Before the discovery of insulin, diabetics were doomed. Even on a strict diet, they could last no more than three or four years.
However, despite the many types of insulin and the first oral hypoglycemic agents that came to market around 1957 in Canada, glycemia control – the control of blood glucose (sugar) levels – still remains an imprecise science.
In the 1950s, the method a person used to control his blood glucose levels was to drop a reagent tablet into a small test tube containing a few drops of urine mixed with water. The resulting colour – from dark blue to orange – indicated the amount of sugar in the urine.
Even when they monitored their patients closely, doctors realized that blood glucose levels had to be much better controlled in order to delay the major complications significantly affecting their patients’ lives: blindness, kidney disease, gangrene, heart attack and stroke.
Belgian doctor Jean Pirart, a pioneer in diabetes treatment, discovered the link between good glucose control and the prevention of complications.
Between 1947 and 1973, Dr. Pirart divided more than 4,000 patients into three groups based on their level of blood sugar control: good, fair, poor.
Using reagent tablets as the measurement method, Dr. Pirart’s findings clearly demonstrated a higher incidence and prevalence of complications in patients with poor glycemic control.
The 1970s and 1980s marked are a turning point in the treatment of diabetes. Innovations such as blood glucose readers and strips measuring blood glucose (sugar) levels gave people with diabetes and their doctors some indispensable tools.
In 1976, American scientists discovered that sugar attaches to red blood cells (hemoglobin) and that this could be used to determine how well blood glucose had been controlled in the previous two to four months. This discovery led to the creation of the glycated hemoglobin (A1C) test.
The advent of monitoring tools enabled researchers to create large-scale studies. Their findings changed the way diabetes was treated.
Then two important studies, the Diabetes Control and Complications Trial (from 1983 to 1993) and the United Kingdom Prospective Diabetes Study (from 1977 to 1997), showed, for both types of diabetes, that maintaining blood glucose (sugar) levels close to normal values delays and slows the onset of chronic complications from diabetes.
Intensive insulin therapy – multiple injections of insulin mimicking the normal functioning of the pancreas – appeared in the treatment of type 1 diabetes, and now is an increasingly popular treatment option for type 2 diabetes.
By the late 1940s, insulin syringes became available, and in the 1950s, people with diabetes could easily monitor the sugar in their urine, thanks to tablets and test strips.
In 1958, people with type-2 diabetes caught a big break when oral sulfonylureas — which stimulate the pancreas to release more insulin — hit the market.
Englishman Frederick Sanger was awarded the Nobel Prize in 1958 after identifying the structure of insulin, laying the groundwork for synthetic insulin.
Blood-glucose testing strips became available in 1962.
In 1965 Donald Steiner identified proinsulin, the natural precursor of insulin. This led to purer insulin preparations, reducing allergies, side effects and resistance.
The 1970s welcomed new diagnostic and delivery methods, such as the first blood-glucose meters and portable insulin pumps.
By the early 1980s, researchers in California, using recombinant DNA technology had figured out how to trick E. coli bacteria into producing human insulin.
In 1983, the first biosynthetic human insulin was introduced to rave reviews.
People with diabetes hailed the arrival of one-step insulin pens in 1986, and the 1990s saw a host of new drugs approved to treat type 2 diabetes, including acarbose, metformin, and repaglinide.
Majority of the treatment methods available for the management of diabetes offer means of controlling the disease. The ultimate goal of doctors treating people with diabetes is to achieve a cure.
There have been many attempts to develop safe and effective methods of curing diabetes.
In 1966, University of Minnesota surgeons performed the first cadaver pancreas transplant.
Attempts at bringing down the body weights of obese Type 2 patients was heightened by Edward Mason and Chikashi Ito in 1967 when they developed a gastric bypass procedure which resulted in minimal complications .
In 1972, Paul Lacy and coworkers published the paper on methods of isolation of intact pancreatic islet cells.
First attempts at islet cell transplants were performed in animals with experimental diabetes and resulted in the reversal of hyperglycemia.
First autologous islet cell transplant was performed by surgeons at the University of Minnesota in 1977.
Autologous islet cell transplants are reported to have 75% long-term success rate.
Autologous transplants are usually used in the setting of chronic pancreatitis requiring removal of pancreas.
The first living donor transplant was performed in 1978.
Innovations in 2005 brought a new modification of laser therapy in treatment of retinopathy in diabetes, using a Pascal photocoagulator .
In 2006, the first dipeptidyl peptidase-4 (DPP-4) inhibitor, sitagliptin was approved and made available for clinical use in Type 2 diabetes.
In 2010, the controversies and inconsistencies in the clinical laboratories estimation of HbA1C values were resolved by the international agreement of standardisation of values, to the present, mmol/mol from percent (Hanas & John 2010). This rectification and agreement brought about comparable estimations between laboratories.
In 2013, a new class of antidiabetic medications, sodium-glucose co-transporter 2 (SGLT-2) inhibitors (e.g., canagliflozin) was made available for clinical use in people with Type 2 diabetes.
New drugs and breakthroughs in dosing and delivery systems have quite literally revolutionized the treatment of both type 1 and type 2 diabetes over the last few years.
The range of medications to control blood glucose levels in type 2 diabetes has expanded, and insulin regimens can now be adjusted very precisely to the individual patient with type 1 or type 2 diabetes.
Diabetics can become much more involved in controlling meal-time spikes by adjusting the dosage of short-acting insulin to the particular meal.
Insulin aspart, lispro and glulisine can be administered up to 15 minutes before or 15 minutes after starting a meal.
Diabetes remains a complex and complicated disease. However today, health professionals are equipped to tailor treatments and combinations designed to help keep their patients with diabetes on target.
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