oral medication, such as Metformin, or sometimes even daily insulin injections to manage blood sugar levels adequately. 

Prediabetes, a precursor to type 2 diabetes, develops when the body starts to become insulin resistant, with resulting high blood sugars that are elevated, but not yet high enough to warrant a type 2 diabetes diagnosis. 

Risk factors for type 2 diabetes include (but are not limited to) being overweight or obese, being over the age of 45, having a family history of type 2 diabetes, having prediabetes yourself, or living a sedentary lifestyle. 

Learn more: What’s the Difference Between Type 1 and Type 2 Diabetes?

What does the research say? 

While the research is preliminary and more is required to officially reclassify type 2 diabetes as an autoimmune disease, type 1 and type 2 diabetes may have more in common than initially thought. 

According to a 2019 study, people with type 2 diabetes have markers of an autoimmune disease, similar to those with type 1. 

These markers include:

  • Changes in the number and function of immune cells
  • Notable antibody activity
  • Changes in the number of T-cells 
  • Long-term inflammation in the body 

Another study, from 2011, found that lab mice prone to develop type 2 diabetes were able to prevent the onset of the disease when treated with an antibody called Anti-CD20, which targeted and eliminated mature B cells in the immune system, restoring blood sugar levels to normal.

The researchers then studied 32 overweight or obese people and split them into two groups (matched for height and weight): one group were insulin resistant, and the other were insulin sensitive. 

After studying the participants, they found that those that were insulin resistant were actually developing antibodies against some of their own proteins, whereas the people who were insulin sensitive were not. 

They found this to be highly suggestive that the development of insulin resistance, and thus prediabetes and type 2 diabetes, in humans involves the body targeting its own proteins, linking the concept of insulin resistance to autoimmunity. 

These findings could radically change the way researchers and doctors alike think about, prevent, and treat type 2 diabetes. 

What could this mean for people with type 2 diabetes? 

If type 2 diabetes is indeed an autoimmune disease, it might respond to drugs that help moderate the immune system, like immunosuppressants, to help prevent the onset of the disease. 

Anti-CD20, already available in the United States under the trade names Rituxan and MabThera, is currently approved for the treatment of some autoimmune diseases in humans, but more research is needed to see if it can help prevent type 2 diabetes in humans as it did in mice

These medications can target and eliminate immune cells that are attacking healthy tissue. 

Other researchers believe that there may eventually be a type 2 diabetes vaccine that would blunt an immune response, essentially preventing the body from developing the disease, although those technologies are a long way off. 

Learn more: Is Type 2 Diabetes Reversible?

Conclusion

In conclusion, the science behind whether or not type 2 diabetes is an autoimmune disease is evolving, but it would radically change the way researchers, doctors, and society at large think about, prevent, and treat this condition. 

The development of type 2 diabetes is so often blamed on the individual, but reclassifying it as an autoimmune disease could serve to eliminate some of the stigma associated with the disease. 

Furthermore, prevention of type 2 diabetes could radically change from simply recommending changes to diet and exercise to potentially treating patients with immunosuppressant therapy, or even administering a vaccine on a larger scale for those at highest risk. 

More research is needed to find the direct cause of both type 1 and type 2 diabetes, but future treatments and prevention could look very different than they do today. 

However, until that day comes, preventing and treating non-insulin-dependent type 2 diabetes will require managing blood sugar levels through more traditional ways, including increasing physical activity levels and managing diet. 

Talk with your doctor about the most appropriate treatment plan for you, if you’ve been recently diagnosed with type 2 diabetes. 



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