DIABETES

Diabetes has been in the spotlight on the news and medical programs more than ever lately, due to the fact that more and more people appear to be diagnosed with this illness.  This is due, in part to the fact that people do not exercise as often as they should, and they consume diets much higher in fat than they did years ago.

Although the current media focus has been on the number of people diabetes is targeting in today's society, have you ever wondered about the history of this illness, and how it was detected in patients hundreds of years ago?  The following information offers an interesting insight to the earliest testing and diagnosis of diabetes.

Terminology

The term diabetes was coined by Aretaeus (81–133 CE) of Cappadocia. The Greek word diabaínein literally means passing through, or siphon, a reference to one of diabetes' major symptoms—excessive urine production.  The word became diabetes from the English adoption of the medieval
Latin diabetes. In 1675 Thomas Willis added mellitus from the Latin word for honey (in the sense of honey sweet) when he noted that the blood and urine of a diabetic has a sweet taste. This had been noticed long before in ancient times by the Greeks, Chinese, Egyptians, and Indians. In 1776 it was confirmed the sweet taste was because of an excess of a kind of sugar in the urine and blood of people with diabetes.  The ancient Indians tested for diabetes by observing whether ants were attracted to a person's urine, and called the ailment sweet urine disease; medieval European doctors tested for it by tasting the urine themselves, a scene which was occasionally depicted in Gothic reliefs.

While the term diabetes without a modifier usually refers to diabetes mellitus, there is another, rarer condition named diabetes insipidus (unquenchable diabetes) in which the urine is not sweet; it can be caused  by either kidney  or pituitary gland damage.

History

Although diabetes has been recognized since antiquity, and treatments of various efficacy (all close to being ineffective, however) have been known in various regions since the Middle Ages,  the clear development of diabetes occurred mainly in the 20th century. 

The discovery of the role of the pancreas in diabetes is generally credited  to Joseph von Mering and Oskar Minkowski, European researchers who in 1889 found that when they completely removed the pancreas of dogs, the dogs developed all the signs and symptoms of diabetes and died shortly afterward.   

In 1910, Sir Edward Albert Sharpey-Schafer of Edinburgh suggested that people with diabetes were deficient in a single chemical that was normally produced by the pancreas—he proposed calling this substance insulin. The term is derived from the Latin insula, meaning island, in reference to the islets of Langerhans in the pancreas that produce insulin.  The endocrine role of the pancreas in metabolism, and indeed the existence of insulin, was not fully clarified until 1921, when Sir Frederick Grant Banting
and Charles Herbert Best repeated the work of Von Mering and Minkowski, but went further and demonstrated that they could reverse induced diabetes in dogs by giving them an extract from the pancreatic islets of Langerhans of healthy dogs.   Banting, Best, and their colleagues went on to isolate the hormone insulin from bovine pancreases at the University of Toronto in Canada. This led to the availability of an effective treatment—insulin injections—and the first clinical patient was treated in 1922. For this, Banting and MacLeod received the Nobel Prize in Physiology or Medicine in 1923; both shared their Prize money with others in the team who were not recognized. Banting and Best made the patent available without charge and did not attempt to control commercial production. Insulin production and therapy rapidly spread around the world, largely as a result of this decision.

Despite the availability of treatment, diabetes remained a major cause of death. For instance, statistics reveal that the cause-specific mortality rate during 1927 amounted to about 47.7 per 100,000 population in Malta.  The distinction between what is now known as type 1 diabetes and type 2 diabetes was first clearly made by Sir Harold Percival (Harry) Himsworth in 1935 and was published in January 1936.

Diagnostic Screening for Diabetes

Diabetes screening is recommended for many types of people
at various stages of life or with several different risk factors.
The screening test varies according to circumstances and local policy and may be a random glucose, a fasting glucose and insulin, a glucose two hours after 75 g of glucose, or a formal glucose tolerance test.

Many healthcare providers recommend universal screening for adults at age 40 or 50, and sometimes occasionally thereafter. Earlier screening is recommended for those with risk factors such as obesity, family history of diabetes, high-risk ethnicity (Hispanic/Latin American, American Indian, African American, Pacific Island, and South Asian ancestry).

Many medical conditions are associated with a higher risk of various types of diabetes and warrant screening. A partial list includes: high blood pressure, elevated cholesterol levels, coronary artery disease, past gestational diabetes, polycystic ovary syndrome, chronic pancreatitis, fatty liver, hemochromatosis, cystic fibrosis, several mitochondrial neuropathies and myopathies, myotonic dystrophy, Friedreich's ataxia, some of the inherited
forms of neonatal hyperinsulinism, and many others. Risk of diabetes is higher with chronic use of several medications, including high-dose glucocorticoids, some chemotherapy agents (especially L-asparaginase), and some of the antipsychotics and mood stabilizers (especially phenothiazines and some
atypical antipsychotics).

Diabetes is often detected when a person suffers a problem frequently caused by diabetes, such as a heart attack, stroke, neuropathy, poor wound healing or a foot ulcer, certain eye problems, certain fungal infections, or delivering a baby with macrosomia or hypoglycemia.

Causes and statistics

In 2006, according to the World Health Organization, at least
171 million people worldwide suffer from diabetes. Its incidence
is increasing rapidly, and it is estimated that by the year 2030,
this number will double. Diabetes mellitus occurs throughout the
world, but is more common  in the more developed
countries. The greatest increase in prevalence is, however, expected to occur in Asia and Africa, where most patients will likely be found by 2030. The increase in incidence of diabetes in developing countries follows the trend of urbanization and lifestyle changes, perhaps most importantly a "Western-style" diet. This has suggested an environmental (dietary) effect, but there is little understanding of the mechanism(s) at present.

Diabetes is in the top 10, and perhaps the top 5, of the most significant diseases in the developed world, and is gaining in significance there and elsewhere.

For at least 20 years, diabetes rates in North America have been
increasing substantially. In 2005 there are about 20.8 million people
with diabetes in the United States alone. According to the American Diabetes Association, there are about 6.2 million people undiagnosed and about 41 million people that would be considered prediabetic.   However, the criteria for diagnosing diabetes in the USA means that it is more readily diagnosed than in some other countries. The Centers for Disease Control has termed the change an epidemic. The National Diabetes Information Clearinghouse estimates that diabetes costs $132 billion in the United States alone every year.