Over the past 50 years, treatment and outcomes for diabetes have changed dramatically. At a recent symposium, experts looked back at how lives have changed over the past 5 decades and what remains to be addressed over the next 5.
The symposium was held at the American Diabetes Association’s (ADA) 75th Scientific Sessions.
“There are things that have happened over the past 50 years that clearly make life a lot better for people,” says Dr. Fred Whitehouse, of the Henry Ford Health System in Detroit, MI. “There’s been a lot of change, most of it for the better, but what people want is a cure and we don’t have that yet.”
Dr. Whitehouse has overseen many changes in how people with diabetes have been treated. When he first started treating people with the condition, the only form of treatment was the injection of animal insulin, obtained from cows or pigs, which could sometimes cause adverse reactions.
Nowadays, human insulin is used, produced by microorganisms and delivered through a variety of different systems including insulin pumps. There are now fewer adverse reactions and no fear of supplies running out, Dr. Whitehouse says, with methods of delivery that are more accurate than ever before.
Glucose levels can also be tracked more accurately. Previously, diabetes control could only be assessed by analyzing the levels of sugar in urine. There are many more options available to patients now, including the noninvasive A1C test that measures average levels over 3 months, “showing whether a person is on the right road or not,” states Dr. Whitehouse.
As methods for treating and tracking the disorder have improved for patients, so too has the collective understanding of diabetes shared by researchers and clinicians. It takes a long time for research to make a clinical impact and recent years have seen the results of 50 years of hard work.
Dr. Daniel Porte, Jr., a professor at the University of California-San Diego, describes one of the most recent discoveries in the field:
“This year, amazingly enough to me, it was discovered that insulin sent to the central nervous system not only feeds back to the brain, it also affects glucose production. It regulates the islet cells, so there is a complete integration of the endocrine system and the nervous system. It took 40 years to discover this.”
Originally, the endocrine and nervous systems were believed to function completely independently of each other, with glucose the sole regular of insulin.
In 50 years, ‘complications of diabetes should become historical memories’ Dr. Porte states that with diabetes research, it is crucial to be patient. “For example, the drugs we use now to treat diabetes were first studied 30 to 40 years ago. And there are many more than the one or two that were being used back in the 1970s.”
Such research not only leads to an improved understanding of diabetes but of other conditions as well. “We now believe that perhaps impaired insulin action in the central nervous system leads to the behavioral changes we see in Alzheimer’s patients,” Dr. Porte explains.
Dr. Michael Brownlee, associate director for biomedical sciences at the Albert Einstein College of Medicine’s Diabetes Research Center in New York City, NY, states that diabetes is such a serious health problem due to its complications. His research on the mechanisms that cause complications such as eye and kidney disease has led to great change.
“Prior to the Diabetes Control and Complications Trial (DCCT) study that was published [in 1993], the general dogma was that diabetes caused both metabolic changes and complications, which had nothing to do with each other. They were just two parallel manifestations of the disease,” he says.
“Now it’s known that prolonged high glucose levels increase the risk for eye and kidney complications associated with diabetes, and maintaining tighter control of blood glucose levels reduces that risk.”
Although the landscape of diabetes treatment and research has changed radically over the past 50 years, physicians are still only able to manage the disease rather than cure it. Dr. Robert Ratner, chief scientific & medical officer for the ADA, outlines what needs to be done:
“The next 50 years must elucidate the mechanisms by which both type 1 and type 2 diabetes occur, along with those critical steps at which we might intervene to prevent disease. Treatments must provide optimal glucose and metabolic control, without the risk of hypoglycemia, and complications of diabetes should become historical memories.”
If research and treatment can progress at the same rate over the next 5 decades as it has over the past 5, who is to say what can be accomplished?