What’s in a name: Does the patient have diabetes or is the patient 'a diabetic'?

I am at the Annual Meeting and Clinical Congress of the American Association of Clinical Endocrinologists and there is much to report — too much in fact. But there was one plenary lecture that really got my attention — “New surgical approaches to metabolic diseases,” delivered by Francesco Rubino, MD, from New York.

In brief he described what I had previously known as bariatric surgery and discussed the short- and long-term benefits with the message that in some, possibly most, patients the surgery can cure diabetes and complications such as hypertension. I did not agree with all that he said during a very excellent presentation, but we did have a chance to chat and discuss our differences with amicable resolution.

Importantly we are in agreement that it is possible to “cure” diabetes which brings me to the question I posed in the title of this blog. When I meet a patient with diabetes for the first time and verify that there are no discernable adverse effects (eg, retinopathy, nephropathy, neuropathy, etc.), I approach management with the goal of achieving good glycemic control — normal HbA1C maintained off therapy. Whether this constitutes a cure or not is a matter of semantics, but I am convinced that this should be the goal of management even if it is achieved only infrequently.

There were a number of posters dealing with all aspects of type 2 diabetes, and I was struck that most referred to “diabetic patients” rather than “patients with diabetes.” More semantics to be sure but a difference that I think impacts the goals and expectations of both the patient and the treating physician.

All would agree that optimal glycemic control and avoidance of complications are the desired endpoints of care for a patient with diabetes. In most patients, that would require initially prescribing oral agents and/or insulin and that all patients require lifestyle modification — diet, physical activity, correction of sleep apnea. In overweight patients, weight loss is also a desired endpoint. Labeling the patient diabetic connotes a disease process that is not reversible and may give the patient the mindset that he or she will always have diabetes — ie, be a diabetic.

Since the goal is not often enough achieved, I am at a loss as to how best to study whether disease labeling makes a difference to short- and long-term outcomes. Any suggestions?

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