Early phase of diabetes mellitus may just be a reversible insufficiency of pancreas against excess fat tissue

Background: Excess fat tissue may be a reversible etiology of early diabetes mellitus (DM). Methods: Sickle cell diseases (SCD) patients were studied. Results: We studied 222 males and 212 females (30.8 vs 30.3 years of age, p>0.05, respectively). Smoking (23.8% vs 6.1%, p<0.001), alcohol (4.9% vs 0.4%, p<0.001), transfused red blood cells (RBC) in their lives (48.1 vs 28.5 units, p=0.000), disseminated teeth losses (5.4% vs 1.4%, p<0.001), ileus (7.2% vs 1.4%, p<0.001), stroke (12.1% vs 7.5%, p<0.05), chronic renal disease (CRD) (9.9% vs 6.1%, p<0.05), cirrhosis (8.1% vs 1.8%, p<0.001), chronic obstructive pulmonary disease (25.2% vs 7.0%, p<0.001), coronary heart disease (18.0% vs 13.2%, p<0.05), leg ulcers (19.8% vs 7.0%, p<0.001), and clubbing (14.8% vs 6.6%, p<0.001) were all higher in males. Conclusion: As a prototype of accelerated atherosclerosis, hardened RBC-induced capillary endothelial cell damage terminates with end-organ deficiencies in early decades in SCD. Although atherosclerotic endpoints are so common, we detected no case of DM probably due to lower excess fat. As the most common cause of CRD, DM may be a reversible insufficiency of pancreas against excess fat tissue in early phases. Increased blood and insulin needs of excess fat in contrast to decreased blood supply of excess tissue and pancreas both due to excess pressure on vasculature, externally and atherosclerosis, internally may be important in DM. Acarbose and metformin are safe, cheap, oral, long-term used, and effective drugs for excess fat which may be curative in early phases of DM before development of other atherosclerotic endpoints. Key words: Sickle cell diseases, early diabetes mellitus, excess fat tissue, acarbose, metformin, capillary endothelial cell inflammation, atherosclerotic endpoints