Time for change

Lack of community education and information about type 2 is leading to discrimination, writes Sherl Westlund, a director of Diabetes Research WA

Type 2 and discrimination

An estimated 1 million Australian adults (that’s 1 in 20 of us) were living with type 2 diabetes in 2014–15. And globally, according to the International Diabetes Federation, it’s estimated

425 million people had diabetes in 2017, and this figure is expected to increase to 693 million by 2040. With the cost of all forms of diabetes in Australia estimated at $14.6 billion each year, it’s clearly in everyone’s best interests to find an effective solution to stopping the soaring rates of type 2 diabetes.

The discrimination that exists against people with type 2 diabetes relates to the belief that it is solely linked to obesity and lifestyle issues brought about by an unhealthy diet and lack of exercise. It’s because of this that many in the community believe the solution is as simple as telling people with diabetes to lose weight and get fit. This approach essentially blames those with the condition for creating their own situation – and leaves them feeling unfairly judged and powerless.

IGNORANCE LEADS TO SHAME GAME

The recently released Amcal 2018 Diabetes Care Review found that more than a quarter (27 per cent) of Australians surveyed believed diabetes to be a self-inflicted disease and 1 in 7 believed diabetes was largely avoidable through simple lifestyle changes. It also found that

1 in 3 of those with diabetes surveyed said feelings of embarrassment and guilt for being made to feel they brought the condition on themselves were key reasons they had not spoken out and sought the emotional support they needed.

A recent online poll by Diabetes Research WA also found that 3 out of 4 respondents felt other people blamed them for causing their own type 2 diabetes.

This issue doesn’t affect just those with type 2 either. Those with type 1 diabetes are also often caught up in this discrimination as the bulk of the community struggles to understand that type 1 and type 2 are distinct conditions with different risk factors.

SO WHY IS THE DISCRIMINATION UNFAIR?

Well, for one, the research shows that while some people might be able to avoid developing type 2 diabetes by maintaining a healthy weight and lifestyle, not everyone can.

The international diabetes community now believes that around 1 in 3 people probably won’t be able to avoid it, even if they make significant lifestyle changes.

Type 2 diabetes is incredibly complex. Research so far tells us it’s likely to involve an intricate interaction between genetic and environmental

The cost of all forms of diabetes in Australia is estimated at $14.6 billion

each year

factors, which is why even people at normal weight with a healthy lifestyle can be at risk. Studies have shown, for example, that a short period of moderate or severe under-nutrition during development after birth can increase type 2 diabetes risk in adulthood, that people perceive hunger differently, and that inflammatory lung disease can be a risk factor for type 2 diabetes.

There is also much evidence to show that type 2 diabetes has a strong genetic basis. Research shows having one parent with diabetes increases the risk of developing type 2 by up to 40 per cent, and having both parents with it increases the risk by 70 per cent. Even having a sibling with it raises a person’s risk considerably.

While there is a lifestyle component to this, it is believed shared genetic factors are also a contributor.

Although it is incredibly important to keep assisting and reminding people to live a healthy lifestyle, as it can help many people, the above few examples demonstrate why telling people to change their lifestyle should not be the only strategy. It also emphasises why further research is critical if we are to uncover how to prevent all type 2 cases.

BETTER ACCESS TO FRESH FOOD NEEDED

Even when considering the 68 per cent of cases it is believed could be prevented by maintaining a healthy body weight and exercising, the challenges many people face in doing this are undeniably large. In this modern world, there are so many hurdles that can make staying healthy extremely difficult. Issues include longer working hours, the affordability and availability of fresh food in some areas, incredibly savvy and often underhand fast-food marketing campaigns, a lack of structured nutrition education in schools, emotional issues that can cause overeating, and many more. All of these issues need to be addressed to help tackle the difficulty some people have in maintaining a healthy lifestyle.

STOP THE BLAME AND SHAME GAME

For all these reasons, the discrimination that is directed at people with diabetes is misguided – and it has to stop. It has to stop because of the negative impact it is having on those people who are the targets and it has to stop so that the focus can be put on prevention and further our understanding of the condition and linked issues, rather than blame.

There is so much that needs to be done immediately to help tackle rising rates of type 2 – including designing healthier communities that make exercising easier and safer, tightening regulations relating to junk-food marketing, supporting our young kids to learn about nutrition, recognising obesity as a medical condition, and ensuring affordable access to fresh fruit and vegetables. There’s no time for discrimination, there is work to be done.