Reflecting on 50 Years of Diabetes Research and Management

BOSTON – The role of the endocrinologist in the management of diabetes has changed dramatically over the past 50 years and will continue to change rapidly in the years to come.

A special symposium held at the 75th Scientific Sessions of the American Diabetes Association (ADA) highlighted everything doctors and researchers have learned about managing diabetes and how patients’ lives have changed over the past five decades.

“The role of the endocrinologist has evolved over the past 50 years from a glucose-centered approach to a patient-centered approach. Managing diabetes is a pharmacophysiologic approach to chronic disease that requires attention beyond glycemic control, ”said Farhad Zangeneh, MD, assistant professor of clinical medicine at the George Washington University School of Medicine in Sterling, Va. . Endocrinology advisor.


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“Today the barriers are real but visible and we share a lot with other chronic diseases. We need to find effective ways to translate advances in our clinical science into everyday clinical practice. Our role as endocrinologists is that of conductor responsible for the metabolic symphony of homeostasis.

New treatments

The way people test their glucose levels for how long they can expect to live has changed dramatically over the past 50 years for Americans with diabetes.

When Fred Whitehouse, MD, division chief emeritus at the Henry Ford Health System in Detroit, began seeing patients about 50 years ago, the only treatment option for type 1 diabetes was to inject insulin. animal, from cows or pigs and sometimes causing adverse effects, according to a press release.

Today, Whitehouse noted, patients with diabetes benefit significantly from long-acting and rapid-acting insulins and a variety of new delivery systems, including insulin pumps and other innovative technologies.

In the years to come, endocrinologists will play an even bigger and more practical role, according to Zangenah.

“Knowing our patients and connecting our patients to the right treatment plan is what we do on a daily basis. Endocrinologists are chronic disease managers with a strong understanding of the pathophysiology of type 2 diabetes, ”said Zangeneh.

“The care of people with diabetes is individualized. Hypoglycemia and weight gain remain the Achilles heel of the reduction in HbA1c. Fortunately, we’ve recently had great success with glucose-dependent therapies to mitigate these risks while achieving targeted weight loss of 5% and beyond. ”

Advances in basic research

Although dramatic improvements have occurred in the management of diabetes, there is still no cure. Nevertheless, advances in basic research have made it possible to better understand the disease.

Daniel Porte Jr., MD, who has conducted diabetes research for over 50 years, recalled the days when the endocrine and nervous systems were seen as completely independent. Now, it is known that the insulin sent to the central nervous system not only returns to the brain, but also affects the production of glucose. Porte noted that it regulates islet cells, so there is complete integration of the endocrine system and the nervous system.

Although it took 40 years to make this discovery, he said the findings are important and could have implications for other diseases as well. For example, Porte, who is a professor at the University of California at San Diego, mentioned the link between altered insulin action in the central nervous system and behavioral changes seen in patients with Alzheimer’s disease.

Areas of interest

Michael Brownlee, MD, who lived the life of a person with diabetes, said the changes in the management of diabetes are amazing.

When he applied to medical school, only half of people with type 1 diabetes had to live in their 40s or 50s, Brownlee said. Some schools were even reluctant to admit him because they weren’t sure he would be able to practice medicine all his life. Brownlee, who is now associate director of biomedical sciences at the Diabetes Research Center at Albert Einstein College of Medicine in New York City, said the feeling was then they should give way to someone with a normal life expectancy.

Brownlee’s research into the mechanisms that cause diabetic complications has created a paradigm shift in the field. He said the damaging effects of early hyperglycemia persisted for many years after the improvement in HbA1c levels, a phenomenon called metabolic memory. One of the main axes of his current research is to identify the mechanisms responsible for metabolic memory.

Look ahead

Robert Ratner, MD, scientific and medical director of the American Diabetes Association, said that despite the tremendous growth in understanding of diabetes and its complications, there is still a long way to go.

“The next 50 years must elucidate the mechanisms by which type 1 and type 2 diabetes occurs, as well as the critical steps we could take to prevent the disease,” he said in the statement. “Treatments should provide optimal blood sugar and metabolism control without the risk of hypoglycemia, and the complications of diabetes should become historical memories.”

Reference

  1. Ratner RE. Session 3-CT-SY16: Fifty years of diabetes research and treatment. Presented at the 75th Scientific Sessions of the American Diabetes Association (ADA); June 5-9, 2015; Boston.


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