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How Has Diabetes Treatment Changed Over The Years

Diagnosis And Classification Of Diabetes Mellitus: New Criteria

Diagnosis And Classification Of Diabetes Mellitus: New Criteria

New recommendations for the classification and diagnosis of diabetes mellitus include the preferred use of the terms “type 1” and “type 2” instead of “IDDM” and “NIDDM” to designate the two major types of diabetes mellitus; simplification of the diagnostic criteria for diabetes mellitus to two abnormal fasting plasma determinations; and a lower cutoff for fasting plasma glucose (126 mg per dL [7 mmol per L] or higher) to confirm the diagnosis of diabetes mellitus. These changes provide an easier and more reliable means of diagnosing persons at risk of complications from hyperglycemia. Currently, only one half of the people who have diabetes mellitus have been diagnosed. Screening for diabetes mellitus should begin at 45 years of age and should be repeated every three years in persons without risk factors, and should begin earlier and be repeated more often in those with risk factors. Risk factors include obesity, first-degree relatives with diabetes mellitus, hypertension, hypertriglyceridemia or previous evidence of impaired glucose homeostasis. Earlier detection of diabetes mellitus may lead to tighter control of blood glucose levels and a reduction in the severity of complications associated with this disease. Diabetes mellitus is a group of metabolic disorders with one common manifestation: hyperglycemia. Chronic hyperglycemia causes damage to the eyes, kidneys, nerves, heart and blood vessels. The etiology and pathophysiology leading to the hyperglycemia, however, are markedly different among patients with diabetes mellitus, dictating different prevention strategies, diagnostic screening methods and treatments. The adverse impact of hyperglycemia and the rationale for aggressive treatment have recently been reviewed.1 In June 1997, an international Continue reading >>

Misdiagnosis By Design - The Story Behind The Ada Diagnostic Criteria

Misdiagnosis By Design - The Story Behind The Ada Diagnostic Criteria

This is the little known story of how--and why--the American Diabetes Association keeps doctors from diagnosing Type 2 diabetes early. If you wait for your doctor to give you a diabetes diagnosis, the chances are good that by the time you are diagnosed you'll already have one or more serious diabetic complications. These include retinal damage, nerve damage, and early kidney damage. It is now known that these diabetic complications only develop after years of chronic exposure to high blood sugars. But, tragically, the way that today's doctors are forced to diagnose diabetes ensures that you will get no warning that you are experiencing those chronically high blood sugars until they have reached a level so high they have already done irreversible damage. This is not an accident. Years ago a committee of medical experts whose task was to decide how diabetes should be diagnosed decided it was better to avoid diagnosing patients with diabetes than to give them early warning that they were suffering from elevated blood sugars. As a result, these medical experts intentionally set the standards for diagnosing diabetes artificially high, so that most patients do not get diagnosed until their blood sugar has reached a level where they may soon develop the diabetic eye disease that leads to blindness. Their reasons for doing this this made sense in the late 1970s when these diagnostic criteria were originally crafted. At that time there was no treatment that could help people with early diabetes, while delivering a diabetes diagnosis could make it impossible for their patients to get health or life insurance. These circumstances led the experts to conclude that an early diagnosis of diabetes was more likely to harm than help their patients. So they defined diagnostic criteria tha Continue reading >>

Type 1 Diabetes

Type 1 Diabetes

Introduction Diabetes is a lifelong condition that causes a person's blood sugar (glucose) level to become too high. The hormone insulin – produced by the pancreas – is responsible for controlling the amount of glucose in the blood. There are two main types of diabetes: Type 1 – where the pancreas doesn't produce any insulin Type 2 – where the pancreas doesn't produce enough insulin or the body’s cells don't react to insulin This topic is about type 1 diabetes. Read more about type 2 diabetes Another type of diabetes, known as gestational diabetes, occurs in some pregnant women and tends to disappear following birth. It's very important for diabetes to be diagnosed as soon as possible, because it will get progressively worse if left untreated. You should therefore visit your GP if you have symptoms, which include feeling thirsty, passing urine more often than usual and feeling tired all the time (see the list below for more diabetes symptoms). Type 1 and type 2 diabetes Type 1 diabetes can develop at any age, but usually appears before the age of 40, particularly in childhood. Around 10% of all diabetes is type 1, but it's the most common type of childhood diabetes. This is why it's sometimes called juvenile diabetes or early-onset diabetes. In type 1 diabetes, the pancreas (a small gland behind the stomach) doesn't produce any insulin – the hormone that regulates blood glucose levels. This is why it's also sometimes called insulin-dependent diabetes. If the amount of glucose in the blood is too high, it can, over time, seriously damage the body's organs. In type 2 diabetes, the body either doesn't produce enough insulin to function properly, or the body's cells don't react to insulin. Around 90% of adults with diabetes have type 2, and it tends to develop l Continue reading >>

History Of Diabetes

History Of Diabetes

The beginnings Diabetes has been affecting lives for thousands of years. An ailment suspected to be diabetes was recognized by the Egyptians in manuscripts dating to approximately 1550 B.C. According to one study, ancient Indians (circa 400–500 A.D.) were well aware of the condition, and had even identified two types of the condition. They tested for diabetes — which they called “honey urine” — by determining if ants were attracted to a person’s urine. The term “diabetes” In Greek, “diabetes” means “to go through.” Greek physician Apollonius of Memphis is credited with naming the disorder for its top symptom: the excessive passing of urine through the body’s system. Historical documents show that Greek, Indian, Arab, Egyptian, and Chinese doctors were aware of the condition, but none could determine its cause. In earlier times, a diagnosis of diabetes was likely a death sentence. Insulin deficiency In the early years of the 20th century, medical professionals took the first steps toward discovering a cause and treatment mode for diabetes. In 1926, Edward Albert Sharpey-Schafer announced that the pancreas of a patient with diabetes was unable to produce what he termed “insulin,” a chemical the body uses to break down sugar. Thus, excess sugar ended up in the urine. Physicians promoted a fasting diet combined with regular exercise to combat the disorder. Diabetes in dogs Despite attempts to manage the disorder through diet and exercise, people with diabetes inevitably died prematurely. In 1921, scientists experimenting with dogs had a breakthrough in reversing the effects of diabetes. Two Canadian researchers, Frederick Grant Banting and Charles Herbert Best, successfully extracted insulin from healthy dogs. They then injected it into dogs th Continue reading >>

The History Of A Wonderful Thing We Call Insulin

The History Of A Wonderful Thing We Call Insulin

Since the dawn of time, we have searched for ways to make life easier for us. The modern age has given us some amazing technological advances—what we would do without the internet, our iPhones or high-speed travel? For many people, surviving life without these things sounds rough. However, if you have diabetes, no doubt you’re also a big fan of one particular 20th-century discovery: insulin. Before insulin was discovered in 1921, people with diabetes didn’t live for long; there wasn’t much doctors could do for them. The most effective treatment was to put patients with diabetes on very strict diets with minimal carbohydrate intake. This could buy patients a few extra years but couldn’t save them. Harsh diets (some prescribed as little as 450 calories a day!) sometimes even caused patients to die of starvation. So how did this wonderful breakthrough blossom? Let’s travel back a little more than 100 years ago.… In 1889, two German researchers, Oskar Minkowski and Joseph von Mering, found that when the pancreas gland was removed from dogs, the animals developed symptoms of diabetes and died soon afterward. This led to the idea that the pancreas was the site where “pancreatic substances” (insulin) were produced. Later experimenters narrowed this search to the islets of Langerhans (a fancy name for clusters of specialized cells in the pancreas). In 1910, Sir Edward Albert Sharpey-Shafer suggested only one chemical was missing from the pancreas in people with diabetes. He decided to call this chemical insulin, which comes for the Latin word insula, meaning “island.” So what happened next? Something truly miraculous. In 1921, a young surgeon named Frederick Banting and his assistant Charles Best figured out how to remove insulin from a dog’s pancreas. S Continue reading >>

Diabetes Treatment In 2025: Can Scientific Advances Keep Pace With Prevalence?

Diabetes Treatment In 2025: Can Scientific Advances Keep Pace With Prevalence?

Go to: Introduction Before the availability of insulin in the 1920s, hailed not only as the cure for diabetes but also as one of the greatest advances in the treatment of any disease, a person diagnosed with diabetes would have faced death within a few years. Today, diabetes is not the devastating diagnosis it would have been 100 years ago; in fact, it is now a common misconception among the public that diabetes is not a serious disease. In reality, the impact of diabetes is so significant that it is affecting overall life expectancy: in the United States (US), life expectancy is falling for the first time since statistics were collected, due to obesity and diabetes [Olshansky et al. 2005], and estimates of diabetes prevalence over the coming years suggest many of us reading this article will develop diabetes during our lives [Whiting et al. 2011]. The predictions of the increased prevalence of diabetes are rarely accompanied by predictions of improvements in the treatment of diabetes; however, given the impact of diabetes, it has been the focus of intensive research, resulting in major advances in our understanding of diabetes as well as in treatment options. As the centenary of the discovery of insulin approaches, it seems timely to consider how treatment options may look in the 2020s, and the likelihood that the elusive cure for diabetes could be found by that time. Go to: Technological solutions The majority of cases of diabetes are type 2 diabetes mellitus (T2DM), and the predicted rise in diabetes prevalence is expected to be driven by increases in the number of T2DM cases. However, it is likely that significant advances in therapy for T2DM will result from the research in type 1 diabetes mellitus (T1DM), as they are both essentially disorders of glucose managemen Continue reading >>

Type 2 Diabetes Faqs

Type 2 Diabetes Faqs

Common questions about type 2 diabetes: How do you treat type 2 diabetes? When you have type 2 diabetes, you first need to eat a healthy diet, stay physically active and lose any extra weight. If these lifestyle changes cannot control your blood sugar, you also may need to take pills and other injected medication, including insulin. Eating a healthy diet, being physically active, and losing any extra weight is the first line of therapy. “Diet and exercise“ is the foundation of all diabetes management because it makes your body’s cells respond better to insulin (in other words, it decreases insulin resistance) and lowers blood sugar levels. If you cannot normalize or control the blood sugars with diet, weight loss and exercise, the next treatment phase is taking medicine either orally or by injection. Diabetes pills work in different ways – some lower insulin resistance, others slow the digestion of food or increase insulin levels in the blood stream. The non-insulin injected medications for type 2 diabetes have a complicated action but basically lower blood glucose after eating. Insulin therapy simply increases insulin in the circulation. Don’t be surprised if you have to use multiple medications to control the blood sugar. Multiple medications, also known as combination therapy is common in the treatment of diabetes! If one medication is not enough, you medical provider may give you two or three or more different types of pills. Insulin or other injected medications also may be prescribed. Or, depending on your medical condition, you may be treated only with insulin or injected medication therapy. Many people with type 2 diabetes have elevated blood fats (high triglycerides and cholesterol) and blood pressure, so you may be given medications for these problem Continue reading >>

Trends In Incidence, Prevalence And Prescribing In Type 2 Diabetes Mellitus Between 2000 And 2013 In Primary Care: A Retrospective Cohort Study

Trends In Incidence, Prevalence And Prescribing In Type 2 Diabetes Mellitus Between 2000 And 2013 In Primary Care: A Retrospective Cohort Study

Abstract Objective To investigate trends in incident and prevalent diagnoses of type 2 diabetes mellitus (T2DM) and its pharmacological treatment between 2000 and 2013. Design Analysis of longitudinal electronic health records in The Health Improvement Network (THIN) primary care database. Outcome measures The incidence and prevalence of T2DM between 2000 and 2013, and the effect of age, sex and social deprivation on these measures were examined. Changes in prescribing patterns of antidiabetic therapy between 2000 and 2013 were also investigated. Results Overall, 406 344 individuals had a diagnosis of T2DM, of which 203 639 were newly diagnosed between 2000 and 2013. The incidence of T2DM rose from 3.69 per 1000 person-years at risk (PYAR) (95% CI 3.58 to 3.81) in 2000 to 3.99 per 1000 PYAR (95% CI 3.90 to 4.08) in 2013 among men; and from 3.06 per 1000 PYAR (95% CI 2.95 to 3.17) to 3.73 per 1000 PYAR (95% CI 3.65 to 3.82) among women. Prevalence of T2DM more than doubled from 2.39% (95% CI 2.37 to 2.41) in 2000 to 5.32% (95% CI 5.30 to 5.34) in 2013. Being male, older, and from a more socially deprived area was strongly associated with having T2DM, (p<0.001). Prescribing changes over time reflected emerging clinical guidance and novel treatments. In 2013, metformin prescribing peaked at 83.6% (95% CI 83.4% to 83.8%), while sulfonylureas prescribing reached a low of 41.4% (95% CI 41.1% to 41.7%). Both remained, however, the most commonly used pharmacological treatments as first-line agents and add-on therapy. Thiazolidinediones and incretin based therapies (gliptins and GLP-1 analogues) were also prescribed as alternate add-on therapy options, however were rarely used for first-line treatment in T2DM. Conclusions Prevalent cases of T2DM more than doubled between 2000 an Continue reading >>

7 Innovations That Are Changing The Way We Manage Diabetes, A Disease That Affects 371 Million People Worldwide

7 Innovations That Are Changing The Way We Manage Diabetes, A Disease That Affects 371 Million People Worldwide

It's been almost a century since researchers discovered a way to treat diabetes. Since then, there have been a number of medical and technological advances that aim to make the lives of people living with diabetes — both type 1 and type 2 — more manageable. Around the globe, the group of conditions affects 371 million people worldwide, a number that's expected to increase to 552 million by 2030. From monitoring blood sugar levels — a taxing experience that people with diabetes must grow used to doing every day — to ways that make insulin easier to deliver, here are some of the innovations that are changing the way we manage diabetes. Medtronic created the world's first 'artificial pancreas.' In September, the FDA approved a device that's often referred to as an "artificial pancreas" for use in people with type 1 diabetes over age 14. The device, made by Medtronic, is called the MiniMed 670G, and it works by automatically monitoring a person's blood sugar levels and administering insulin as needed — no constant checking and injecting required. That way, it can act like a pancreas, the organ in our bodies that in healthy people is able to moderate our blood sugar levels by pumping out insulin that can process the sugars found in food. Livongo is making a glucose monitor that can get software updates just like your phone. "No one cares about the technology," Glen Tullman, the CEO of California-based startup Livongo and whose son has Type 1 diabetes, told Business Insider. "They simply want to live their life." On Wednesday, the company added the capability for the monitor to receive software updates, eliminating the need for people to constantly upgrade to new glucose meters when the technology advances. Livongo also offers the testing strips the machine uses for Continue reading >>

Doctor, You Aren’t Listening To Me... What If I Do Nothing?

Doctor, You Aren’t Listening To Me... What If I Do Nothing?

A month ago my sister wanted to know if her Jack Russell Terrier could be sick because he was drinking and peeing all the time. I told her he needed to go to the vet; he could have a simple urinary tract infection or he could have more going on. Inside my head, I was screaming “diabetes” as polyuria/polydipsia (drinks a lot and pees a lot), or PU/PD as medical types call it, is a hallmark for diabetes mellitus in dogs, cats, and people. In dogs, diabetes mellitus rarely responds to dietary changes - unlike some people and some cats - and almost always requires twice daily insulin injections to control the disease. Having seen clients react to a diagnosis of diabetes, I wondered how my sister and her husband would react if they had to take care of this chronic condition that requires significant planning and scheduling. It’s not for every owner: while it’s not expensive, it requires insulin injections every 12 hours, 7 days a week for the rest of the pet’s life, with no time off for good behavior. It requires considerable commitment, which can be particularly difficult for people like my sister and her husband who work outside the home and can’t drop everything to give a pet medication at the appropriate times. I wondered what they would choose to do if their dog did have diabetes rather than a urinary tract infection. Receiving a diagnosis of a chronic disease can be difficult to wrap your mind around. During my years in practice, I noticed that there are some pretty universal questions most clients ask. “What are my options and what will happen if I do nothing?” When I hear this, I translate this into: a. How will the disease progress? Will this be a disease that progresses quickly or is it going to be something that is a nagging problem for years to co Continue reading >>

The Slippery Slope: A Bittersweet Diabetes Economy

The Slippery Slope: A Bittersweet Diabetes Economy

In 1997, a group of experts convened by the American Diabetes Association changed the definition of type 2 diabetes, lowering the blood sugar threshold, and instantly as many as 1.9 million more Americans had the condition. The same pattern played out in 2003, in an even bigger way, when the association changed the definition of a condition known as pre-diabetes and -- overnight -- 25 million more Americans were affected. In the decade that followed, the diabetes industry boomed -- thanks in part to a 2008 declaration by two endocrinology groups that pre-diabetes could be treated with drugs if diet and exercise didn't lower blood sugar. Last year, sales of diabetes drugs reached $23 billion, according to the data from IMS Health, a drug market research firm. That was more than the combined revenue of the National Football League, Major League Baseball, and the National Basketball Association. But from 2004 to 2013, none of the 30 new diabetes drugs that came on the market were proven to improve key outcomes, such as reducing heart attacks or strokes, blindness, or other complications of the disease, an investigation by MedPage Today and the Milwaukee Journal Sentinel found. The U.S. Food and Drug Administration approved all of those drugs based on a surrogate endpoint: the ability to lower blood sugar. Many of the new drugs have dubious benefit; some can be harmful. "We have an entire industry -- a diabetes economy -- that revolves around glycemic control," said David H. Newman, MD, director of clinical research at Icahn School of Medicine at Mount Sinai Hospital in New York. But the disease is not well understood, is difficult to control, and can't be cured, said Newman, an emergency room physician who founded theNNT, an independent group of physicians who analyze the Continue reading >>

Diabetes Technology During The Past 30 Years: A Lot Of Changes And Mostly For The Better

Diabetes Technology During The Past 30 Years: A Lot Of Changes And Mostly For The Better

I finished my pediatric endocrinology fellowship just over 30 years ago. I can truly say I have participated in the revolution in diabetes management. In 1977, insulin consisted of animal-sourced, relatively impure regular insulin and NPH (neutral protamine Hagedorn), Lente, or PZI (protamine zinc insulin), names many younger readers will not even recognize. Insulin treatment was considered advanced if more than one injection was used for type 1. Glucose monitoring was with urine, mostly Clinitest tablets that boiled urine, along with some glucose monitoring tapes. Ketones were measured with tablets that changed colors. Dipsticks for urine were just being introduced. That said, right at the end of my fellowship at the University of Minnesota, Dr. Don Etzwiler sent me to Wyoming with a dozen teens to hike above the tree line. My mantra then was, “Keep it a trace of glucose.” I have no idea about the true glucose values, but I expect, if measured, the hemoglobin A1c (A1C) values would have been > 9%. We all came home; the greatest danger was the raging thunderstorm in South Dakota on the way back. Those were simple times, even though we thought we were practicing “state-of-the-art” diabetes management. Technology was really nonexistent when compared to 2008. In fact, compared to the past 30 years, the 30 years from 1947 to 1977 really didn't bring any major changes in management. Urine monitoring and a fixed dose of insulin usually one or two times a day was the norm. What, then, did we have to do in 1977, and how is it different in 2008? What are the true costs and the true benefits of 30 years of diabetes management and the changes experienced? Perhaps the best way to look at the true cost of technology is through the lives of real patients. Their experiences ma Continue reading >>

Treating Diabetes: 1921 To The Present Day

Treating Diabetes: 1921 To The Present Day

The lives of people with diabetes has changed considerably in 50 years. They now have specific tools and easier access to information than ever before. The healthcare professionals who treat them also know more about the complexity of the disease, and which treatments work best. Pending the next medical revolution, Diabetes Québec is demanding the implementation of a national strategy to fight diabetes – a strategy founded on education, prevention, support and treatment. The last 60 years have clearly demonstrated that people with diabetes who are well informed, properly supported and treated appropriately live longer lives in better health. The discovery of insulin and glycemic control Insulin, discovered in 1921 by the legendary Banting, Best and MacLeod collaboration, is nothing short of a miracle. Worldwide, it has saved thousands of patients from certain death. 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. A disc Continue reading >>

How Has Diabetes Care In The U.s. Changed Over Time?

How Has Diabetes Care In The U.s. Changed Over Time?

This collection of charts and a related brief explore trends in health outcomes, quality of care, and treatment costs for people with diabetes and related endocrine disorders. Endocrine diseases occur when any of the eight major glands in the endocrine system produce too little or too much of a particular hormone. In the U.S., diabetes is the most common endocrine disease. Diabetes is caused when the body is unable to create enough insulin to break down blood sugar. It is among the 10 leading causes of death in the U.S. and can cause serious health complications such as early mortality, blindness, kidney failure, lower-extremity amputations, and heart disease. There has been a reduction in complications due to diabetes and improvement in disease management, but diagnosis rates and spending continue to grow. Diabetes is among the 10 leading causes of death in the United States Diabetes is an endocrine system disease caused when the body is unable to create enough insulin to break down blood sugar. It is among the 10 leading causes of death in the U.S. and can cause serious health complications such as early mortality, blindness, kidney failure, lower-extremity amputations, and heart disease. There are three types of diabetes: type 1, type 2, and gestational diabetes. Type 1 diabetes, formerly called juvenile diabetes, is usually diagnosed in children and young adults when the body does not produce insulin. There is no way to prevent type 1 diabetes, and proper management includes daily injections of insulin and monitoring blood glucose levels. Gestational diabetes occurs when there is not enough insulin created to support the pregnancy and happens in about 9.2% of pregnancies according to an analysis by the Centers for Disease Control and Prevention. A diagnosis of gesta Continue reading >>

Diabetes Mellitus Type 2

Diabetes Mellitus Type 2

Diabetes mellitus type 2 (also known as type 2 diabetes) is a long-term metabolic disorder that is characterized by high blood sugar, insulin resistance, and relative lack of insulin.[6] Common symptoms include increased thirst, frequent urination, and unexplained weight loss.[3] Symptoms may also include increased hunger, feeling tired, and sores that do not heal.[3] Often symptoms come on slowly.[6] Long-term complications from high blood sugar include heart disease, strokes, diabetic retinopathy which can result in blindness, kidney failure, and poor blood flow in the limbs which may lead to amputations.[1] The sudden onset of hyperosmolar hyperglycemic state may occur; however, ketoacidosis is uncommon.[4][5] Type 2 diabetes primarily occurs as a result of obesity and lack of exercise.[1] Some people are more genetically at risk than others.[6] Type 2 diabetes makes up about 90% of cases of diabetes, with the other 10% due primarily to diabetes mellitus type 1 and gestational diabetes.[1] In diabetes mellitus type 1 there is a lower total level of insulin to control blood glucose, due to an autoimmune induced loss of insulin-producing beta cells in the pancreas.[12][13] Diagnosis of diabetes is by blood tests such as fasting plasma glucose, oral glucose tolerance test, or glycated hemoglobin (A1C).[3] Type 2 diabetes is partly preventable by staying a normal weight, exercising regularly, and eating properly.[1] Treatment involves exercise and dietary changes.[1] If blood sugar levels are not adequately lowered, the medication metformin is typically recommended.[7][14] Many people may eventually also require insulin injections.[9] In those on insulin, routinely checking blood sugar levels is advised; however, this may not be needed in those taking pills.[15] Bariatri Continue reading >>

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