“A problem that cannot be defined in scientific terms cannot have a scientific solution.”
The media release is below.
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Does Type 2 diabetes really exist?
The term “Type 2 diabetes” is leading medical researchers astray, and resulting in sub-optimal treatment for patients, says a leading diabetes expert in a Viewpoint published in the Lancet.
According to Professor Edwin Gale, of Southmead Hospital, Bristol, UK, applying the term ‘Type 2 diabetes’ to the complex and varied set of symptoms experienced by people with the condition is what logicians call a category error, when a problem is assigned to a category inappropriate to its solution.
Speaking to Lancet TV, Professor Gale said, “If you give something a name, you imply an entity; you imply that this thing actually exists. In practice, when somebody like myself talks about Type 2 diabetes, I’m saying ‘a form of diabetes for which I can find no other cause’. In other words, it’s a diagnosis of exclusion…There are various conditions, spectrums, and severities of diseases, all wrapped into this one definition.” [1]
Clinicians diagnose Type 2 diabetes when a patient’s body can no longer produce enough insulin, or when the insulin that is produced doesn’t work properly, which leads to problems maintaining a normal blood glucose level. According to Diabetes UK, Type 2 diabetes is estimated to affect around 2.6 million people in the UK [2].
However, Professor 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.
Treating Type 2 diabetes as a single disease has “has caused the work of generations of young investigators to be wasted in pursuit of indefinable entities”, writes Professor Gale, adding that it has also led to a failure to achieve satisfactory treatment and risk management for many patients, “reinforced by the introduction of one-size-fits-all guidelines for disease management.”
Although Professor Gale predicts that “the ghostly entity of type 2 diabetes is likely to haunt us for years to come”, as an interim solution, he proposes replacing ‘Type 2 diabetes’ with the term ‘idiopathic hyperglycaemia’ [3], which would encourage clinicians to stop thinking about the condition as a disease in its own right, but rather as an outcome of many interacting processes. These processes vary from person to person, argues Professor Gale, and therefore so should treatment.
“A problem that cannot be defined in scientific terms cannot have a scientific solution,” Professor Gale writes. “When a century of scientific endeavour brings us round to the conclusion that we cannot define what we are talking about, it might be time to consider adjusting our minds. It is widely appreciated that type 2 diabetes is not a uniform disease entity with a definable cause, mechanism, and treatment, so why are these terms always used?”
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Actually, bad diet (which includes good ol’ plain over-eating) and lack of exercise are the principal causes of what some know as ‘type 2’ diabetes. That’s all we need to know.
It’s less scientific than you think. Ask a room full of fifth graders what a species is and you’ll get a straight answer. Ask a room full of biologists what a species is and be sure to have a seat handy. You may want to get dinner ordered first. Definitions matter, if for no other reason, than because of the sway they have over public opinion which is what drives political action. “Type 2 Diabetes” allows uninformed idiots to blame everyone who has it for their own disease because of the unsupported claim that diet and exercise are the cause.Similarly, lung cancer consistently gets less charitibal donations and fewer reasearchers working in the field because of the demonization of tobacco, espite the fact that tobacco use is only one of many known and who knows how many unknown contributing factors.
“Do you really think the people engaged in diabetes research are so lame that a label change would change their thoughts and behavior?”
Probably not, but it affects how doctors treat their patients. If it is a seen as a cluster of 4-5 different disorders, then they’ll look further and find the most appropriate treatment. If it is seen as one, then they wont. For example, we know that 15-20 percent of people diagnosed as type 2s are late onset type 1 diabetics. The treatment for type 2 is to give them drugs that make them more sensitive to insulin, have their liver produce less sugar, or have their pancreas produce more insulin, and this would be generally be inappropriate for a type 1.
By using a name like idiopathic hyperglycemia, we are telling our doctors to dig deeper. It tells them that they haven’t actually diagnosed the underlying problem.
In regards to autism, creating distinctions from a medical standpoint would have some meaning in the future if the symptoms come from different underlying issues. For example, maybe what we call ‘autism’ includes people whose autistic traits are genetic in nature (normal differences), related to seizure/sleep problems, related to dietary issues (gluten, wheat, soy), related to a mitochondrial problems, or possibly low birthweight/birth defect related. A lot of people classified as ASD probably have some other disorder, and they should be classified as having something else.
I’d also argue that a DSM identification of autism should look at where they are functionally in terms of communication, intelligence/academics, sensory integration, social skills, etc. Most other DSM diagnoses involve identifying the underlying disorder or problem causing them issues, but autism identifies a group of individuals whose strengths, weaknesses, and functioning vary greatly. Someone diagnosed with OCD gets treated with therapy and meds that targe the disorder, but two people diagnosed with ASD often require completely different therapeutic support and support needs.
If people understand the distinction, they are useful. However, I don’t think most people have the faintest idea what the differences are. It’s just “people with diabetes can’t eat sugar and take shots” and “diabetics pass out and end up in the hospital”. I am thinking that some clearer system might help, though I do agree idiopathic hyperglycemia will probably not help.
I suspect that even if we did have such distinctions in autism, people would still think of anti-social, odd children who scream when touched. It’s kind of like the whole species, family, order classification in living organisms. We know it’s a bird–what kind is much harder to teach everyone and why it’s that species is even harder. The distinctions are scientific, yes. Useful to the general public? Not sure.
I would also point out that individual distinctions are useful. Autism should have such granularity.
“It’s a seriously messed up system.”
I don’t think idiopathic hyperglycaemia will help.
Actually, all of the terms of diabetes need reworked. We have Type 1, Type 2, Type 1.5 (latent autoimmune diabetes), gestational, surgically induced, chemically induced and tentatively Type 3 (the list may not be complete). There are multiple causes, some known, some not. Some are lifelong, some may not be. Plus, diabetic coma refers both to passing out due to low blood sugar and due to high blood sugar. It’s a seriously messed up system.
Yup, just like Fibromyoldageia
Sometimes new names are necessary.
Remember GRID? Gay Related Immunodificiency Syndrome? It was changed to AIDS when it was found to not be related to homosexuality.
Also, the term Swine Flu led to mass slaughter of pigs in Egypt despite the fact that the virus was almost exclusively transmitted Human-to-Human. Referring to it as H1N1 removed that stupidity.
I also think that he classification of diabetes as a symptom instead of a syndrome has merit. However, I think he’s overblowing the importance of a new name.
Dr. Gale’s naval gazing should not have been widely published. His ideas may have merit and might be pursued, but impuning existing activities because they are not inline with his ideas is simply tacky. Wait . . . he’s British. Make that cheeky.
Howdy Gamecock
No, I hope the researchers are open-minded enough to consider new ideas and new terminology can be part of that.
We need to invent new terms for old stuff every so often so folks can market cures for these new diseases.
Do you really think the people engaged in diabetes research are so lame that a label change would change their thoughts and behavior?
I have high blood sugar in the morning. No other time. Not caused by my diet except that I need to eat something heavy in protein and/or fat right before I go to bed to control it. That’s what they mean by “Ideopathic Hyperglycemia.”
Back when I was in the trade, I read a great line: “jaundice is a symptom, not a diagnosis.” Headaches and backaches are a bit the same. Perhaps the cluster of signs and symptoms we’ve called type 2 diabetes, and have treated as if this was a diagnosis, are actually related problems of related diseases but not the same disease. If this article is right, the standardized treatment protocol will only be appropriate in some cases.
“Idiopathic hyperglycemia” is not, in my opinion, word salad. It’s a proposed alternative terminology to try to understand and describe the syndrome better.
Word salad.
“Idiopathic hyperglycaemia? Really? That’s going to help whom?
Damn right. Diabetes type two means your diet and your lifestyle is stuffed up. Simple as that. It is not a classifiable disease as such.