Partha Kar: Diabetes—know your type

When it comes to diabetes, the language we use matters. Partha Kar explains why it is vital we are clear about the type of diabetes we are referring to

In a fast moving world dominated by catchy media headlines, it is easy to misinterpret meaning and intent, or miss the underlying message behind the headline.  Social media makes it easier for people to air their views and comment without the necessary context or sometimes even without the facts. The main message can get lost even further. 

The world of health is no different. We juggle the traditional evidence based methods and meta analyses alongside real world data, conflicts of interest, snap interpretations, or even misinterpretations. Misinterpretations can sometimes be quicker to take hold than the actual message or corrections.

The way that the media report diabetes is a case study in itself. For example, to simply say “diabetes is a lifestyle issue” misses the mark. Any mention of diabetes should specify the type. Type 1 diabetes is an autoimmune disease with no relation to lifestyle, neither are the genetic types of diabetes (e.g. MODY). Undeniably, lifestyle is a determinant in the development of Type 2 diabetes, yet there is plenty of research to show the role of genetic causes and socio-economic deprivation, and thereby a lack of access to healthy food in the development of Type 2 diabetes too.

An example of how messages can be lost in translation is an interview by The BMJ’s editor in chief, Fiona Godlee,  in The Economic Times  in 2016. The interview was about the “epidemic of type 2 diabetes” in India and the need to tackle the underlying causes rather than rush to put people on insulin. The interview focused on the risk of overdiagnosis, overtreatment, and industry influence in medicine, and highlighted the need for healthy lifestyles to treat Type 2 diabetes.  A healthy lifestyle and access to healthy foods continue to be the cornerstone of Type 2 diabetes prevention, care, or as some recent data suggest, remission. The message of the interview was that we must avoid putting people on insulin quicker than required, before the individual or the healthcare professional has had the opportunity to explore other options for treatment.

The published interview did not specify the type of diabetes that was being discussed. In a nation like India, where insulin comes with its own stigmasuch as lack of social awareness around injectionsit is vital that key information like this is specified. Understandably patient organizations representing patients with Type 1 diabetes, as well as healthcare professionals, highlighted this concern. 

Fiona Godlee issued the following comment in response:

“It is important to clarify that in this interview I was referring to Type 2 Diabetes. This is a condition for which lifestyle changes such as diet and exercise are of paramount importance. There is also mounting evidence that Type 2 Diabetes can be reversed through weight loss (for example from the DIRECT study) and these options need to be explored before considering expensive insulin therapy. As well as individual lifestyle change, there is a need for urgent investment in population-based approaches to support healthier lifestyles, including access to healthy food and clean air. On the other hand, for people with Type 1 Diabetes, which is caused by autoimmune disease, insulin continues to be a life-saving treatment and is currently the only option”

This was an important clarification and highlights why it is crucial to always specify the type of diabetes being referred to. We must be aware of the issues around sugar consumption, the growing evidence around its impact on health, the relevance of food constituents, and the need to adopt a broader public health approach towards the prevention and treatment of Type 2 diabetes. Yet we also must be aware of the need for insulin as a treatment option for patients with Type 2 diabetes. There is a fine balance to maintain as one tries to get the right message across in a population where stigma about diabetes and needles are high. It is a balance of ensuring those who need insulin are not dissuaded from using it, yet those who could benefit from a public health approach get that opportunity too.

The evidence base is evolving and as healthcare professionals it is our role to educate our colleagues and the larger population about the difference in the types of diabetes. The language we use matters, and helps to avoid stigma. It’s a balance we all must tread carefully as we aim to get the right message across. 

Partha Kar is a consultant in diabetes and endocrinology. Twitter: @parthaskar

Competing interests: See full declaration