In the 1970s, diabetes was a chronic disease that affected a small portion of Canada’s population. People with diabetes had poorly controlled disease and limited treatment options.
A small number of medications kept Type 2 diabetes in check, and people with Type 1 diabetes had to use syringes to inject their insulin. The quality of insulin wasn’t as good as it is today, and its effects weren’t very predictable, according to Dr. Hertzel Gerstein, professor of endocrinology and metabolism at McMaster University, Hamilton, ON.
Glucose-monitoring devices (glucometers) were relatively primitive, and the importance of good glucose control in reducing the complications of diabetes was not yet understood.
The number of people who have diabetes has increased substantially. The incidence of diabetes, along with obesity, has increased to the point where it is now a public health issue.
The past 30 years have seen a number of changes in the treatment and knowledge of diabetes, says Dr. Gerstein. Several large clinical trials have led to vast improvements in the understanding of the disease. This evidence has shown that good glucose control is vital for reducing the risk of many complications of diabetes, such as vision loss and kidney, nerve, heart and circulatory problems.
People with diabetes can choose from several treatment options that have been developed since the 1970s, and the list of available medications and insulin preparations (short- and long-acting) has grown substantially. Now, people can easily check their own blood glucose levels with the use of sophisticated glucometers. Convenient pen-style injectors are used instead of syringes to inject insulin.
Clinical studies have also shown that people who take control of their diabetes fare better over time. People now assume more personal care of their disease and have more resources to help them learn about their disease. Nurse educators, nutritionists, eye doctors and others play a far bigger role in helping people with diabetes than they did years ago.
It is now known that lifestyle changes, including a healthy diet, maintaining a healthy weight, and exercise may prevent the onset of Type 2 diabetes. “This wasn’t known even 15 years ago,” says Dr. Gerstein.
Canadian researchers are exploring several potential ways to treat and even cure diabetes. Canadians were among the first to attempt islet cell (insulin-producing cells in the pancreas) transplantation to increase the body’s insulin production.
The use of stem cells may lead to new ways to generate insulin-producing cells, allowing people with diabetes to reduce their dependence on insulin injections. Several diabetes-related genes and their potential applications have been identified. For example, genetic screening may make it possible to detect diabetes before it happens, triggering the use of prevention strategies. In the distant future, it may be even possible to correct diabetes-related genetic abnormalities.
“But nothing will change without research,” says Dr. Gerstein.