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Changing social and scientific discourses on type 2 diabetes between 1800 and 1950: a socio-historical analysis.

Since the emergence of type 2 diabetes as a public health threat around the middle of the 20(th) century, accounts of disease causation have focused predominately on lifestyle or genetics, or both, while the role of broader structural issues such as psychosocial distress has been downplayed. Yet in the years prior to this emergence, when diabetes remained the preserve of the upper classes, medical experts drew upon multiple narratives when considering the condition, the most popular of which being the role of social organisation and the interplay between mind, body and environment. This article is based on a discourse analysis of the writings of the most prominent diabetes experts between 1800 and 1950 about both the causes and management of the illness. It highlights how, although the connection between lifestyle and diabetes was well established among physicians, individual-level explanations only fully supplanted the emphasis on social organisation as diabetes began to make the transition from being a disease of the rich to one of the poor. It argues that this discursive shift was shaped by the dynamics of class relations rather than any new forms of scientific evidence developed at the time.