Finding the chase and cutting to it

In the case of diabetes mellitus, a rose by any other name does not necessarily smell as sweet.

As a young child growing up in the seventies, very little was generally known about diabetes mellitus and in many ways the definition of type 1 and 2 helped identify that age was not a factor in the condition being diagnosed.

Since then, our knowledge of these many and varied conditions has increased dramatically. But the classification and naming of these conditions has not helped in allaying some of the biases and struggles we encounter everyday. Not least for the less commonly occurring conditions such as type 1, MODY, neonatal and LADA.

I am proposing a new naming convention that should remove some of the confusion, help medical personnel form appropriate treatment plans and help diabetics across the world. It would help the media to highlight important research to the target audiences. I appreciate I am in 0.2% of the world’s population, but the consequences of misunderstandings by medical and lay personal can have dire consequences for me.

I have experienced such issues myself, in hospital environments and in the work place. Many type 1’s are in similar situations given the media confusion over type 1 and type 2. This is my idea on how to remove such issues. What are your thoughts, please?

Autoimmune acquired diabetes (AAD)

Currently this would be the vast majority of type 1 diabetics. For some reason, often triggered by a virus or other infection, our beta cells die along with our ability to create insulin. Which causes us to die if we don’t have insulin replacement therapy.

LADA (latency or latent autoimmune diabetes of adults) would come under this classification too.

Gene function diabetes (GFD)

Typically this is called MODY (maturity onset diabetes of the young) but would also cover neonatal diabetes. Depending which gene is causing the issues impacts the effective treatment options, sometimes diet or tablets, sometimes insulin assistance therapy.

In neonatal circumstances, the children may only have this for a short period and recover full function depending on the genes in question and effective treatment being given. Calling them type 1, even if they require insulin for a short period, may do them more damage than help them long term!

Insulin resistant diabetes (IRD)

Largely, this is the majority of type 2 diabetics. For whatever reason, they cannot produce enough insulin for what they are doing when diagnosed.

It can be transient: so dieting, exercising and losing weight can mean drug treatment may never be needed. But it never goes away.

For some IRD, medication may be necessary, not least insulin, not because they were “too lazy to stick to the diets” which isn’t the case for many. In the case of GFD, it is obvious why! But naming the two differently makes it easy to distinguish where the diabetes sits and the appropriate treatments.

Gestational diabetes (GD)

This is another transient form of diabetes and may completely go away or evolve into IRD, even if insulin was required during pregnancy. Again, the names can help determine the appropriate treatments.

Physical injury related diabetes (PIRD)

Some people with diabetes mellitus are that way because their pancreas has been affected by injury or disease.  Unlike Autoimmunity Acquired Diabetes, the cause may be due to removal of the pancreas during treated for pancreatic cancer or the pancreas being injured through sport, gunfire or road traffic accident.
Very rare but a different physiology to AAD and usually requires insulin and other hormones to be replaced.
I don’t know a great deal about this but I’d imagine pancreatic transplants work better for these patients as they lack the autoimmune response of AAD.
Because of the mucus Cystic Fibrosis people secret, they can need insulin because they have damaged β-cells so they would fit in here too.

The beauty of these terms is they are tangible, if someone is overweight but GFD, the weight is not the cause! No doubt losing weight would help the diabetic but they do not need to be stigmatised for their diabetes because it is not their fault.

It is obvious that IRD does not develop into AAD because the causes are different. I appreciate that some forms of IRD may be present in AAD, especially where weight is an issue, but again, it is easier to have the conversation with patients when symptoms occur.

The names also suggest that effective treatments for PIRD would not give hope for a cure for AAD.

Diabetes is rarely fully transient, and this can be communicated to more than just the endocrine specialists by use of these terms.

These terms aim to be short and to the point.  They describe what is happening to the individual concerned.

Would this help?  Does this help you to understand what is going on, please?