Many people with diabetes — both Type 1 and Type 2 — have become accustomed to comments in the media that treat diabetes as the inevitable result of poor lifestyle choices such as eating too much sugar, fat, or overall calories. In reality, of course, Type 2 diabetes is caused by a combination of genetic, lifestyle, and environmental factors, while Type 1 diabetes is thought to be caused by an autoimmune reaction to an environmental trigger.
So last week, when Greg Glassman, the CEO of fitness company CrossFit, posted a photo on Twitter that parodied Coca-Cola’s “open happiness” slogan with the phrase “open diabetes” — and included the comment, “Make sure you pour some out for your dead homies” — the online backlash from people with diabetes was predictable. The highest-profile response probably came from Nick Jonas (of Jonas Brothers fame), who has Type 1 diabetes and responded on Twitter, “This is not cool. Please know and understand the difference between type one and type [two] diabetes before making [i]gnorant comments. Sensitivity to all diseases, and proper education on the cause and day to day battle is important.”
The need to understand the differences between Type 1 and Type 2 diabetes has been a common theme in many online commentaries following Glassman’s original Twitter post. Writing for The Huffington Post, diabetes educator Riva Greenberg notes that a great deal of the outrage online has come from people with Type 1 diabetes, and parents of children with the disease, who are tired of people thinking they (or their children) got it by eating too much sugar. But, of course — as Greenberg points out — many people with Type 2 diabetes would still have felt shamed and unfairly singled out if Glassman had been more specific and shared an “open Type 2 diabetes” Coca-Cola parody. Even if many cases of Type 2 diabetes are due, in part, to lifestyle factors, no one asks for the disease, and it’s impossible to know the balance of genetics, lifestyle factors, and environmental factors (such as exposure to certain chemicals and toxins) that led to any single case of Type 2 diabetes.
Like many other commentators and bloggers, Greenberg asserts that sugar does not directly cause Type 2 diabetes. Rather, she writes, it may contribute to being overweight, which is a risk factor for the disease. Yet as a Twitter post from the CrossFit account points out in defense of Glassman, there is data to suggest that sugar plays a role in the development of Type 2 diabetes — independently of its role on body weight. In a 2013 study published in the journal PLOS ONE, researchers used statistical models to show that in a comparison of 175 different countries, an increase in sugar availability of 150 calories per person per day — about the equivalent of a can of soda — was associated with a 1.1% increase in the rate of diabetes. This number was calculated after controlling for other foods consumed, total calories, overweight and obesity, and several other factors including urban versus rural living and income. No other food category was found to significantly affect the rate of diabetes after controlling for overweight and obesity, and rates of diabetes were seen to rise and fall after population-wide increases and decreases in sugar intake. So it seems fair to say that sugar does, in fact, directly lead to Type 2 diabetes, according to at least one study.
What’s your take on the CrossFit Twitter post — was it offensive mostly because it didn’t differentiate between Type 1 and Type 2 diabetes, or because it was utterly lacking in sensitivity toward a serious health condition? Would the parody have been acceptable if it had been accompanied by an explanation of the effect of sugar consumption on diabetes rates, rather than the “dead homies” comment? Can you think of a better way to point out the risks associated with drinking sugary beverages? If the link between sugar consumption and Type 2 diabetes can be more firmly established, would you support restrictions on advertising by manufacturers of sugary beverages, similar to those imposed on tobacco companies after their products were shown to carry significant health risks? Leave a comment below!