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Researchers, patient reflect on 50 years of diabetes treatment
BOSTON — When Kathryn Ham was diagnosed with type 1 diabetes in 1937, she needed a 26-gauge stainless steel needle to inject her insulin and Benedict’s solution to test the glucose level in her urine. Meal times, she recalled, were carefully measured ordeals.
“When I was a kid, I used to lick my plate because I was so hungry, to get every morsel of food,” Ham, now 86, said during a press conference discussing 50 years of diabetes treatment history. “Taking care of myself involves a lot of time. I would like to be able to spend a little less time testing, administering the insulin and eating small portions of food.”
Ham’s long-term prognosis, she was told, would be bleak, with likely complications including blindness and kidney disease. But 75 years after her initial diagnosis, Ham continues to live a full life.
Ham, along with a panel of clinicians, participated in a special symposium held at the American Diabetes Association’s 75th Scientific Sessions. In a press conference before the event, the panel shared personal reflections from the past 50 years on participating in diabetes research, diabetes care and living with diabetes.
“I think it’s critically important to consider how far we’ve come ... and [to] begin to look forward to how far we have yet to go,” said Robert Ratner, MD, chief scientific medical officer for the ADA and moderator of the panel.
Robert Ratner
Michael Brownlee, MD, an associate director for biological sciences at the Albert Einstein College Diabetes Research Center, recalled an influential ADA book published in the 1950s, advising clinicians to tell the families of patients that their children could expect to live until the age of 40 years, though they may experience kidney failure or blindness.
In addition, an influential scientific paper published 1968, he said, claimed that blood sugar has nothing to do with complications of diabetes.
“And virtually every doctor said, ‘Look at that paper,’” said Brownlee, who also has type 1 diabetes. “And when I would go to my eye doctor’s waiting room to have my eyes checked every 6 months, the place was filled with people with white canes and seeing-eye dogs, for years. It was discouraging, but that’s the way it was.”
He cautioned clinicians to remember that new discoveries can prove current ways of thinking wrong.
“We’re now living in an era ... where we have things like ‘road maps’ and ‘timelines’ and kind of romantic, but naïve, thinking,” Brownlee said, referring to diabetes treatment and management plans. “Because people don’t realize that, if we knew what the answer was to these big problems, we’d be doing it. We can’t make a timeline and a road map, that’s the point.”
Daniel Porte Jr. , MD, a former ADA president from the University of California at San Diego, recalled when it was commonly accepted that the nervous system and endocrine system had nothing to do with one another.
Daniel Porte, Jr.
“When I started, the nervous system was thought to be a completely separate system from the endocrine system,” Porte said. “Over 50 years, what we’ve learned is that those two systems are talking to each other all of the time.”
It was considered a landmark discovery, Porte said, when researchers learned that the brain and the pancreas were constantly interacting.
“It’s a circuit, and it’s these circuits which provide the regulation, which is so critical to blood sugar, which is the ultimate measure of what we think is going on and need to take care of in the field of diabetes,” Porte said.
The medically trained investigators who do scientific research have a difficult role and are often underappreciated, Porte said — not accepted completely as scientists, or completely accepted in the medical world as expert clinicians. Yet, they are critical to the time-consuming process of diabetic research. Those investigators need to be supported, Porte said.
“[In research] we have to wait 20 years to find out [new discoveries] and, along the way, we’re going to have these disappointments and great eureka moments,” Porte said. “We celebrate the eureka moments, but we need to remember there are the great disappointments, too. And they are a part of the process. So you cant have one without the other.”
Panel members said they hoped to see many advances on the horizon, including better methods of insulin delivery and possibly preventing the occurrence of type 1 diabetes altogether.
Ham hopes to see a cure, she said. For now, she is careful to follow her treatment plan.
“I think discipline is an extremely important part of one’s life,” Ham said. “You can live a full, healthy life if you follow the directions of your medical people, and I feel very fortunate to have been able to take advantage of things that have occurred through the years.” – Regina Schaffer
Reference:
Fifty Years of Diabetes Research and Treatment. Presented at: American Diabetes Association’s 75th Scientific Sessions; June 5-9, 2015; Boston.