Sunday, March 15, 2009

The Diabetes Syndrome

I got the above image of Romeo and Juliet from here.

In this famous Shakespearean play Juliet says:

What's it in a name? that which we call a rose
By any other name would smell as sweet;

BUT ALAS, LIFE IS NOT AS SIMPLE AS JULIET THE ROMANTIC LOVER OF ROMEO THINKS. Names are everything. Relationships are forged on names and surnames, employers provide employment based on names and surnames ... many things happen because of the name. Names have a lot of power and relevance in transactions - particularly in business. For example, there are many shoppers who buy any footwear that is branded as Bata - Bata by choice! People are convinced that a Bata product is a quality product and value-for-money buy. Similarly, many patients refuse to buy alternative pharma brands even though they are cheaper (with the same generic). There are patients who want to purchase brands prescribed by the doctor - they dislike substitutions made by the chemist (or pharmacist). In diagnosis, names have a lot of value - for example between diabetes insipidus and diabetes mellitus there is a difference in clinical presentation. Names carry a lot of value, trust, and import.

Do names change?

Oh! Yes!! In social, spiritual, and business life names change, and ownership of names also change hands. After marriage, most women change surnames with pride to show their new identity to society. It is a recognition that she has won a great new life partner. In spiritual life, name change is often resorted to, showing allegiance to a new faith. In business, names are protected with fervor. Brand names are built with passion and protected zealously. The TATA group has an entire department devoted to prevention of misuse of the TATA brand name. Thums Up is the leader cola brand of India. Although it was an Indian brand it has now changed hands - it is owned by The Coca Cola Company today. Names are so powerful that when they are deeply entrenched into the mass consciousness it is difficult to kill them - for example, even though Coca Cola is trying its best to kill or phase out the brand Thums Up, it still rules the cola market in India. The power of the THUMS UP brand name is such that as per this report, even though Thums Up sells in just 30% of the Indian market, it is the largest selling cola of India. As per the report, which cites A C Nielsen figures, Thums Up has 16.4% share of the cola market in India and is the largest selling cola brand of India. So the moral is that names have a lot of value in marketing - and in fact brand name potency is a source of sustainable competitive edge.

In disease management and medical sciences, name changes do take place

The most recent and popular example of name change is the change of IGT (Impaired Glucose Tolerance) to Prediabetes. IGT is a prediabetic state. 4.1 crore Americans are said to suffer from prediabetes. If the fasting blood glucose level is between 100 mg/100 ml of plasma to 125 mg/100 ml of plasma, the condition is defined as prediabetes. Patients of prediabetes are more susceptible to heart, blood vessel, and kidney disease. These patients are just a step away from becoming diabetic.

Why the name change from IGT TO PREDIABETES?

The name IGT was changed to prediabetes for the following reasons:

a) easy to pronounce

In one way prediabetes is the first stage of diabetes. It is possible that the definition of diabetes may be changed to include prediabetes also in the future.

What is diabetes?

All contemporary medical literatures recognize the fact that diabetes (ie., diabetes mellitus) is a SYNDROME OF METABOLIC DISORDERS characterized by hyperglycemia, and defects in insulin production and/or impaired tolerance to insulin effect (ie., peripheral tissues show 'insulin resistance'.). Diabetes implies a group of metabolic diseases.

Diabetes is a disease characterized by hyperglycemia and increased susceptibility to accelerated atherosclerosis (thickening, hardening and loss of elasticity of blood vessel walls & narrowing of blood vessel), cardiomyopathy (disease of the heart), chronic kidney disease, neuropathy (disease of the nerves), angiopathy or vasculopathy (disease of blood vessels), and retinopathy (disease of the retina in the eye). In fact, this link states clearly that diabetes is a syndrome of disordered metabolism.

A syndrome is a set of signs and symptoms that tend to occur together and reflect the presence of a particular disease.

There is a term called METABOLIC SYNDROME. It does not mean diabetes. Metabolic syndrome or Syndrome X is a disorder characterized by high blood pressure, high LDL and cholesterol levels, abdominal obesity, and IGT (or prediabetes). There is increased risk of diabetes and cardiovascular disease in patients suffering from metabolic syndrome.

The bottomline is that diabetes is a syndrome

It is evident that diabetes is a syndrome where the patient has high blood sugar levels, increased thirst, hunger, urination, weight loss, lethargy, irritability, and mental confusion.


Firstly, patients, healthcare providers and PHARMA MARKETERS will emphasize that diabetes is not just about lowering blood sugar - it is much more.

It means patients will talk about lowering blood lipids, lifestyle changes to avoid accelerated atherosclerosis, taking care of feet (foot problems are common in diabetics), avoiding and treating skin infections quickly, focusing on ensuring good wound healing, taking precautions to avoid worsening of infections (like respiratory infections) since immunity is weaker in diabetics, ensuring lifestyle practices that promote health of kidneys, taking medications that provide micronutrients to nerves (like methylcobalamin), testing the eyes regularly ....

Healthcare providers including doctors will treat the signs, symptoms, and susceptibilities of a diabetic patient FROM HEAD TO TOE. Normally, when diabetics are treated, the general focus is on normal blood sugar levels - but that is only one part of the treatment game.

FOR PHARMA AND HEALTHCARE MARKETERS this is a radical change in outlook as far as marketing communication and sales activities are concerned. Also it is about offering a bouquet of medications to prescribers which take care of the HEAD TO TOE signs, symptoms, and special susceptibilities of diabetic patients. The approach to sales and marketing management of diabetes will change if the focus of the marketers is on THE DIABETIC SYNDROME. (all signs, symptoms, and special susceptibilities of diabetics from HEAD TO TOE.).

By this name changing exercise, society will stand to benefit. The stakeholders like doctors, healthcare providers, pharmacists, patients, and healthcare/pharmaceutical marketers will of course gain because of the buzz. Hence, the powers-to-be and global healthcare authorities should now focus on a NAME CHANGING EXERCISE, from diabetes to THE DIABETES SYNDROME just as IGT was changed to prediabetes (to signify the importance of the diagnosis). In fact, if a new definition of THE DIABETES SYNDROME is made, prediabetes can also be included under this umbrella term. This will help the cause of global diabetes syndrome management.

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