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THE TERM ‘TYPE 2 diabetes’ is leading medical researchers astray, and resulting in suboptimal treatment for patients.
That’s according to Professor Edwin Gale, of Southmead Hospital in the UK, who believes applying the term ‘type 2 diabetes’ to the complex and varied set of symptoms that us associated with the disease is wrong.
In a Viewpoint published in The Lancet, Professor Gale said, “If you give something a name, 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.”
Type 2 diabetes is diagnosed when a patient’s body can no longer produce enough insulin, or when the insulin that is produced does not 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.
However, Professor Gale argues that because the symptoms referred to by the term ‘type 2 diabetes’ have such widely varying causes and treatments, the term is misleading both researchers and patients.
Treating type 2 diabetes as a single disease has wasted the times of young investigators says Professor Gale, by the introduction of one-size-fits-all guidelines for disease management.
Although Professor Gale says an interim solution would be to replace ‘type 2 diabetes’ with the term ‘idiopathic hyperglycaemia’, 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.
“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?” asks Professor Gale.
I do feel that Type 1 and Type 2 should be called different illnesses at the very least so callng type 2 a different name would be a start (have had type 1 diabetes since childhood).
Fair comment, I refer to my type 2 as non insulin dependent. Bus as I have to take 2000mgs of glucophage every day along with asprin blood pressure tablet and cholesterol tablet at night I do take my condition very seriously. As I said I was never overweight and I get very annoyed when people refer to type 2 diabetes as fat and lazy people who overeat and don’t exercise and that we must be living a very unhealthy lifestyle. I walk about 15 hours a week and am 10 stone. However I do agree that some people who have type 2 diabetes are living a very bad lifestyle. My type 2 is not self inflicted.
Some type 2′s take insulin – there are several conditions masquerading under the type 2 banner which does make treatment more difficult as there are several illnesses with several treatments…
Idiopathic suggests an unknown cause. But the causes of type 2 diabetes are known, even if they are multiple and interacting.
You’re missing the point. He’s saying that there is no such thing as “Type 2 Diabetes”, rather that people are suffering from hyperglycaemia due to unknown causes, hence idiopathic.
In the vast majority of cases, the underlying causes of the onset of disrupted glucose homeostasis, decreased insulin sensitivity etc are well known and well characterised.
The causes are not unknown, they are multivariate.
Feel unbelievably stupid now, I’ve even red thumbed myself!
Thanks for the correction Dr. Hempenstall :)
Seems like he is rooting to have this named after him!
‘Gales disease’ anyone?
Wouldn’t that just cause a lot of confusion?
Don’t see why it would cause confusion- its a hell of a mess as-is, at least there would be a recognition of the condition in its own right.
Will it make any difference in management?
No, but it’ll get his name in the papers.
I was first diagnosed with type 2 diabetes at age 12 I was never over weight in fact quiet skinny. It went away a popped up again during my pregnancy at age 25. I a. Now 53 and still have type 2 and am on 4 tablets a day. I am not overweight. The diabetic doctor said I have a sluggish Pancreas who runs in my family. My mother had type 1 and my father had type 2. There is a list of symptoms that go with type 2 diabetes, heart disease, stroke, high blood pressure, and high cholesterol. Which I have a d also had a mild stroke 4 years ago. This is a real disease with real side effects and long term damage, and should be taken very seriously. If I didn’t take my tablets I would end up in casualty with hypoglycaemia taking up a hse hospital bed. This disease is a type of diabetes and should continue to be called type 2 diabetes as if it goes untreated it can turn Into type 1. I think this professor is just trying to make a name for himself. If it ain’t broken why fix it. Most people know the difference between type 1 and type 2 diabetes thanks to media coverage.
Type 1 is due to your immune system deciding to destroy the insulin producing cells in the pancreas. You are totally dependant on insulin injections/the pump for your insulin requirements as you do not produce any insulin. Type 2 is where your body is less responsive to insulin or does not produce the full amount for your requirements. I feel that type 1 is a dufferent illness to Type 1 and should not be called the same. There is a huge stigma with diabetes (have people say that I can not be diabetic as I am not fat) and the media does not help these steryotypes. It is true that a lot of tpe 2 are not overweight but type 2′s do still produce insulin whereas type 1′s do not. Thus they should be called different names.
I agree with Aoife on this, the amount of times I’ve been asked “Oh is that from eating too much sweets?” (or of course “But you’re not fat?!”) When I say I’ve Type 1 Diabetes, and the media are terrible for lumping the two in together (The Daily Mail is the worst for it) and saying “Diabetes is on the rise due to a rise in obesity” (without ever saying which type!) Type 1 and Type 2 are two very different diseases with very different causes and very different treatments!
The point I’m trying to make eoin is that not all type 2 diabetics are fat overeating lazy lumps. The bottom line is that in both types the pancreas is malfunctioning and either not producing insulin or not producing enough, so as far as I’m concerned it is all in the diabetes family. Shall we just call type 2 no insulin dependent as I do if asked.
Some type 2′s take insulin so that would not work. Also, a lot of type 2′s are skinny and some type 1′s are fat…it is like the way that a fast heart rate can be due to thyroid issues or something else but if someone has thyroid disease that is listed as the factor not just that they have issues with their heart rate…
Opps, I should have said a better example – graves disease is a thyroid illness that can cause increased heart rate and like type 1 diabetes is an illness where the body attacks itself. The illness should be named related to the cause and not the general symptoms. You can get fitting if your blood sugar is too low but unless you have epilepsy iself you are not epileptic.
Mary- most people do not know the difference between type 1 and type 2 diabetes. Media coverage does not differentiate between the two conditions- the terms type 1 and type 2 are rarely mentioned, it is all ‘Diabetes’- and attributed to an epidemic of obesity, a lack of exercise and of course our new sedentary lifestyles. There is a symptomatic difference between type 1 diabetes and type 2 diabetes- type 1s do not produce insulin, but react as normal to the presence of insulin. This tends to be through an overactive autoimmune response, where a person’s immune system attacks it’s pancreas. Type 2 diabetics, in contrast, may produce their normal compliment of insulin- however they have a resistance to this insulin- typically a muscular resistance, but also in the liver and fat cells. Yes- Type 1 and Type 2 diabetes can present similar sympthoms (hyper or hypoglycaemia) however even this is a generalisation- as type 1s have over 30 times more frequest hypoglycaemic attacks than they have hyperglycaemic attacks, and the inverse is true of Type 2 diabetes.
Type 2 diabetes does exist- certainly it does- however lumping it in with Type 1 diabetes, is clearly misleading- and the hamfisted manner in which the media seem to lump all diabetics in the one boat- is unhelpful in the extreme.
So….can I stop testing my blood and taking the drugs ?!?!?
There is a huge perception in the media and in general that type 2 diabetes is caused by obesity/drinking too much sugary drinks etc so it is only understandable that a lot of type 2′s want type 1 and 2 to be lumped together but they are different illnesses – Type 1 is where no insulin is produced and is an auto-immune response – type 2 produce some or enough but can be insulin resistant in some cases and the causes are multi-factorial. Some type 2′s take insulin so simply saying insulin and non-insulin dependant is not enough. They are different illnesses though (type 2 as it stands is several illnesses)..
Type I NEVER turns into Type II, although in extraordinarily rare cases you may develop both. To repeat what others have said, Type I is an auto immune disorder. In fact, if you are prone to auto immune disorders ((ex) you have developed Type I diabetes), your risk of developing a second or third autoimmune disorder is measurably increased: Hashimoto’s (thyroid), Coeliac, Crohn’s, Sjogren’s, rheumatic arthritis, etc. Type II diabetics do not face this increased risk.
I think more people are becoming more aware that diabetes is not always related to lifestyle, although a lot of cases in type 2 is related to lifestyle, there are some that are not. Its quite funny some of the questions people ask ye like ” what happen if you drank coke ? would u collapse or get really hyper ? haha
I was diagnosed with type 2 diabetes in 2013 with a HBa1c of 15 and I was prescribed 2000 mg of MMetheringham a day. I lost just over 4 stone in weight and a year later my Hba1c was 5.1 therefore taken off of medication but I’m confused why this happened
Great words you have shared. Also excess intake of saturated fats, trans fat, sodium and cholesterol may increase your risk of heart stroke and other health complications. Consult your health nutritionist or dietitian to prepare a proper diet that works with your overall lifestyle in controlling your diabetes
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