Diabetes & its Types: Insulin only treatment for T1D, say experts

"It is important to clarify that I was referring to Type 2 Diabetes," says Ms Fiona Godlee, Editor-in-chief, BMJ

30 November 2019
By Pragya Bakshi

In the year 2016, an interview was published in the Economic Times. The interview was with Fiona Godlee, the editor-in-chief of the British Medical Journal (BMJ). The headline splash read, “Putting patients on insulin is A Big Scam”. The Q&A ranged from corruption in the medical industry to growing pollution in India. One of the Q&As was on diabetes and read as follows:

Q. Your recent report reveals that most of the people with diabetes in India are largely dependent on foreign-made insulin, which is expensive… 

A. There are certain things which are not going right. To put patients on insulin is a big push by industry and the doctors who in turn are influenced by the industry. Rather than tackling the lifestyle issues, going straight to insulin is not the right option. That is a big worry because insulin is not without its harm and is expensive in India. I think it’s a medical scam, an industry scam. Patients think that this is the best drug for them, and they need to pay for it or else they would die, and a very big group of people are vulnerable to it.

I think we need to speak out against the pressure to put people on insulin. With diabetes becoming such an epidemic in India, we need to look at the root causes and put money there rather than putting people on insulin.

Insulin is a hormone produced by the pancreas to convert Glucose into fuel for energy. The condition of no Insulin production in the body is known as Type 1 Diabetes (T1D). Now, for a well-informed person living with Type 1 Diabetes the above-mentioned interview is misinformation. For an ill-informed person living with T1D, it is reliable information because a) it's coming from a recognized expert and b) it's published by a leading daily. And for any patient and/or family of a patient, who may still be in the process of making peace with their diagnosis, this may make it more difficult for them to accept the harsh reality.

Professor Partha Kar, National Specialty Advisor for Diabetes with NHS England was asked for his views and said, “Whenever we talk about ‘reversing’ diabetes or indeed in any context, it is paramount we mention the type of diabetes. Type 1 Diabetes has fundamental differences with Type 2 Diabetes, most important of them being that Type 1 Diabetes is something which is not reversible and it cannot be treated with anything but Insulin." He further adds, "Insulin is a life-saving medication in these group of patients and brought on by autoimmune disorder. It has no relationship to lifestyle, which does tend to have a significant bearing in development of Type 2 Diabetes.” 

Type 2 Diabetes, commonly referred just as Diabetes, is a metabolic condition wherein the body is either insulin resistant or isn't producing enough insulin; it is mostly treated with tablets but patients with poor control, particularly senior citizens, may be put on Insulin. All this strictly as per doctor's instructions.

Ms Godlee in her interview with ET almost makes the right point when speaking of pharma influence and corruption in medicine but it is a hit and miss because she's questioning a treatment altogether instead of questioning the brands/pharmas which provide that treatment and their work ethic. This particularly for the Indian readership is bad because knowledge of Diabetes even today revolves around myths like “sugar causes Diabetes”.

When we reached out to Ms Godlee via Dr Kar regarding the interview — which has many times created doubt in the minds of Insulin-dependent people in India — she graciously issued a statement for clarification. “It is important to clarify that in this interview I was referring to Type 2 Diabetes. This is a condition for which lifestyle changes such as diet and exercise are of paramount importance. There is also mounting evidence that Type 2 Diabetes can be reversed through weight loss (for example from the DIRECT study) and these options need to be explored before considering expensive insulin therapy. As well as individual lifestyle change, there is a need for urgent investment in population-based approaches to support healthier lifestyles, including access to healthy food and clean air. On the other hand, for people with Type 1 Diabetes, which is caused by autoimmune disease, insulin continues to be a life-saving treatment and is currently the only option.”

As far as the standards for journalism are concerned, it is important this is maintained by correct information — and not using headlines simply to attract attention — especially without any consideration it may have on the lives of many others. “As professionals, it continues to be our role to educate our colleagues and the larger population about the difference in these two types of diabetes — as the language we use matters — and helps to avoid stigma,” Professor Kar concluded in his statement.

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