50 years of diabetes research and treatment

From how people test their glucose levels to how long they can expect to live, almost everything has changed over the past 50 years for Americans with diabetes. A special symposium held at the American Diabetes Association's 75th Scientific Sessions features a look back at what physicians and researchers have learned and how the lives of patients have changed during the past five decades.

"There are things that have happened over the past 50 years that clearly make life a lot better for people," said Fred Whitehouse, MD, Division Head Emeritus at the Henry Ford Health System in Detroit, who has been treating people with diabetes for just as long.

For example, when Whitehouse first started seeing patients the only option for the treatment of type 1 diabetes was to inject animal insulin, which came from cows or pigs and sometimes caused adverse reactions in people. Today, human insulin produced by microorganisms is used, an important difference because not only are there fewer adverse reactions, there's no fear of running out of it, he said. What's more, there are now long- and rapid-acting insulins and a variety of delivery systems, including insulin pumps, which improve accuracy and comfort while tightening blood glucose control and reducing hypoglycemia.

The way glucose levels are tested has also changed dramatically, said Whitehouse. Whereas once the only way to assess diabetes control was by testing for the presence of sugar in a person's urine, today there are numerous, far more accurate ways to test blood glucose levels, including the non-invasive A1C, which measures average blood glucose levels over a three-month period. "This gives us a nice marker for showing whether a person is on the right road or not," Whitehouse said.

Yet there is still a long way to go, he noted. "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."

Daniel Porte, Jr., MD, has been conducting diabetes research for more than 50 years and has witnessed a sea change in how much is known about the mechanisms involved in diabetes. He remembers when the endocrine and nervous systems were considered completely unrelated, when glucose was considered the only regulator of insulin and when there was only one method for administering insulin. While researchers have learned much about diabetes over the past 50 years - including how it develops, how to prevent or delay it and how it affects the rest of the body, all of which were virtually unknown in the 1960s - perhaps the most important lesson, he said, is that the fruits of investigation don't ripen overnight.

"In order to understand disease, you have to do basic research," said Porte, a professor at the University of California, San Diego and Professor Emeritus at the University of Washington. "But you've got to be patient, because it takes a long time to go from basic research to clinical impact."