In my opinion, based on a 53 year-long clinical experience, the primary prevention of type 2 diabetes mellitus and its well-known and harmful so-called “complications”, which precede really for decades diabetes occurrence, as well as the prevention of all other serious and common human diseases, often associated to form Pre-Metabolic, and then Metabolic Syndrome, is nowadays possible on very large scale if we want it.
As a consequence, doctor may initiate a “particular” type of primary prevention, easy and efficaciously realized at the bed-side, i.e., with the aid of a stethoscope (See http://www.semeioticabiofisica.it, Biophysical-Semeiotic Constitutions). In a few words, performing an efficacious primary prevention of type 2 diabetes mellitus, we must go “beyond obesity, adiposity, LDL raised blood level, and even hyperinsulinemia-insulin-resistance” in the sense that doctors must know and recognize “quantitatively the “biophysical-semeiotic diabetic constitution”. In other words, every screening programme for whatever disease and its complications, including diabetes and cancer, needs efficacious "clinical" tools to obtain the best results. In fact, for instance, it is generally admitted that non-insulin-dependent diabetes mellitus (i.e. about 95% of diabetic disorders) may occur at least 12 years before the clinical diagnosis of DM is made, i.e., after long time of IIR, adiposity, obesity, a.s.o., and retinopathy can develop at least 7 years before the diagnosis. In a few words, national screening programmes for diabetic complications should be intended for people who don't present any clinical symptomatology, at the moment, a part from “diabetic and dislipidemic constitutions” with related Inherited Real Risk. Actually, during the time that diabetes is "undiagnosed" and untreated, complications, that could be avoided by a different, really efficacious prevention, are developing. Therefore, early diagnosis must certainly be established in "asymptomatic" patients who are evolving slowly towards diabetes mellitus, i.e. long time before disease onset, in order to avoid those complications. In fact, to prevent well known diabetic complications, including diabetic retinopathy, it is extremely necessary that doctors use a clinical tool reliable in diagnosing early diabetes mellitus stages, i.e. from its initial stages, i.e., even before Reaven’s syndrome, both classic and “variant”, I described previously (1, 2, 3, 5). Until now, unfortunately, diabetes mellitus is too often diagnosed accidentally, e.g. by occasional urinary or blood tests. Furthermore, epidemiological studies indicate that 50% of individuals with 2-hour postglucose challenge values over 200 mg/dL, a value diagnostic for diabetes, were not previously diagnosed as being diabetic (3, 4). Fortunately, it is now easy to realize "clinically" an efficacious DM primary prevention, as well as the prevention of other common human diseases, including malignancies, in a simple manner, with the aid of some biophysical-semeiotic signs, reliable in recognizing the different ”constitutions”, in a quantitative way. Certainly, we can prevent type2 diabetes mellitus if we know the above-referred clinical method, easy to perform, which can be Authors agree with such statement, written in
Medscape(http://boards.medscape.com/forums?10@33.MZq8as0jbdr^0@.ee99d0a): "Diabetes is, of course, a disease of complications. But landmark studies such as the Diabetes Control and Complication Trial have shown that achieving tight glycemic control can directly reduce the risk of complications, especially microvascular complications. New screening tools and potential new treatments also hold promise for making microvascular complications such as retinopathy and neuropathy more manageable and less inevitable". I agree with it, of course, exclusively regarding diabetes occurrence. Unfortunately, this statement indicates that now-a-days, even skilled diabetologists all over the world, ignore or, worse, overlook the existence of quantum-biophysical-semeiotic "diabetic and dislipidemic" constitutions, recongnised at the bed-side in a "quantitative" way, which allows us to perform diabetes mellitus PRIMARY PREVENTION, conditio sine qua non of all diabetic so-called “complications”, including the microvasculopathies disorders.
Finally, in doing that, we do not need, at least initially, laboratory methods, as oral glucose tollerance test, PPG, FG, in order to recognize individuals at inherited real risk of type 2 diabetes mellitus (4-9). Thanks to a new physical semeiotics, i.e. Quantum-Biophysical Semeiotics (http://www.semeioticabiofisica.it) doctors can, all around the world with the aid of a simple stethoscope, recognize and quantitatively evaluate the presence of "diabetic, and dislipidemic constitutions", by means of bed-side assessing microcirculatory conditions of the Langheran's islets, as I described previously (2, 3, 7-12). In facts, in both absorptive and post-absorptive state, we can "clinically" assess pancreatic histangium acidosis, correlated with local microcirculatory blood-flow situation or more precisely evaluating local Microcirculatory Functional Reserve (MFR) in Langheran's islets: in healthy, lasting cutaneous pinching of VI thoracic dermatomere, brings about gastric aspecific reflex after a latency time (lt) of 12 sec. exactly, which is the measure of local histangium acidosis. By contrast in subjects at "inherited real" risk of type 2 diabetes and obviously in diabetic patients, reflex latency time is less than 12 sec, in inverse relation to pancreatic islets impairment. In addition, biophysical-semeiotic “preconditioning” (doctor assess for a second time the same parameters after an intervall of exact 5 sec.) give useful information: in healthy, lt is more than 12 sec.; on the contrary, in subject at real risk of type 2 diabetes latency time either appears unchanged or clearly reduced, in relation to the severity of underlying metabolic disorder.
1) Stagnaro S., Istangiopatia Congenita Acidosica Enzimo-Metabolica condizione necessaria non sufficiente della oncogenesi. XI Congr. Naz. Soc. It. di Microangiologia e Microcircolaz. Abstracts, pg 38, 28 Settembre-1 Ottobre, 1983, Bellagio
2) Stagnaro S., Istangiopatia Congenita Acidosica Enzimo-Metabolica. X Congr. Naz. Soc. It. di Microangiologia e Microcircolazione. Atti, 61. 6-7 Novembre, 1981, Siena
3) Stagnaro S., Istangiopatia Congenita Acidosica Enzimo-Metabolica. Una Patologia Mitocondriale Ignorata. Gazz Med. It. Arch. Sci. Med. 144, 423, 1985 (Infotrieve).
4) Stagnaro S. Diet and Risk of Type 2 Diabetes. N Engl J Med. 2002 Jan 24;3 (Medline) 5) Stagnaro-Neri M., Stagnaro S., Semeiotica Biofisica: la manovra di Ferrero-Marigo nella diagnosi clinica della iperinsulinemia-insulino resistenza. Acta Med. Medit. 13, 125, 1997.
6) Stagnaro-Neri M., Stagnaro S., Semeiotica Biofisica: valutazione clinica del picco precoce della secrezione insulinica di base e dopo stimolazione tiroidea, surrenalica, con glucagone endogeno e dopo attivazione del sistema renina-angiotesina circolante e tessutale Acta Med. Medit. 13, 99, 1997.
7) Stagnaro Sergio. Newborn-pathological Endoarteriolar Blocking Devices in Diabetic and Dislipidaemic Constitution and Diabetes Primary Prevention. The Lancet.
8) Stagnaro Sergio. New bedside way in Reducing mortality in diabetic men and women. Ann. Int. Med. http://www.annals.org/cgi/eletters/0000605-200708070-00167v1
9) Stagnaro S., Stagnaro-Neri M. Valutazione percusso-ascoltatoria del Diabete Mellito. Aspetti teorici e pratici. Epat. 32, 131, 1986.
10) Stagnaro S., Stagnaro-Neri M., Le Costituzioni Semeiotico-Biofisiche.Strumento clinico fondamentale per la prevenzione primaria e la definizione della Single Patient Based Medicine. Travel Factory, Roma, 2004. http://www.travelfactory.it/
11) Stagnaro S., Stagnaro-Neri M., Le Costituzioni Semeiotico-Biofisiche.Strumento clinico fondamentale per la prevenzione primaria e la definizione della Single Patient Based Medicine. Travel Factory, Roma, 2004. http://www.travelfactory.it/
12) Stagnaro S., Stagnaro-Neri M., Single Patient Based Medicine.La Medicina Basata sul Singolo Paziente: Nuove Indicazioni della Melatonina. Travel Factory, Roma, 2005. http://www.travelfactory.it/