Question: I read so much about type 2 (adult-onset) diabetes being associated with obesity. About 10 years ago, I was diagnosed with type 2 diabetes. However, I weigh just 98 pounds and am 5 feet tall with a small frame. My age is 80 and I'm still very active. Can you explain why I developed type 2 diabetes? - A.M., Cape May
Answer: Clearly, obesity is a major risk factor for adult-onset diabetes. Eight-five percent of those who have developed diabetes are overweight/obese. Surprisingly though, 12-15 percent of adults with type 2 diabetes are of normal weight - sometimes even skinny. An article in the Aug. 8 issue of the Journal of the American Medical Association found in a retrospective analysis of 2,625 people identified with type 2 diabetes that 12 percent were of normal body weight (with a Body Mass Index less than 25).
There are a couple of possible explanations: First of all, especially among diabetic Asians and the elderly, there's a tendency for them to have "TOFI" - Thin on the Outside, Fat on the Inside around their abdominal organs. Metabolically, these folks are very similar to the visibly obese folks with type 2 diabetes. In fact, the aforementioned study revealed a disturbing statistic that these "TOFI" folks have an overall death rate nearly twice as high as obese type 2 diabetics (2.8 percent versus 1.5 percent, respectively). A second possible explanation for the incidence of type 2 diabetes in normal weight adults may come down to a genetic predisposition for having improper insulin production and insulin resistance. Thin folks with type 2 diabetes must closely watch their carbohydrates and avoid high-glycemic foods, just like their obese counterparts.
Question: I just heard a news story that described how the HIV virus was being used as a new treatment to attack leukemia. Can you please tell me more about this? - S.G., Marietta, Ga.
Answer: The story you heard was that of Emily Whitehead, a 7-year-old child who was enrolled in an experimental last-hope treatment for leukemia. She was diagnosed with acute lymphocytic leukemia nearly three years ago, and after failing on chemotherapy, her oncologists tried an experimental cancer treatment using a genetically-modified (made safe) form of the HIV virus. Taking advantage of the HIV virus' ability to readily get into cells, the modified HIV virus was used as a vehicle to safely deliver a special gene to her T cells (a type of white blood cell) to empower them to seek out and destroy leukemic cancer cells in her blood. The modified killer T cells began multiplying and attacking her leukemic cells. This gene effectively paints a bulls-eye on leukemia cells in need of destruction. Treatment for Emily began at Children's Hospital of Philadelphia in February. The treatment resulted in fever, chills, flu-like symptoms and low blood pressure, but she survived and reportedly is doing well in remission as of December.
This experimental treatment for leukemia is also being investigated at the University of Pennsylvania, the National Cancer Institute and Sloan-Kettering Cancer Center. To date, 12 people have received the treatment at the University of Pennsylvania, three of whom had complete remissions, and two of whom had no signs of disease after two years. Four of the 12 people saw disease improvement, but not full remission. Two adults did not respond well to the treatment, while one recently completed treatment and could not yet be evaluated. While the treatment clearly has promise, it's not yet the magic bullet for leukemia.