For decades, doctors and researchers believed that type 2 diabetes was a metabolic disorder. This type of disorder occurs when your body’s natural chemical processes don’t work properly.

However, some research now suggests that type 2 diabetes may be an autoimmune disease. If so, it may be possible to treat it with new approaches and preventive measures.

Currently, there isn’t enough evidence to fully support this idea. For now, doctors will continue to prevent and treat type 2 diabetes primarily with lifestyle changes and then introduce medication and insulin as options over time.

Read on to learn more about the research and the implications it may have on the treatment and prevention of type 2 diabetes.

Historically, doctors have seen type 2 diabetes as a different type of disease than type 1 diabetes, despite their similar names.

Type 1 diabetes

Type 1 diabetes is an autoimmune disease. It’s often diagnosed in children and teens, but it can appear at any age.

In people with type 1 diabetes, the immune system mistakenly attacks the healthy tissues of the body and destroys the insulin-producing cells of the pancreas. The damage from these attacks prevents the pancreas from supplying insulin to the body.

Without an adequate supply of insulin, cells can’t get the energy they need. Blood sugar levels rise, leading to symptoms such as frequent urination, increased thirst, and irritability.

Type 2 diabetes

Type 2 diabetes occurs when your body becomes resistant to insulin and eventually can’t produce enough insulin. The hormone insulin moves glucose from your blood to your cells. Your cells convert glucose to energy.

It can occur at any age, but the risk increases as people get older.

Without insulin, your cells can’t use glucose, and symptoms of diabetes can occur. These may include fatigue, increased hunger, increased thirst, and blurred vision.

Early research suggests that the two types of diabetes may have more in common than previously believed. In the last decade, researchers have tested the idea that type 2 diabetes is an autoimmune disease, similar to type 1 diabetes.

An autoimmune disease happens when a person’s immune system mistakenly attacks and destroys healthy cells and tissue.

There is growing evidence that the following features either are or may be present in people with diabetes:

  • long-term, low grade inflammation at every stage, from the first changes through to the development of complications
  • changes in the number and function of immune cells
  • unusual antibody activity, in some cases
  • changes in some T cells

These are features of an inflammatory response and may indicate autoimmune activity, according to a 2019 research article.

If type 2 diabetes is an autoimmune disease, the discovery may have big implications on our understanding of obesity. It’ll also affect the way obesity-induced type 2 diabetes is treated.

Doctors currently treat type 2 diabetes with two traditional approaches.

The first focuses on a healthy lifestyle. A healthy diet and frequent exercise are the pillars of this treatment.

Doctors then typically prescribe oral medications that work in different ways to increase your body’s ability to use insulin, to make less glucose, and to perform other actions.

If medications don’t work, you may need to use insulin. Injections of insulin can help your cells absorb glucose and generate energy.

Some people with diabetes may be able to postpone insulin injections with healthy lifestyle changes and medications. Others may need them right away.

If type 2 diabetes is an autoimmune disease, that could change the treatment strategy. Similar to type 1 diabetes, a doctor could introduce insulin therapy at an earlier stage.

Some researchers have also suggested that, if type 2 diabetes is an autoimmune disease, it might respond to drugs that moderate the immune system.

One such immunosuppressant medication is rituximab (Rituxan, MabThera). It belongs to a group of drugs known as anti-CD20 antibodies. These medications are designed to target and eliminate the immunity cells that are attacking healthy tissue.

In one 2011 study, anti-CD20 antibodies successfully prevented lab mice at high risk for type 2 diabetes from developing the disorder. The treatment even restored their blood sugar levels to normal.

Some research indicates that medications affecting the immune system may benefit people with type 2 diabetes. Immunosuppressant medications such as anti-CD20 antibodies could prevent immune system cells, such as B cells, from attacking healthy tissue.

Currently, doctors use anti-CD20 antibodies to treat some autoimmune diseases, including rheumatoid arthritis (RA) and multiple sclerosis (MS). Using immunosuppressant medications to treat type 2 diabetes is a long way off, but the early results are promising.

The research suggesting that type 2 diabetes is an autoimmune disease represents a major advancement in medicine and in our understanding of the condition.

A greater understanding of what might be causing type 2 diabetes is vital to providing the best and most effective treatments.

Future research could confirm that it is indeed an autoimmune disease. Then treatment and prevention will turn to novel therapies and medicines. This research opens the door to wider discussions about why and how diabetes develops — and what can be done to stop it.

More research is needed before type 2 diabetes is considered an autoimmune disease. Until that time, talk with your doctor about the future of this research. It’s good to have an ongoing conversation with them about the most recent diabetes research.

In the meantime, continue to test your blood sugar levels regularly, pump or inject insulin to maintain a “normal” range of blood sugar levels, and keep your body healthy.

It can also be helpful to connect with other people who understand what you’re going through. Our free app, T2D Healthline, connects you with real people living with type 2 diabetes. Ask questions, give advice, and build relationships with people who get it. Download the app for iPhone or Android.