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\"An eye-opening, comprehensive history of diabetes research and treatment, by the best-selling author of Why We Get Fat and award-winning journalist\"-- Provided by publisher.

One of medicine's most remarkable therapeutic triumphs was the discovery of insulin in 1921. The drug produced astonishing results, rescuing children and adults from the deadly grip of diabetes. But as Chris Feudtner demonstrates, the subsequent transformation of the disease from a fatal condition into a chronic illness is a story of success tinged with irony, a revealing saga that illuminates the complex human consequences of medical intervention. Bittersweet chronicles this history of diabetes through the compelling perspectives of people who lived with this disease. Drawing on a remarkable body of letters exchanged between patients or their parents and Dr. Elliot P. Joslin and the staff of physicians at his famed Boston clinic, Feudtner examines the experience of living with diabetes across the twentieth century, highlighting changes in treatment and their profound effects on patients' lives. Although focused on juvenile-onset, or Type 1, diabetes, the themes explored in Bittersweet have implications for our understanding of adult-onset, or Type 2, diabetes, as well as a host of other diseases that, thanks to drugs or medical advances, are being transformed from acute to chronic conditions. Indeed, the tale of diabetes in the post-insulin era provides an ideal opportunity for exploring the larger questions of how medicine changes our lives.

In the late 1980s, pediatric endocrinologists at the Children's Hospital in Winnipeg began to notice a new cohort appearing in their clinics for young people with diabetes. Through dozens of interviews, Krotz shows the impact of the disease on the lives of individuals and families, especially in communities far removed from the medical personnel and facilities available in the city.

Diabetes is an increasingly common chronic metabolic disorder in children worldwide. The discovery of insulin in 1921 resulted in unprecedented advancements that improved the lives of children and youth with diabetes. The purpose of this article is to review the history of diabetes in children and youth over the last century and its implications for future developments in the field. We identified 68 relevant events between 1921 and 2021 through literature review and survey of pediatric endocrinologists. Basic research milestones led to the discovery of insulin and other regulatory hormones, established the normal physiology of carbohydrate metabolism and pathophysiology of diabetes, and provided insight into strategies for diabetes prevention. While landmark clinical studies were initially focused on adult diabetes populations, later studies assessed etiologic factors in birth cohort studies, evaluated technology use among children with diabetes, and investigated pharmacologic management of youth type 2 diabetes. Technological innovations culminated in the introduction of continuous glucose monitoring that enabled semi‐automated insulin delivery systems. Finally, professional organizations collaborated with patient groups to advocate for the needs of children with diabetes and their families. Together, these advances transformed type 1 diabetes from a terminal illness to a manageable disease with near‐normal life expectancy and increased our knowledge of type 2 diabetes and other forms of diabetes in the pediatric population. However, disparities in access to insulin, diabetes technology, education, and care support remain and disproportionately impact minority youth and communities with less resources. The overarching goal of diabetes management remains promoting a high quality of life and improving glycemic management without undermining the psychological health of children and youth living with diabetes.

The introduction of insulin in the treatment of juvenile-onset, now type 1, diabetes mellitus transformed a rapidly fatal disease into a chronic degenerative one. During the insulin-treatment era, long-term microvascular and cardiovascular complications proved to be the bane of existence for people with type 1 diabetes, leading to blindness, kidney failure, amputations, cardiovascular disease (CVD) and premature mortality. The nascent understanding of the link between non-physiologically regulated glucose levels and these complications led to the development of new treatment tools in the 1970s and 1980s that facilitated the delivery of insulin to achieve glucose levels closer to non-diabetic levels. These therapeutic advances set the stage for definitive testing of the glucose hypothesis. The Diabetes Control and Complications Trial (DCCT), supported by the National Institute of Diabetes Digestive and Kidney Diseases, National Institutes of Health (NIH), definitively established the benefits and risks of intensive therapy that substantially lowered mean blood glucose levels, measured by HbA1c, over a mean 6.5 years of therapy. Intensive therapy in the DCCT, resulting in a mean HbA1c of ~7% (53 mmol/mol), reduced the development and progression of early microvascular and neurological complications associated with diabetes by 34–76% compared with the conventional-treatment group, which maintained an HbA1c of ~9% (75 mmol/mol). Intensive therapy was also associated with weight gain and a threefold increased risk for hypoglycaemia. At the end of the DCCT, a long-term observational follow-up study, the Epidemiology of Diabetes Interventions and Complications (EDIC) study, commenced. Despite the convergence of HbA1c levels between the two groups during EDIC, owing to the adoption of intensive therapy by the original DCCT conventional-treatment group and the return of all participants to their own healthcare providers for diabetes care, the development and progression of complications continued to be substantially less in the original intensive-treatment group vs the conventional-treatment group; this phenomenon was termed ‘metabolic memory’. The DCCT demonstrated a major reduction in early-stage complications with intensive therapy and the metabolic memory phenomenon during EDIC contributed to a substantially lower burden of advanced complications over time. These included a 57% lower risk of CVD events and 33% lower rate of mortality in the original intensive-treatment group compared with the conventional-treatment group. DCCT/EDIC has ushered in the intensive-treatment era, which has been universally adopted and includes the goal of achieving HbA1c levels less than 7% (53 mmol/mol) for most patients. Although the challenge of making intensive therapy (with the aim of achieving normoglycaemia) as widely accessible and safe as possible remains, continuing improvements in insulin therapy 100 years after its introduction promise a brighter future for people with type 1 diabetes.

Purpose To explore whether glycated albumin (GA) or fasting plasma glucose (FPG), both routinely monitored during patients’ hospital stay, can be used to predict post-transplantation diabetes mellitus (PTDM). Methods All kidney transplantation recipients (KTRs) from January 2017 to December 2018 were followed-up for 1 year. PTDM was diagnosed from day 45 post-operation to 1 year. When the completeness was above 80%, FPG or GA data on the day was selected, analyzed, and presented as range parameters and standard deviation (SD) and compared between PTDM and non-PTDM groups in fluctuation and stable periods. The predictive cut-off values were determined via receiver operating characteristic (ROC) analysis. The PTDM combined predictive mode, formed by the independent risk factors derived from logistic regression analyses, was compared with each independent risk factor with the independent ROC curve test. Results Among 536 KTRs, 38 patients developed PTDM up to 1 year post-operatively. The family history diabetes mellitus (OR, 3.21; P  = 0.035), the FPG SD in fluctuation period >2.09 mmol/L (OR, 3.06; P  = 0.002), and the FPG maximum in stable period >5.08 mmol/L (OR, 6.85; P  < 0.001) were the PTDM independent risk factors. The discrimination of the combined mode (area under the curve = 0.81, sensitivity = 73.68%, and specificity = 76.31%) was higher than each prediction ( P  < 0.05). Conclusions The FPG standard deviation during the fluctuation period, FPG maximum during the stable period, and family history diabetes mellitus predicted PTDM with good discrimination and potential routine clinical use.

Who gets diabetes and why? An in-depth examination of diabetes in the context of race, public health, class, and heredity Who is considered most at risk for diabetes, and why? In this thorough, engaging book, historian Arleen Tuchman examines and critiques how these questions have been answered by both the public and medical communities for over a century in the United States.   Beginning in the late nineteenth century, Tuchman describes how at different times Jews, middle-class whites, American Indians, African Americans, and Hispanic Americans have been labeled most at risk for developing diabetes, and that such claims have reflected and perpetuated troubling assumptions about race, ethnicity, and class. She describes how diabetes underwent a mid-century transformation in the public's eye from being a disease of wealth and \"civilization\" to one of poverty and \"primitive\" populations.     In tracing this cultural history, Tuchman argues that shifting understandings of diabetes reveal just as much about scientific and medical beliefs as they do about the cultural, racial, and economic milieus of their time.

Although scientific advances have led to effective prevention strategies, the pathway to a cure for diabetes has remained elusive. This anniversary article describes progress in the understanding, diagnosis, and management of diabetes during the past 200 years. Diabetes was first recognized around 1500 B.C.E. by the ancient Egyptians, who considered it a rare condition in which a person urinated excessively and lost weight. The term diabetes mellitus, reflecting the fact that the urine of those affected had a sweet taste, was first used by the Greek physician Aretaeus, who lived from about 80 to 138 C.E. It was not until 1776, however, that Matthew Dobson actually measured the concentration of glucose in the urine of such patients and found it to be increased. 1 Diabetes was a recognized clinical entity when the New England Journal of Medicine and . . .

Background Type 2 diabetes mellitus represents a multifaceted disorder characterized by intricate pathophysiological mechanisms, encompassing diminished insulin secretion, augmented hepatic glucose production, and heightened insulin resistance. This study aims to assess the sex (Male and Female only) and family history-based differences in the prevalence of T2DM and explore the determinants contributing to this disparity among clinical patients. Subjects and methods The study encompassed a diverse pool of clinical patients, encompassing both individuals with diabetes and those without the condition, who had previously sought medical attention for clinical checkups at healthcare centers. The collected data included essential parameters such as blood pressure, weight, height, smoking habits, educational background, and physical activity levels. To ensure methodological rigor and data accuracy, blood pressure measurements adhered to the stringent guidelines set forth by the World Health Organization. Results Participants of the present study reported diabetes, among which notable findings emerged regarding health indicators. It was observed that the prevalence of high blood pressure, obesity, and high blood cholesterol exhibited a statistically significant increase among the female participants, underscoring the sex-based disparities in these health parameters. The male population aged 60 or older, the presence of a family history of DM accentuated this risk, resulting in a striking 3.1 times higher prevalence compared to females, who exhibited a 2.4 times higher risk (OR = 2.4, p  = 0.0008). This intriguing relationship between diabetes and cholesterol levels was not limited to sex. Both male (OR = 2.47) and female (OR = 2.1) diabetes patients displayed highly significant associations with cholesterol levels. The risk of T2DM was significantly associated with triglycerides in both sexes (1.58 times higher in males, and 1.71 times higher in females). Conclusions The significance of hypertension as a comorbidity in T2DM, highlighting sex-specific associations and the potential impact of a family history of diabetes on blood pressure. Our findings emphasize the importance of considering lipid profiles, obesity, and their sex-specific associations when assessing and managing diabetes risk. Comprehensive diabetes care should include strategies for lipid control, weight management, and cardiovascular risk reduction, tailored to the individual’s sex and specific risk profile.

Although ancient and medieval doctors knew of the disorder called diabetes, the disease they treated was rare and largely confined to young sufferers. By the late Renaissance, however, the increasing incidence of diabetes in older adults required a re-examination of what caused the malady and how to cure it. Led by English healers, such as controversial apothecary Nicholas Culpeper and elite physician Thomas Willis, the study of diabetes produced significant debate in print over the locus of the disease and remedies for its treatment. These debates paralleled the growing schism in English medical circles over contradictory iatric theories and professional jurisdiction. On the eve of insulin's discovery, diabetologists still quarrelled over what diets might alleviate its symptoms. Including perspectives from patients and drawing on myriad sources, this book examines changing approaches to diabetes and its victims within the context of medical and scientific progress.