Data from Partha Kar - Curated by EPG Health - Last updated 07 April 2017
You could call it the Batman syndrome. Actually you could call it anything you like - anything which would take the pathology away from being wrapped in the same paradigm of “diabetes”. I am talking about type 1 diabetes - and in the main, at least in the UK, this particular condition has been subsumed by the overarching realms of type 2 diabetes.
2 different pathologies, 2 different ways of treating, 2 different needs - yet in the main, in this country, due to some reason of convenience or lack of leadership from the specialist body, we have continued to badge them together. Type 2 diabetes is managed primarily by practice nurses - with support from GP colleagues and secondary care where appropriate - with the treatment ethos being different - the priorities of glucose control being variable depending on duration of pathology, other morbidities, along with a general dearth of hard outcome measures. On the other hand, type 1 diabetes is an autoimmune condition, needing tight glucose control, access to technology, different targets to achieve, different challenges - it makes little sense for both these pathologies to be lumped as one.
The media doesn’t help either - the number of times I see or hear type 1 patients or their parents stigmatised by comments of “should have eaten less” is not too uncommon - an immensely frustrating situation when you have developed a pathology due to autoimmune condition - rather than mainly via lifestyle issues. A 21 year old type 1 diabetes patient does not need a statin for a slightly raised cholesterol. Apart from the potential teratogenicity in a woman, it is not evidence based either.
So perhaps it’s time to either rename the condition or separate the 2 pathologies - in the way it is managed, in the way it is commissioned - lock, stock and barrel. It’s an important question to raise whether in a “free” healthcare system, choice takes a backseat or not. Should all type 1 diabetes patients be under specialist care - let me clarify - I don’t mean hospitals per se - I mean the personnel, their location could be anywhere per se. Due to the inevitability of demand, GPs, quite rightly, are the vanguards or as per an often used analogy, the robust gatekeepers to the people demanding to see the wizard. Does type 1 diabetes lend itself to that - should all type 1 patients have access to specialist care - and thus be considered earlier for pumps, psychology support, higher expertise - expertise that’s fundamentally different from type 2 diabetes care?Recent studies show the reduced life expectancy in type 1 diabetes population - and it’s a genuine question as to whether we do enough as a healthcare community to improve their care. In the next part, I would like to discuss some possible options which could look at changing the paradigm of care for this group of patients - as things stand, we need to do better, much better than we are. If you aren’t convinced, just have a look at social media. The cry for help and support is loud and clear.