From the way people measure their glucose levels, until the time one expects to live, almost everything has changed during the last 50 years for Americans with diabetes.A special symposium held during the 75 scientific sessions of the American Diabetes Association offers a retrospective look at what doctors and researchers have learned and how the lives of patients have changed during the last five decades.
"Things have passed during the last 50 years that have clearly made life much better for people," said Fred Whitehouse, MD, head of Emeritus Division of Henry Ford Health System in Detroit, who takes the same amount of time to treatPeople with diabetes.
For example, when Whitehouse began to see patients, the only option for the treatment of type 1 diabetes was to inject animal insulin from cows and pigs that sometimes caused adverse reactions in people.Today, human insulin produced by microorganisms is used, an important difference because not only less adverse reactions occur, but also there is no problem with the end, he said.Moreover, there are now fast and prolonged insulins and a variety of supply systems, including insulin pumps, which improve accuracy and comfort while reinforcing blood glucose control and reduces hypoglycemia.
The way in which glucose levels have also changed dramatically, Whitehouse explained.While before the only way to evaluate the control of diabetes was to detect the presence of sugar in people's urine, today there are more numerous and more precise ways to examine blood glucose levels, including the A1Cnon -invasive that measures the average level of glucose in the blood for a period of three months."This provides us with a convenient indicator to show if the person is on the right track or not," said Whitause.
However, there is still much to do, he noticed."There have been many changes, most of them in positive terms, but what people want is a cure and we don't have it yet."
Daniel Porte, Jr., MD, has been conducting diabetes investigations for more than 50 years, and has witnessed a radical change in how much is known about the mechanisms involved in diabetes.He remembers when endocrine and nervous systems were considered totally alien, when glucose was considered the only insulin regulator and when there was a single method to administer insulin.While researchers have learned a lot about diabetes during the last 50 years, including how it develops, how to prevent or delay it, and how it affects the rest of the body, all practically unknown in the 60s, perhaps the most important lesson,He said, is that the fruit of the investigation does not ripen overnight.
"In order to understand the disease, basic research must be carried out," said Porte, professor at the University of California, San Diego, and Professor Emeritus at the University of Washington."But it has to be patient because it takes a long time to transition basic research to clinical impact."
"For example," he said, "the drugs we now use to treat diabetes were studied for the first time 30 or 40 years ago. And there are many more than one or two that were used in the 70s."
In the time that carries investigating diabetes, discipline has gone from taking simple hormone measurements to increasingly complex research that enters the interrelation between hormones and the nervous system, an area that continues to explore for new discoveries."This year, by incredible it seems to me," he said, "it was discovered that theInsulin sent to the central nervous system is not only carried out by the brain, it also affects glucose production.Regulates the island cells, causing the total integration of the endocrine system and the nervous system.It took 40 years to make this discovered. "
These discoveries not only helped us develop better diabetes treatments, Porte explains, they can also help in the treatment of other diseases, such as Alzheimer's disease."Now we believe that perhaps the deteriorated action of insulin in the central nervous system is responsible for the behavior changes we observe in patients with Alzheimer's," he said.
Michael Brownlee, who has experienced life as a person with diabetes, doctor and researcher, said that the thread that has united to all three papers together is the question of diabetes complications.
"The reason why diabetes is a serious health problem is complications," said Brownlee, head of the Anita and Jack Saltz chair in diabetes research and associate director for biomedical sciences at the Diabetes de la Diabetes Research Center of Diabetes de la Diabetes de la Diabetes de la DiabetesThe Faculty of Medicine of Albert Einstein College."If there are no complications, diabetes would be like hypothyroidism and other easily control diseaseand that would require billions of dollars in investigations. "
Brownlee, diagnosed with type 1 diabetes at the age of 8, has suffered the two potentially fatal complications of this disease, celtaacidosis and severe hypoglycemia, but none of the chronic complications that produce blindness, renal failure and heart attack.He recalls that when he requested admission to the Faculty of Medicine, the life expectancy was 40 to 50 years for only half of the people with type 1 diabetes. Some schools were not willing to admit it because "I would not be able to exerciseMedicine all your life, "he said."They said they preferred to give the place to someone with normal life expectancy. Fortunately, the advances in research and treatment of diabetes have made these old obsolete statistics."
Brownlee's research on mechanisms that cause diabetic complications has created a paradigm shift in the field.He noted that until 1993, diabetic complications, such as ocular and renal disease, were considered consequences of diabetes, instead of high blood glucose levels."Before the control test and complications of diabetes (Diabetes Control and Complications trial, DCCT) published that year, the general dogma said that diabetes caused both metabolic changes and complications, that they had nothing to do withanother were two parallel manifestations of the disease simply, "he said.
"Now we know what prolonged glucose levels increase the risk of ocular and renal complications associated with diabetes, and maintaining stricter control of blood glucose levels this risk is reduced," he said."We also learned from the Edic, the study that followed the DCCT, that the adverse effects of early blood glucose levels last years after improving the A1C, a phenomenon called 'metabolic memory'."An important approach to this ongoing research is to identify the mechanisms responsible for metabolic memory.
Kathryn Ham, who turns 86 this week, has seen tremendous changes in the treatment of diabetes during his 78 years with type 1 diabetes. But he also firmly believes in the importance of leaving certain things as they are, such as, for example, whenIt is administeredInsulin every day and when you check your blood glucose levels.That type of discipline, she said, means not making mistakes or forgetting to take her insulin.
"Each person with diabetes needs to create a system to remember and/or deal with their treatment," she said."My system, although outdated, works for me. I still inject insulin four times a day. I have a cup where I keep the test syringe and insulin syringe used. If they interrupt me while I take the treatment, with a phone call for example,I can look in the cup to see if I have already taken insulin because I am forgetful.I recommend that you develop your own system. "
Over the years, HAM said, she has noticed increasingly small syringes, as well as the addition of the Blood glucose test A1c, new forms of insulin, new treatments for ocular disease related to diabetes andIntroduction of digital glucose meters in the blood, "which have made a tremendous difference in diabetes care."
"Despite the enormous growth of our understanding of diabetes and its complications, we are still only able to control the disease," said Robert Ratner, the main scientific and medical officer of the American Diabetes Association."The next 50 years must clarify the mechanisms by which both type 1 and type 2 diabetes occur, together with the critical steps in which we would intervene to prevent diseases. The treatments must provide optimal control of glucose and metabolism, withoutThe risk of hypoglycemia, and diabetes complications should become memories. "
The American Diabetes Association leads the fight to stop diabetes® and its mortal consequences and fight for people affected by diabetes.The association finances research to prevent, cure and control diabetes;provides services to hundreds of communities;provides objective and reliable information;and gives a voice to those who are deprived of rights due to diabetes.During the last 75 years, our mission has been to prevent and cure diabetes and improve the lives of all people affected by diabetes.For more information, please call the American Diabetes Association at 1-800-Diabetes (800-342-2383) or visit Diabetes.org.In both information is offered in English and Spanish.
American Diabetes Association source
Boston, June 6, 2015
