July 24, 2013

More Evidence, Type 2 Is Idiopathic Hyperglycemia

This time it is a doctor in the United Kingdom calling for a name change for type 2 diabetes. I think this has more merit than the name change for type 1 diabetes will ever have. Edwin Gale, MD, of Southmead Hospital, Bristol, United Kingdom wants the name to be idiopathic hyperglycemia. I don't envision this name sticking, but it is more descriptive than type 2 diabetes.

At this point, I think the definition from the American Heritage® Stedman's Medical Dictionary is appropriate.
idiopathic id·i·o·path·ic (ĭd'ē-ə-pāth'ĭk)
  1. Of or relating to a disease having no known cause; agnogenic (another name for idiopathic).
  2. Of or relating to a disease that is not the result of any other disease.

"We talk about type 2 diabetes as if it were an actual, well-defined, formulated disease, and the moment we start talking about this…we assume it's a disease that has a cause, that has a mechanism for which there are specific treatments and for which there may be prevention and cure," explains Dr. Gale.

I admit that I have suspected what he describes. Why else would we have people labeled as type 2 diabetes in such a wide range of conditions and medications. I know people not needing any medications and all through the spectrum to people like myself that are on insulin shortly after diagnosis. There are people that have little or no insulin resistance to people like myself that have high insulin resistance.

One of the major fallacies of lumping everything together under the term type 2 diabetes is the introduction of one-size-fits-all guidelines for disease management. Dr. Gale is also concerned about treating everyone the same whether you are 40 or 90.  Using the term idiopathic hyperglycemia would encourage clinicians to think of the condition as an outcome of many interacting processes.

"If you talk about type 2 diabetes as being a single condition, you are going to then automatically assume there is a single best treatment, a single best path to follow. People get hypnotized by a name… A name can be very deceptive. It's best to have a name that makes no assumptions," he concludes.

Dr. Gale argues that, “Because the symptoms referred to by the term 'Type 2 diabetes' have such widely varying causes, mechanisms, and treatments, the term is misleading both researchers and patients.”  I am sure that the ADA will have disagreements with Dr. Gale. Someone within the organization will probably feel the need to spout off to attempt to repudiate him.

Read this blog by Tom Ross about this topic. It is in the second part of the blog for May 30, 2013. You will need to scroll down to it because the link takes you to May 31.

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