Prevention of type 2 diabetes; from science to therapies

Abstract

At the beginning of the twentieth century, a newly diagnosed diabetic patient had a life expectancy of 44 years. Little could be offered to treat diabetes except for dietary restriction and starvation, and death from hyperglycemic coma was common. After the discovery of insulin in 1921, the average age life expectancy in patients with diabetes rapidly increased to 61 years, death rates from coma declined, while death from cardiovascular disease, gangrene, and renal complications began to increase [1]. Diabetes research, for many years to follow, focused on understanding the pathophysiology behind diabetes and its complications, and the development of new treatments and technologies to improve the care of diabetic patients. Improvements in sanitation in the early 1900s resulted in an increase in life expectancy for the entire population, and by 1933, it was already recognized that the risk of developing diabetes increased with advancing age. In addition to advancing age, it was also noted that genetics and obesity contributed to one's risk of developing diabetes. The social changes at the time allowed easier access to food, and the transition of labor from manual to mechanical in both urban and rural societies led greater numbers of people becoming overweight. Therefore, as the population was living longer and becoming more overweight, it was predicted that a rise in the incidence of diabetes was inevitable [2]. By the end of the twentieth century, diabetes was being described as a global epidemic. Life expectancy continued to rise; the social changes leading to overconsumption of food and an increasingly sedentary lifestyle caused the rates of obesity to escalate worldwide (Fig. 1.1). As diabetes and its complications could be effectively managed with modern medicine, the cost of diabetes care was growing annually. Therefore, in the twenty-first century, the focus of diabetes care is shifting toward diabetes prevention. In 1933, Joslin commented that diabetes is not a contagious disease and is a disease for the doctor to treat, rather than the state, the city, or the boards of health. However, given the extent of the current diabetes epidemic, professional societies, health boards, and government are becoming increasingly involved in diabetes prevention and there have been suggestions that the epidemic should be addressed in a similar manner to the outbreak of an infectious disease [3].