I sat next to a man at a dinner program who introduced himself “Hi! (shakes hand) I’m Eric. I’ve been living with type 1 diabetes for 12 years.”
I like this introduction, but it struck me after 10 years of working in this space of diabetes – I’ve never once heard someone introduce themselves “as a person living with type 2.” Not at a conference, not at an event, not in my job setting with a patient.
Ninety percent of all people with diabetes are type 2; and yet, most of the hype centers around type 1. I love type 1 for demanding innovation and education surrounding their issues. I believe in their calling wholeheartedly, but it did make me wince when I saw the disparity in presentations at AADE this year. I think of type 2 as a cousin to type 1. They’re not separate in my mind; and yet, they’re the cousin no one talks about.
Here are a few examples that stood out to me:
- I heard from four type 1 influencers throughout the conference. They were paid to speak about personal experiences with diabetes for drug companies, CGM devices, and pump manufacturers… but there wasn’t a single type 2 influencer paid to speak.
- I went to multiple CGM talks where the only data presented were from type 1 patients. The libre has been out for over a year. These type 2 graphs didn’t make it to the conference this year, but a presentation did show a libre graph with type 1 data.
- Diatribe is an amazing journalism project made popular by their editors Kelly Close and Adam Brown – two diabetes communication leaders with type 1. Where were the type 2 journalists waiting to get the scoop?
- I met a man who participated in “Bike Beyond” a completely sponsored bike ride across America for 22 riders with type 1 diabetes to serve as ambassadors to the US. What a great idea! Let’s do it for type 2 as well.
The nagging voice in my head was back again…
“If a parent had 10 children and one of them is more complicated than the other nine – would they forget the nine?”
I care primarily for the nine.
I pushed myself to attend lectures that would relate more to type 2 patients. I walked into a lecture for “A Taste of African Heritage: Integration of a Culturally Sensitive Cooking Curriculum to Improve Outcomes.” The speakers were passionate about helping African Americans to get back to health through their cultural roots. They covered the issue of mistrust in healthcare systems. African Americans want respect and real solutions, not bad science and haphazard efforts.
The presenters cited several studies displaying the need for a new approach. There is a rising risk for diabetes, high blood pressure, cancer, and metabolic syndrome in African cultures. They identified soul food as one of the main contributors and made a new food pyramid for an African heritage diet. The base of the pyramid contains greens, fruits, beans/peas, vegetables, whole grains, and tubers. Fish, seafood, eggs, poultry, and oils are at the top – indicating less of these foods would be needed.
They designed a 6-week cooking course: traditional herbs and spices, greens, whole grains, beans and rice, tubers and stews, fruits and vegetables were covered on consecutive weeks. While all these foods can be healthy, I was concerned the diet seemed based in carbohydrate. It’s easy to overdo portions of carbohydrate foods when protein and fats are discouraged and whole grains are listed in the same priority as vegetables.
The presenters covered results of their program - lifestyle changes were measured, and I was pleased to see that 34% of participants increased consumption of vegetables and leafy greens, 25% increased home cooking.
However, they also mentioned 33% increased whole grains and 29% increased fruit. That sounds good if you work for the government, but I’ve seen many high blood glucose responses from too much brown rice and fruit. I panicked again, “Maybe they ate less highly processed carbohydrates as a result of adding whole grains? But what if they just switched their white minute rice to brown minute rice? They could have given up their candy to eat more fruit or maybe they just added it in addition to their candy?” The study didn’t say.
Here comes the finale. For biometric outcomes, they measured weight, blood pressure, and inches lost from their waist. At the end they offered to sell this cooking curriculum to you for the price of $300 per site.
Wait. What about blood glucose? Did you measure blood glucose? Surely, they measured it.
They said no.
No?
I was happy to support their work, but research on diet changes in diabetes patients without measuring blood glucose didn’t sound like good research to me. How do they know it’s really working?
I’m going to come out and say it. We need better studies for type 2 diabetes. We need better representation at conferences.
There are exciting things coming out right now for type 2 diabetes, but where is the buzz?
- Did you know researchers recently uncovered there are different types of beta cells, just like we have different types of blood (O+, A-, B+, etc)? They didn’t know that before. It changed the timetable for when we expect to be able to offer beta cell transplants.
- Did you know some type 2 patients are suspected to have a “sex change” in their pancreas where beta cells aren’t dying, but changing over to alpha cells? This could be the first great explanation for the type 2 fasting rise with ultra-low carbohydrate diets. It might even explain the supernatural ability of a type 2 to rescue themselves when their physician puts them on too much insulin.
- Or what about the fact that this is the first full year of CGM available to type 2 patients? How much have we learned?
So why is type 2 underrepresented? Perhaps because we’re too busy passing the buck. It’s too easy to blame it on the patient and they don’t have a mother or father at the time of their diagnosis that wants to fight for them.
Microstigma is when people decide things about you that aren’t true of just you, but all humans. They put an unfair amount of weight on your behavior because there is a consequence for you looming that doesn’t apply to themselves. Let’s not do that to people with type 2 diabetes. They already have enough trouble in life without the people who are supposed to be looking out for them joining in on the same.
Here’s to you… resilient, beautiful, rustic, and charismatic persons living with type 2. You may feel ashamed or alone. You may feel discouraged and desperate. You may think no one is looking out for you. But I see you. Let’s give honor with our profession to persons living with type 2 in the same way we’ve been called to change the way we think about type 1.
Let’s love all 10 children we serve.