Tracing the History of Diabetes Treatment

The Big Diabetes Lie

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More than 2,000 years ago, people writing in China and India described a condition that must have been diabetes mellitus. The description is the same one that the Greeks and Romans reported — urine that tasted sweet. Scholars from India and China were the first to describe frequent urination. But not until 1776 did researchers discover the cause of the sweetness — glucose. And it wasn't until the nineteenth century that doctors developed a new chemical test to actually measure glucose in the urine.

Later discoveries showed that the pancreas produces a crucial substance that controls the glucose in the blood: insulin. Since that discovery was made, scientists have found ways to extract insulin and purify it so it can be given to people whose insulin levels are too low.

After insulin was discovered, diabetes specialists, led by Elliot Joslin and others, recommended three basic treatments for diabetes that are as valuable today as they were in 1921:

1 Diet (see Chapter 8) 1 Exercise (see Chapter 9) 1 Medication (see Chapter 10)

Although the discovery of insulin immediately saved the lives of thousands of very sick individuals for whom the only treatment had been starvation, it did not solve the problem of diabetes. As these people aged, they were found to have unexpected complications in the eyes, the kidneys, and the nervous system (see Chapter 5). And insulin did not address the problem of the much larger group of people with diabetes now known as type 2 (see Chapter 3). Their problem was not lack of insulin but resistance to its actions. (Fortunately, doctors do have the tools now to bring the disease under control.)

Tracking diabetes around the world

Diabetes is a global health problem. A 2004 study in Diabetes Care in October estimated that approximately 171 million people around the world had diabetes in 2000 and that by the year 2030, the number would rise to more than 366 million.

Diabetes is most concentrated in areas where large food supplies allow people to eat more calories than they need so that they develop obesity, a condition of excessive fat. Several different types of diabetes exist, but the type usually associated with obesity, called type 2 diabetes (see Chapter 3), is far more prevalent than the other types.

Another reason diabetes cases have continued to grow in number throughout the world is that the lifespan of the population is increasing. What's the connection? Well, as a person ages, his or her chances of developing diabetes increases greatly. Along with obesity, age is a major risk factor for diabetes. (See Chapter 3 for more risk factors.) So, as other diseases are controlled and the population in general gets older, more diabetes is being diagnosed.

One very interesting study traced people of Japanese ancestry as they went from living in Japan to living in Hawaii to living in the United States mainland. In Japan, where people customarily maintain a normal weight, they tended to have a very low incidence of diabetes. As they moved to Hawaii, the incidence of diabetes began to rise along with their average weight. On the U.S. mainland, where food is most available, these Japanese had the highest rate of diabetes of all.

In general, as people migrate, not only the number of calories they consume but the composition of their diets changes. Before they migrate, they tend to consume a low-fat, high-fiber diet. After they reach their destination, they adopt the local diet, which tends to be higher in fat and lower in fiber. The carbohydrates in the new diet are from high-energy foods, which do not tend to be filling, promoting more caloric intake.

The Japanese provide another interesting lesson about the place of obesity as a factor in the onset of diabetes. Japanese Sumo wrestlers have to gain enormous quantities of weight in order to fight in a certain weight class. Even while they are still fighting, they demonstrate a high frequency of diabetes. After they become more sedentary, the frequency goes up to 40 percent, a huge prevalence.

The North American Indian, another group, shows the consequences of switching from a moderate calorie, relatively nutritious diet to a higher calorie diet. Some tribes, such as the Pima Indians, have a prevalence of diabetes as high as one out of two people. In contrast, the presence of diabetes in South American Indian tribes, such as in Chile where they have maintained a more traditional diet, is extremely rare.

In China, as the country becomes more affluent, doctors are seeing a significant increase in the incidence of diabetes. Migrant Chinese populations show even higher rates, especially where the environment allows them to gain more weight and be more sedentary.

In the United States in the year 2005, about 20.8 million people had diabetes. This number represents about 7 to 8 percent of the population. Currently only two thirds of the people with diabetes are aware that they have the condition. The big project is to get people to know their blood glucose level just like they know their cholesterol, and to seek treatment.

The next major leap in the effort to treat diabetes, occurring in 1955, was the discovery of the group of drugs called sulfonylureas (see Chapter 10), the first drugs that could be taken by mouth to lower blood glucose levels. But even as those drugs were improving patient care, the only way to know if someone's blood glucose level was high was to test the urine, which was entirely inadequate for good diabetic control (see Chapter 7).

Around 1980, the first portable meters for blood glucose testing became available. It became possible, for the first time, to relate treatment to a measurable outcome. This development has led, in turn, to the discovery of other great drugs for diabetes like metformin, pioglitazone, and others yet to come.

If you are not using these wonderful tools for your diabetes, you are missing the boat. You can find out exactly how to use portable meters in Part III.

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