February 25, 2009

Stigmatized by Type 2 Diabetes

I’ve been diagnosed with type 2 diabetes, yet I am not overweight. I sometimes feel stigmatized by my illness, especially in an Adventist setting, where some talk as if every illness is caused by a lifestyle failure.


We are very sorry you feel stigmatized by your illness, and also sorry that you should be made to feel that way by others who have been fortunate enough to be healthy up to this point in their lives. We know only too well the pain experienced when well-meaning but poorly informed folk, in their attempt to make one feel better, offer their gratuitous advice.

It is true that the increased prevalence of obesity has contributed to an increase in type 2 diabetes, but thousands like yourself have developed this form of diabetes without being overweight—and millions who are overweight have not developed diabetes. Genetics plays a strong predisposing role.
Fat cells have been found to produce protein substances called adipocytokines, which play a role in regulating glucose metabolism. The insulin resistance developing in the obese may be mediated through these proteins.
Another glycoprotein called fetuin-A, however, is produced in liver cells and secreted into the serum. This substance binds the insulin receptor in muscle and fat, resulting in insulin resistance in these tissues.
In a study reported in the Journal of the American Medical Association (July 9, 2008, vol. 300, No. 2), fetuin-A was associated with insulin resistance and incident diabetes. It has been recognized for quite some time that higher fetuin-A levels are associated with the metabolic syndrome and type 2 diabetes.
The study described in JAMA has limitations that do not permit generalization to all age groups, but illustrates that several factors other than obesity may be involved in a person developing diabetes.
Of course, exercise and temperate eating are beneficial in type 2 diabetes, regardless of the causative factors.

We appreciate your frankness and hope our healthy readers will become sensitized to the indignity to which those with type 2 diabetes may be exposed by uncalled-for comments.


I note with interest that the General Conference policy for health-care institutions has been modified to state they should engage in only those practices that have a biblical, Spirit of Prophecy, or “evidence” base. How can we trust modern medical science when it is so influenced by those funding the research?


Your question will resonate with many Adventists. The church’s emphasis on prevention through balanced and simple living, along with a diet that is natural and minimally processed, leads some to conclude that treatment should also always be simple, natural, and possibly minimally processed. Such thinking has some potentially grievous errors.
We agree with the assertion that some medical science is manipulated. In fact, the medical profession is extremely concerned that its integrity is threatened by the influence of the pharma-ceutical and medical device industries. A redeeming feature, however, is that such influence is recognized, analyzed, reported, and evaluated. This means that “evidence” is weighed; and we know about malpractice, complications, side effects, and a myriad of other effects because of such reviews. Excellent articles exposing the manipulation by Merck & Co., Inc., in the situation of rofecoxib appeared in the April 16, 2008 (vol. 299, No. 15), issue of JAMA. These articles castigated both the company and the authors and editors of journals—but the fact that they were published is a credit to JAMA.
Of course, skepticism, then, is heightened, but integrity requires the same degree of skepticism be directed at our own pet beliefs. So often, anything we like to hear is accepted with open arms, while less popular views are rejected without consideration of the evidence.

The General Conference policy is calling for rational treatments based on a rationale, supported by a wide consensus of literature, and seeking to do for patients the best that is known. In rejecting practices that have no evidence base, the policy calls for accountability.

Allan R. Handysides, M.B., Ch.B., FRCPC, FRCSC, FACOG, is director of the General Conference Health Ministries Department; Peter N. Landless, M.B., B.Ch., M.Med., F.C.P.(SA), F.A.C.C., is ICPA execu-
tive director and associate director of Health Ministries.
Send your questions to: Ask the Doctors, Adventist Review, 12501 Old Columbia Pike, Silver Spring, Maryland 20904. Or you may send your questions via e-mail to [email protected]. While this column is provided as a service to our readers, Drs. Landless and Handysides unfortunately cannot enter into personal and private communication with our readers. We recommend that you consult with your personal physician on all matters of your health.