What better way to start than relaying how the National Institute of Diabetes and Digestive and Kidney Diseases, a part of the U.S. National Institute of Health, defines diabetes:
Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high.
Source: https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes
How fun that the highly-regarded NIH not only incorrectly defines diabetes, but basically gets it backwards. Sorry, NIH, high blood glucose does not create diabetes. In fact, diabetes isn’t something that “occurs.” Diabetes is the term we currently use to describe one or more very different conditions when your body no longer can maintain healthy unaided glucose homeostasis.
How about another U.S. Government entity, the Center for Disease Control (CDC):
Diabetes is the condition in which the body does not properly process food for use as energy.
Source: https://www.cdc.gov/media/presskits/aahd/diabetes.pdf
Here we have another highly-regarded U.S. health institution, whiffing on defining diabetes. This attempt tries to define diabetes by describing how the condition impacts the metabolic process. It’s an impact-centric definition, which is a theme I see in parts of the medical community, which concerns me (more on that later). Disease definitions should be about the cause, not the impact. It’s also completely incomplete: the issues surrounding diabetes go far beyond food processing, CDC!
What about the World Health Organization – surely they get it right?
Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys, and nerves.
Compared to the NIH and the CDC, this is light years better. Yet, it’s still not great. Characterizing diabetes as purely a metabolic disease is misleading at best, and downright inaccurate at worst. For instance, the root cause of type 1 diabetes is an autoimmune disease, which leads to a metabolic condition. Most importantly (and this points to one of the primary objectives of this very manifesto), this definition guarantees serious bodily damage. This is patently untrue. It only “leads over time to serious damage” if not properly managed.
Let’s try the Diabetes Research Institute Foundation:
Diabetes is a serious condition that causes higher than normal blood sugar levels. Diabetes occurs when your body cannot make or effectively use its own insulin, a hormone made by special cells in the pancreas called islets (eye-lets). Insulin serves as a “key” to open your cells, to allow the sugar (glucose) from the food you eat to enter. Then, your body uses that glucose for energy.
This is the best definition by far, but it’s still not great. It is spot-on when it comes to focusing on insulin, which is the common denominator in every type of diabetes. And they see diabetes as a condition that causes things to happen. Close! The fundamental issue is that diabetes, as we define it today, is not a single condition. It’s a myriad of conditions that cause higher than normal blood sugar levels (among other things).
All of this begs the question:
Why do so many of these top-tier organizations define diabetes so poorly?
This manifesto will make the case that the fundamental problem is not with our organizations, but rather our nomenclature.