Talk:Type 2 diabetes/GA1

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

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GA Review

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Reviewer: Aircorn (talk · contribs) 11:37, 15 January 2012 (UTC)

I will review this over the next few days. I must say that many of the sections look a bit sparse from my initial glance. AIRcorn (talk) 11:37, 15 January 2012 (UTC)

Thanks. It is a succinct overview. Let me know what further you think deserves being discussed.Doc James (talk · contribs · email) 09:39, 16 January 2012 (UTC)

Got about halfway through last night. Will have some comments for you tonight. AIRcorn (talk) 22:44, 16 January 2012 (UTC)

Finished my first read through. Fixed what I considered obvious errors[1], and noted some that I wasn't comfortable touching below. I am far from being an expert in this field, although I had a few lectures on diabetes at university, so I hope the comments are constructive. I also see this as a collaborative process, so feel free to disagree with any comment below.

Criteria

GA review (see here for what the criteria are, and here for what they are not)

1. It is reasonably well written.

   a (prose): b (MoS for lead, layout, word choice, fiction, and lists):

   Just a few minor points on prose below. Should be really easy to clean up. On the whole I liked the technical level, most people should be able to read this and understand it.

2. It is factually accurate and verifiable.

   a (references): b (citations to reliable sources): c (OR):

   I usually check these on my second read through when the prose and content is sorted. Don't foresee any problems looking at the quality of the references.

3. It is broad in its coverage.

   a (major aspects): b (focused):

   I understand that this is an overview article, but still feel it skips over details too much. I have posed some questions below that came to my mind when reading. Don't feel that an answer is needed in each case, I was more hoping you could use some of them to flesh out sections.

4. It follows the neutral point of view policy.

   Fair representation without bias:

5. It is stable.

   No edit wars, etc.:

6. It is illustrated by images, where possible and appropriate.

   a (images are tagged and non-free images have fair use rationales): b (appropriate use with suitable captions):

   Could the diagram of the person under signs and symptoms be enlarged slightly, I can't easily read the text.

7. Overall:

   Pass/Fail:

   Hold for now.

Comments

Some of these are questions that might help expand the article, others are parts that I didn't understand or thought could use clarification. Prose issues are also included. All of them are negotiable and I won't be offended if you disagree. However, purely to make it easier for me to keep track of the review, it would be appreciated if you could respond under each one (even if it is just to say fixed).

• Would be good to know early on how this differs from Type1.

Sure added to the lead.--Doc James (talk · contribs · email) 05:35, 31 March 2012 (UTC)

• It mentions the United States a few times in the text, but no other nations. Are there some stats for other nations? Not a biggy as i consider the map enough to cover world view as far s GA is concerned.

Have added a few others in the epidemiology section. --Doc James (talk · contribs · email) 05:38, 31 March 2012 (UTC)

• What are the other (non-classical) signs and symptoms? The ones in the diagram?

Added some --Doc James (talk · contribs · email) 06:51, 31 March 2012 (UTC)

• Can more information be given on how lack of sleep is causative and in general what is the fetus lacking?

Sure --Doc James (talk · contribs · email) 07:06, 31 March 2012 (UTC)

• Lifestyle causes is overly short. Could more detail on this be added? I would be interested to know the thinking behind urbanization being a factor (pollution?). What fats (long chain, short chain?). Should it be "lack of physical activity"? If not, that could be explained. Is smoking a factor?

Urbanization leads to more food and less excise. --Doc James (talk · contribs · email) 07:06, 31 March 2012 (UTC)

• Diet playing a role is mentioned twice. Maybe reword the last sentence.

Fixed I think --Doc James (talk · contribs · email) 07:12, 31 March 2012 (UTC)

• Gender and age are mentioned as causes, but not how. Are men more susceptible? What ages are at the most risk? Other demographic information could also be included (ethnicity and income levels spring to mind). I see now that I have read to the end that some of this is mentioned in Screening and Epidermology. At the risk of repeating I feel it would still be worth mentioning, very briefly, here. Another approach could be to remove age and gender. Would they not fall more under risk factors than actual causes. In fact maybe this section should be renamed as genetics and even obesity really just increase the risk. I am not sure what the best approach would be.

Clarified --Doc James (talk · contribs · email) 07:15, 31 March 2012 (UTC)

• Type 2 diabetes is due to .... Starts both the Cause and Pathopysiology section. I am not sure this is wrong, but it reads funny to me. Would "the development of type 2 diabetes is caused by ..." be better for Causes? I think the Pathopysiology on is alright

Sure Doc James (talk · contribs · email) 18:54, 20 January 2012 (UTC)

• Most cases of diabetes involved many genes contributing small amount to the overall condition - Grammar, clarify

Fixed --Doc James (talk · contribs · email) 07:16, 31 March 2012 (UTC)

• Are there a few genes we could name that predispose more than the others? Are these generally genes that predispose to obesity or are some expressed in the pancreas? Are any insulin receptors?

Added details --Doc James (talk · contribs · email) 07:12, 31 March 2012 (UTC)

• Would you consider moving Pathophysiology above signs and symptoms? I feel it would be good to know what it is before finding out what causes it.

Articles are ordered per WP:MEDMOS for consistency. Thus people know in what part of the article to look for what type of information. Doc James (talk · contribs · email) 18:54, 20 January 2012 (UTC)

• Could a little bit more on insulin resistance be added. Is it partial or full? The second sentence could be expanded too. When is the glucose released from the liver (in response to low glucose levels in the blood)? Why does this release increase when you have Diabetes type 2?

Clarified --Doc James (talk · contribs · email) 19:11, 31 March 2012 (UTC)

• Does the Diagnosis section apply to both types? If so how is type 2 diagnosed from type 1.

Clarified --Doc James (talk · contribs · email) 08:15, 31 March 2012 (UTC)

• In those with impaired glucose tolerance, diet and exercise and/or metformin or acarbose may decrease the risk of developing diabetes This is unclear. What decreases the risk? I am assuming everything except the impaired glucose tolerance, but it could easily read that acrabose works for those with an impaired diet or a number of other permutations. Also I read somewhere not to use "and/or". It doesn't overly bother me, but if it can be written without the forward slash too that would improve the sentence.

Reworded. --Doc James (talk · contribs · email) 08:29, 31 March 2012 (UTC)

• Managing other cardiovascular risk factors including hypertension, high cholesterol, and microalbuminuria improves a person's life expectancy. Parenthesis need to be applied here for the "including ..." or maybe it could be rewritten?

Fixed I hope --Doc James (talk · contribs · email) 08:15, 31 March 2012 (UTC)

• What is intensive blood sugar lowering involve and how is it accomplished? How is standard and intensive quantified?

Clarified --Doc James (talk · contribs · email) 08:27, 31 March 2012 (UTC)

• If lifestyle measures in those with mildly elevated blood sugars have not resulted in an improvement within six weeks medications should than be considered How do you measure lifestyle?

Fixed --Doc James (talk · contribs · email) 07:35, 31 March 2012 (UTC)

• Metforin is mentioned a few times, maybe a short description of its action would be appropriate?

I typically leave mechanism of action to the pharmacology articles.Doc James (talk · contribs · email) 07:31, 31 March 2012 (UTC)

• When insulin is used, a long-acting formulation is typically added initially at night, while oral medications are continued. Could this be rearranged so intially at night fits in better. Is it needed?

Attempted Doc James (talk · contribs · email) 07:31, 31 March 2012 (UTC)

• Doses are than increased to effect Is this supposed to be then inceased to effect? What does effect mean? until an effect is seen?

Clarified Doc James (talk · contribs · email) 07:28, 31 March 2012 (UTC)

• The long acting insulins, glargine and detemir, do not appear much better than NPH but have a significantly greater cost making them as of 2010 not cost effective What is NPH? The as of 2010 doesn't sit right where it is. Could it be removed or re-written? There is a similar one in Epidermology, but it works much better there (although some commas around it would improve it in my opinion).

Clarified NPH by a link. Cost effectiveness is very time dependent as it depends on if something is on or off patent.Doc James (talk · contribs · email) 07:28, 31 March 2012 (UTC)

Sorry for the delay and getting to this...Doc James (talk · contribs · email) 06:26, 31 January 2012 (UTC)

Don't worry, I'm not going anywhere. Might pay to ping me on my talk page when you are ready for me to have another look. AIRcorn (talk) 05:54, 3 February 2012 (UTC)

Additional comments

I hope its ok to chip into the review process. A couple of comments for now as I don't have a lot of time at present and I had to scan through. Anyway, I will try and contribute as much as I can.

• I think you should include fatigue in the list of sign and symptoms. I know its a vague and ill-defined symptom, but it is a common manifestation of endocrine dysfunction, including diabetes.

Done --Doc James (talk · contribs · email) 07:17, 31 March 2012 (UTC)

• I think it's no longer correct to say that diabetes is the commonest cause of blindness (in complications), I believe its been overtaken by age-related macular degeneration. However I think diabetes is the commonest cause of blindness in people of working age. Sorry I dont have a reference to hand but I think I could find one if you needed it.

This is supported by a 2009 review. Do you have something more recent? --Doc James (talk · contribs · email) 08:17, 31 March 2012 (UTC)

The review is inaccurate - the source it cites (National Diabetes Fact Sheet United States, 2005 http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2005.pdf) actually says that 'Diabetes is the leading cause of new cases of blindness among adults aged 20 - 74 years.' - the review seemed to overlook the qualification regarding age (hence my comment about working age people above). A better source is the WHO (RESNIKOFF, Serge et al. Global data on visual impairment in the year 2002. Bull World Health Organ [online]. 2004, vol.82, n.11 [cited 2012-04-13], pp. 844-851 . Available from: <http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S0042-96862004001100009&lng=en&nrm=iso>. ISSN 0042-9686. http://dx.doi.org/10.1590/S0042-96862004001100009.) and this is consistent with more recent data in the UK (Bunce C, Xing W, Wormald R (2010). "Causes of blind and partial sight certifications in England and Wales: April 2007-March 2008". Eye (Lond). 24 (11): 1692–9. doi:10.1038/eye.2010.122. PMID 20847749. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)). Of course I agree that diabetes is a very important and treatable cause of blindness and visual impairment. Adh (talk) 19:55, 13 April 2012 (UTC)

• The most recent recommendation of the International Expert Committee Report on the Role of the A1C Assay in the Diagnosis of Diabetes proposed that the diagnosis of diabetes is made if the A1C level is ≥6.5% (as you say). However they advocate that diagnosis should be confirmed with a repeat A1C test unless there are clinical symptoms and glucose levels are >200 mg/dl (>11.1 mmol/l). (International Expert Committee Report on the Role of the A1C Assay in the Diagnosis of Diabetes. Diabetes Care July 2009 32:1327-1334; published ahead of print June 5, 2009, doi:10.2337/dc09-9033) My impression from colleagues in the diabetes field (I'm not a diabetologist) is that most people who have access to A1C will move to that assay routinely, since it doesn't involve fasting or an oral glucose load , so it may be worth amending the text here.

Added --Doc James (talk · contribs · email) 08:16, 31 March 2012 (UTC)

• It would probably be good to mention retinal screening. In uk everyone over 11 with diabetes gets screened annually (at least in theory) and screening is also recommended in the US, although probably only half of eligible people receive it (Lee PP, Feldman ZW, Ostermann J, Brown DS, Sloan FA: Longitudinal rates of annual eye examinations of persons with diabetes and chronic eye diseases. Ophthalmology 110:1952–1959, 200).

Found a ref that recommends screening in everyone with the diagnosis. --Doc James (talk · contribs · email) 07:45, 31 March 2012 (UTC)

Overall I thought the article was good, although I agree with the other reviewer that a few sections might benefit from some expansion. Hope the comments were helpful Adh (talk) 21:50, 4 February 2012 (UTC)

You are more than welcome to comment and can stick around for as long as you wish. AIRcorn (talk) 22:43, 4 February 2012 (UTC)

Thanks. Another comment on re-reading the article - the statement regarding beta-agonists and type 2 diabetes in Medical conditions might need some revision - beta-agonists do cause hyperglycemia and can worsen control of established diabetes but I am not aware of evidence that their chronic use (e.g. in asthma) is associated with incresed risk of type 2 diabetes. Perhaps a more nuanced statement is needed here. In contrast, beta-blockers (beta-adrenoceptor antagonists) are associated with an increase in new onset diabetes, (Elliott WJ, Meyer PM. Incident diabetes in clinical trials of antihypertensive drugs: a network meta-analysis. Lancet. 2007 Jan 20;369(9557):201-7.) particularly when combined with thiazides.(Manrique C, Johnson M, Sowers JR. Thiazide diuretics alone or with beta-blockers impair glucose metabolism in hypertensive patients with abdominal obesity. Hypertension. 2010 Jan;55(1):15-7.). Both hypo and hyperthyroidism are associated with diabetes but I think its not clear whether the link is causal except in type 1 diabetes with autoantibodies (LH Duntas, J Orgiazzi, G Brabant. The interface between thyroid and diabetes mellitus. Clinical Endocrinology 2011; 75: 1–9). Psychotropic drugs such as phenothiazines, levodopa/dopa, chlordiazepoxide, lithium, are also associated with hyperglycaemia and diabetes (Izzadine et al., Expert Opin Drug Saf 2005; 4:1097-1109) - this reference has a long list but I have focused on commonly used drugs. In this context statins should probably also be listed since recent data does suggest that they have a modest effect on new onset diabetes (Sampson UK, Linton MF, Fazio S. Are statins diabetogenic? Curr Opin Cardiol. 2011 Jul;26(4):342-7.)Adh (talk) 23:43, 5 February 2012 (UTC)

Good refs. Have updated. --Doc James (talk · contribs · email) 19:27, 31 March 2012 (UTC)

I am away for the next 4 weeks. Will take thus up again in mid march. Doc James (talk · contribs · email) 06:11, 12 February 2012 (UTC)

Will fail this as the main contributor is away for a month and most of the recent changes are minor. There is some good advice here and it should not take much more effort to get it to GA standard. AIRcorn (talk) 05:15, 17 February 2012 (UTC)

Under Epidemiology, wrong information is presented about Type 2 diabetes: the article states that Type 2 diabetes is 90% of all cases of diabetes, but that is an old statistic that includes slow-onset Type 1 diabetes (latent autoimmune diabetes of adults or LADA) in the Type 2 stats. Quite consistently worldwide, in many many peer-reviewed studies, about 10% or more of "Type 2 diabetics" are found to be autoantibody positive (GADA, ICA, IA-2, ZnT8), are misdiagnosed, and in fact have Type 1 autoimmune diabetes. The advent of antibody testing more than 30 years ago demonstrated about 10% of people who had been diagnosed with Type 2 diabetes were antibody positive. Although this population has Type 1 diabetes, and its presence is increasingly acknowledged, this population of Type 1 diabetics is still included in the statistics and information on Type 2 diabetes (a fundamentally different disease not only clinically but genetically). If people with LADA are removed from the Type 2 diabetes statistics and correctly included in the statistics for Type 1 diabetes, Type 2 diabetes represents about 75-85% of all diabetes and Type 1 represents about 15-25%. See DIABETES CARE, VOLUME 36, APRIL 2013 (Adult-Onset Autoimmune Diabetes in Europe Is Prevalent With a Broad Clinical Phenotype: Action LADA 7). Redyoga (talk) 03:40, 9 June 2013 (UTC)

New meds

A review of DPP http://www.bmj.com/content/344/bmj.e1369 Doc James (talk · contribs · email) 01:43, 18 March 2012 (UTC)

Clinics

2010 review [2] --Doc James (talk · contribs · email) 10:39, 1 April 2012 (UTC)

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The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.