Numerous media reports and scientific studies on diabetes mellitus — both type 1 and type 2 — tend to describe one cause or treatment of the disease, often in a cause-and-effect approach. Recent examples include an article published on Food Consumers that sesame oil intake can help male rats reduce the risk of diabetes and an article published in Medical Daily that describe the link between depression and diabetes. Although having chronic high blood sugar and eating too much sugary foods for a long time can increase the risk of type 2 diabetes, having high triglycerides, lack of physical activity, and high stress — which leads to high blood pressure — could also be risk factors, according to Mayo Clinic. Therefore, the cause or treatment of type 2 diabetes mellitus is rarely a single answer since the disease is multifactorial.
In a recent study and report published in the American Journal of Managed Care, Charles H. Hennekens, M.D, senior academic advisor to the dean in the Charles E. Schmidt College of Medicine at Florida Atlantic University, and colleagues urged clinicians to take on a multi-disciplinary approach to reduce the risk of type 2 diabetes mellitus, including supportive drug therapies and lifestyle changes that promote an increase in exercise, weight reduction, and stability of blood pressure, blood lipid, and blood glucose. Despite the increased knowledge of type 2 diabetes and better identification of the disease, the percentage of adult Americans with diabetes has risen from 25.8 percent in 2010 to almost 30 percent in 2012, based on the latest statistics from the American Diabetic Association.
Hennekens and colleagues wrote that many patients in the U.S. prefer taking prescription drugs rather than taking gradual measures to adopting a healthier lifestyle, which will make them more likely to reduce their reliance on drugs. They emphasized that evidence-based doses of aspirin, ACE inhibitors, statins, and ARBs “should be prescribed as adjuncts, not alternatives,” to therapeutic lifestyle changes. Currently, the decline of mortality is due to treatment, not prevention.
Type 2 diabetes mellitus is rarely caused by a single factor, and some clinicians recognize the false dilemma fallacy (or false dichotomy) of diabetic treatment, which is a mindset that limits the number of options in a problem or situation. In reality, there may be more options that are left unconsidered or ignored, according to Philosophy Index. A 2011 study that was published in Psychoneuroendocrinology addressed the link between depression and diabetes, stating that “depression and diabetes should be treated together rather than as isolated diseases. The mind/body dualism is a false dichotomy and a truly team-based approach is necessary to address both issues of depression and diabetes.”
A false dichotomy gives the impression that the two options are mutually exclusive in which only one may be true. For example, some clinicians may provide two options for their diabetic patients, such as surgery or meds, without taking consideration of exercise, smoking cessation, or other lifestyle changes to decrease the risk of diabetes. From the patients’ viewpoint, they could default to false dichotomy thinking, such as only consider sugar as the prime culprit of increasing the risk of type 2 diabetes mellitus while resorting to a high-fat diet with little vegetables and fruits, smoking, and a couch potato lifestyle.
Substituting the “either/or” thinking with a more open and broader approach to treating and preventing diabetes (and a host of other diseases and disorders) is the first step in recognizing and dealing with the problem. Since type 2 diabetes rarely has a single answer to its cause and treatment, clinicians and patients should take a step back and the bigger picture of the problem. If the mutlifactorial approach to treating diabetes is ignored, then it is very likely that one out of three American adults will have diabetes by 2050 if current trends in obesity and inactive lifestyles continue, Hennekens warned.
By Nick Ng