The American Diabetes Association estimates that 18.2 million Americans have diabetes. Diabetes' links to heart attack and stroke make it the sixth leading cause of death, and it is the leading cause of new cases of blindness among adults 20-74 years old. Diabetic nerve damage is a major contributor to non-traumatic lower limb amputations, and diabetic kidney damage creates 43 percent of all cases of end-stage renal disease.
Proponents of the theory argue that the primary cause of such tissue damage is a key compound in energy production other scientists long ago rejected as a contributor to diabetic side effects. The researchers address the many objections and questions raised by critics of their hypothesis in a 47-page appendix available online in conjunction with their study.
"The metabolic imbalances caused by diabetes are quite complex, and that has made it very difficult to gain acceptance or even consideration of our hypothesis," says senior investigator Joseph Williamson, M.D, a retired pathology faculty member at Washington University School of Medicine in St. Louis. "Being able to publish the online appendix finally gave us the room we needed to respond to everyone's concerns."
Williamson's theory focuses on the energy-producing compound's reversible transformation between two forms, nicotinamide adenine dinucleotide (NAD) and NADH (NAD plus H, or one atom of hydrogen). Cells transform NAD into NADH when they transfer electrons and protons from the sugar glucose to NAD during an energy-making process called glycolysis.