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Rename Type 2?
June 5, 2013
A few weeks ago, we wrote about an online petition to change the name of Type 1 and possibly also Type 2 diabetes. That effort was begun by two mothers of sons with Type 1 diabetes, who didn’t feel that their children’s condition was being taken seriously enough by teachers and other parents. In the petition, which is addressed to the American Diabetes Association, the National Institutes of Health, and the International Diabetes Federation, they write that a name like “autoimmune beta cell apoptosis diabetes” could help teach people what is really going on in Type 1 diabetes. Similarly, they write, a name like “insulin-resistant diabetes” could do the same for Type 2.
Then, last week, a British professor and diabetes expert proposed a new reason for renaming Type 2 diabetes. Writing in the journal The Lancet, Edwin Gale, a professor emeritus at Bristol University, argues that unlike Type 1 diabetes, Type 2 does not actually describe a single condition in which the cause of high blood glucose levels is known. Instead, he writes, the Type 2 label is applied to a wide spectrum of conditions, ranging from diabetes that is accompanied by hypertension and obesity in which insulin resistance is clearly present, to diabetes in thin people who may exhibit signs of autoimmunity even though their pancreases still produce at least some insulin. Although, according to Gale, most doctors are aware of the variety of factors that may be present in Type 2 diabetes, using a single label that implies specificity can lead even experts to ignore this knowledge when making both clinical and research decisions.
In a video accompanying the Lancet article, Gale outlines what he believes to be the negative consequences of the one-size-fits-all Type 2 label. Many doctors, he says, act as if there should be a single best approach or treatment to Type 2 diabetes, regardless of the patient’s specific condition. In reality, he suggests, the best course of treatment may depend on whether a patient has the metabolic syndrome (in which elevated blood glucose is accompanied by high blood pressure, obesity, and high blood lipid levels) or is, for example, a thin person with just diabetes and high blood pressure. Age, he notes, is also a relevant factor, and existing guidelines may lead some doctors to treat diabetes too aggressively in elderly people. Finally, Gale suggests renaming Type 2 diabetes “idiopathic hyperglycemia,” meaning high blood glucose for unknown reasons.
What do you think — does a name change for Type 2 diabetes make sense, or is “idiopathic hyperglycemia” no better as a name? Would this new name change the way you think about your diabetes, if you have Type 2? Does having a specific name like Type 2 diabetes give you more peace of mind than if you were told, essentially, that you have “mystery diabetes”? Leave a comment below!
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