Rename 'Ragbag' Type 2 Diabetes as Idiopathic Hyperglycemia

May 30, 2013

The term type 2 diabetes is a "ragbag" representing "various spectrums of diseases all wrapped up in one definition," which is misleading medical researchers and resulting in suboptimal treatment for patients, says a leading diabetes expert in a contentious new viewpoint published online today in the Lancet.

"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 Edwin Gale, MD, of Southmead Hospital, Bristol, United Kingdom, in an interview with Lancet TV that accompanies his article.

And although Dr. Gale predicts that "the ghostly entity of type 2 diabetes is likely to haunt us for years to come," he proposes the interim solution of using the term idiopathic hyperglycemia instead: "High blood glucose; we don't know why. That would be an honest description of it."

Clinicians Know Diabetes Patients Are Varied

One of the major drawbacks of lumping everything together under the banner type 2 diabetes is the introduction of one-size-fits-all guidelines for disease management, he observes.

" 'You have type 2 diabetes, so this is the treatment you need.' But there is a difference if you are 40 or if you are 90. Or if you are in, say, South India, North India, or Arizona, there is going to be a difference. So to come up with the idea that 1 treatment is ideal for everyone makes no sense.

"I think any clinician knows that people coming in to a diabetes clinic are enormously heterogeneous, they are very varied. Some have a major problem, which is actually being overweight. Some are thin, but they also have diabetes and might have high blood pressure," he continues.

"My concern is that by extracting out the type 2 component and trying to treat that in isolation we are missing the main message."

"I'm skeptical about guidelines; they are useful as guidelines, but they can lead to overtreatment, particularly in people like the elderly, who actually don't need such intensive treatment," he says.

In fact, he notes, clinicians are increasingly recognizing this "and saying, 'We have to individualize guidelines.' "

And using the term idiopathic hyperglycemia would at least encourage clinicians to think of the condition as an outcome of many interacting processes rather than a disease in its own right, he asserts.

"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.

Lancet 2013. Published online May 29, 2013.Abstract


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