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46 Cardio Diabetes Medicine 2017

Ethical issue that should be considered is, how long of the population, including low-risk subgroups. Low-
can hyperglycemia be permitted to continue in dia- risk individuals may ignore these recommendations
betic subjects undergoing trial? Prolonged hypergly- and consequently put their health conditions at risk.
cemia or more than 6 months hyperglycemia has the In presence limited or moderate clinical validity bur-
potential to exacerbate macrovascular complications densome or too strong preventive measures will raise
and will have an adverse effect on the quality of life ethical issues, such as psychological harms: at-risk
creating an ethical dilemma children who do not adhere to lifestyle recommenda-
tions and when they develop the disease later in life,
Ethical Issues in Genetic susceptibility blame may be attributed to themselves or be blamed
testing services for Type 2 Diabetes by others. Such ‘victim-blaming’ or feelings of guilt
will not always be justified in the context of a multi-
Meletus is available but experts are not convinced factorial disease for which susceptibility testing is of
of its current clinical validity and utility generating an moderate predictive ability: some at-risk individuals
ethical issue. With the rising number of individuals may develop the disease even if they take appropri-
affected with diabetes and the significant health care ate measures, whereas other at-risk individuals may
costs of treatment, the emphasis on prevention is not fall ill despite their failing to take preventive ac-
key to controlling the health burden of this disease. tion.
Several genetic and genomic studies have identified
genetic variants associated with increased risk to di-
abetes. As a result, commercial testing is available Ethical Issues with costly therapy and
to predict an individual’s genetic risk. Although the diabetic complications
clinical benefits of testing have not yet been demon- Various scientific trials have shown the enhanced
strated, it is worth considering some of the ethical im- benefits of aggressive insulin therapy to control and
plications of testing for this common chronic disease. delay the onset of complications in sever diabetes,
From an ethical perspective, several issues should but intensive therapy with insulin is costly. So, the
be considered during the translation of predictive ethical dilemma faced by many doctors is whether to
testing for diabetes, including familial implications, start costly, intensive therapy with expensive human
improvement of risk communication, implications for insulin to prevent future complications or to continue
behavioral change and health outcomes, the Genet- traditional therapy which could lead to early compli-
ic Information Nondiscrimination Act, direct-to-con- cations. Medical practitioners are often faced with
sumer testing, and appropriate age of testing. an ethical dilemma rooted in economics. An example
would be, foot gangrene a dreaded complication of
The variability of the severity of Type 2 Diabetes diabetes. It is often possible to salvage the foot, but
Meletus poses difficulties for the ethical evaluation at great expense. The family must incur heavy debts
of susceptibility testing for the disease. From a pre- for this high-technology treatment. The alternative
cautionary perspective, it could be argued that Type to taking on this economic burden may be ampu-
2 Diabetes Meletus should be viewed as a severe tation. In young diabetics, the loss of a limb can be
disease and require high levels of genetic counsel- crippling, affecting one’s employment. The difficult
ing and psychological support or hardly causes any decision to amputate is often based on social and
psychological harm or emotional impact at all. There economic factors. The similar can be considered in a
may be discrepancies between the severity of a dis- case of end stage renal disease, where renal trans-
ease as perceived by medical professionals and the plant is not feasible and the patient has multisystem
severity of the same disease as perceived by oth- failure. The issue might well be as to how long hemo-
er publics. There are both therapeutic options and dialysis should be continued given the costs and an
well-established preventive strategies available for almost certain unfavorable outcome. Such dilemmas
diabetes for children as well as for adults, at the lev- are likely to increase as the number of diabetics with
el of lifestyle improvements. Existence of preventive complications increases and the resource availability
options for Type 2 Diabetes Meletus implies a poten- becomes scarce leading to a wider debate on ethical,
tial for medical benefits to be obtained from suscep- social and economic issues related to management
tibility testing. Therefore, if false reassurance occurs, of diabetic complications.
it may lead to harm. Individuals who are found to
be at decreased risk may wrongly feel assured that Ethical issues with Embryonic stem cells: Stem cell
they will remain free from disease, regardless of their research could provide a means of replacing dam-
lifestyles. They may fail to understand that general aged tissue in patients with diabetes and embryos
health recommendations are relevant to the whole are a potentially rich source of viable stem cells.

GCDC 2017