A Global Epidemic of What? A Century of Debate About the Rising Rates of Diabetes and How it is Relevant Today

Abstract

The present rallying cries about a 'global epidemic' of diabetes prioritize moral appeals over proper assessment of what the diabetes statistics mean. Over the past century, epidemiological data on the prevalence of diabetes have regularly raised alarms. Dutch medical understandings of the diabetes problem have evolved, first, from the framing of diabetes as a disease of civilization in the early twentieth century; secondly, through concerns about detected cases being only the tip of a 'hidden iceberg' of undetected cases in the post-war era; and thirdly, to the notion of 'high risk populations' from the late 1980s onwards. Conceptual, definitional and practical developments, in the process, constituted the current picture of diabetes, which "represents a collage of different ways in which the disease has been conceptualized within the last century". This collage encompasses the spectrum from the symptomatic tip of the diabetes iceberg to the sea of risk factors; the "convergence of risk and disease"- that is, of two fundamentally different ways of modelling-, and balancing intensive glycaemic control with individual patient needs and desires for both the present and the future. A lack of (historical) insight into this collage leads to conceptual confusion, contributes to the paradox of an increasingly uniform 'glucocentric' approach to an increasingly heterogeneous group of people, and results in an erroneous focus on the prevention of 'disease' rather than on the prevention of suffering.