Diabetes

"On October 30th, 1920, I was attracted by an article by , in which he pointed out the similarity between the degenerative changes in the cells of the pancreas following experimental ligation of the duct, and the changes following blockage of the duct with s. Having read this article, the idea presented itself that by ligating the duct and allowing time for the degeneration of the acinus cells, a means might be provided for obtaining an extract of the islet cells free from the destroying influence of trypsin and other pancreatic enzymes."

"Even for most of us who spend our time working in the field of experimental diabetes, the primary concern is the disorder which occurs in the human subject. To stimulate our thoughts in this field, I will attempt, briefly, to list the possible causes of this disorder. ... Some Possible Causes of Diabetes 1. Defects in the pancreas as a whole, including the beta cells. 2. Defects in the formation of insulin. 3. Defects in the liberation of insulin. 4. Abnormal destruction of insulin. 5. Genetic defects involving insulin-dependent reactions. 6. Excess of diabetogenic agents. 7. Genetic defects making tissues abnormally suspectible to diabetogenic substances. 8. Genetic defects independent of hormonal actions."

"The modern era of diabetes knowledge began with the accidental discovery by a European research physiologist, , that in its most severe manifestation, now called type I diabetes, the disorder is generated with the pancreas, not, as had been previously believed, the liver or the stomach."

"The susceptibility and severity of is made more severe by diabetes, with the impact on the disease process inversely proportional to the level of glycemic control. Although type 1 diabetes mellitus and type 2 diabetes mellitus have different etiologies, and their impact on bone is not identical, they share many of the same complications. Studies in animals and humans agree that both forms of diabetes increase inflammatory events in periodontal tissue, impair new bone formation, and increase expression of in response to bacterial challenge. High levels of glucose, reactive oxygen species, and advanced glycation end-products are found in the periodontium of diabetic individuals and lead to increased activation of nuclear factor-kappa B and expression of inflammatory cytokines such as tumor necrosis factor and interleukin-1. Studies in animals, moreover, suggest that there are multiple cell types in periodontal tissues that are affected by diabetes, including leukocytes, vascular cells, mesenchymal stem cells, periodontal ligament fibroblasts, osteoblasts, and osteocytes."

"Believing that the want of success to prepare extracts of uniform potency as due to the destruction of the antidiabetic hormone by the digestive enzymes also present in the gland, F. G. Banting suggested preparing them from duct-ligated pancreas, and with the aid of C. H. Best, and under my direction, he succeeded in 1922 in showing that such extracts reduced the hyperglycaemia and glycosuria in depancreatized dogs. The general symptoms of diabetes were also found to be alleviated and the duration of life of the depancreatized animal prolonged, by the repeated injection of alcoholic extracts of foetal, as well as of adultox pancreas. Later it was shown, in collaboration with Collip, that other symptoms of diabetes, namely the ketonuria and the absence of glycogen from the liver, were favourably influenced by the extracts and, with Hepburn, that the respiratory quotient became raised. These results on depancreatized dogs showed beyond doubt that the antidiabetic hormone was present in potent form in the extracts, and the time seemed ripe to investigate their action on the clinical forms of diabetes. This was done by Banting in a severe case under the care of W. R. Campbell, with the result that the hyperglycaemia and glycosuria were diminished. At the same time, however, it was found that it would be necessary to rid the extracts of irritating substances before the value of their repeated injection in the treatment of diabetes in man could be adequately put to the test. This was accomplished by Collip, and the name insulin was decided upon for the purified extract."

"Evidence from observational studies and randomized trials suggests that prediabetes and type 2 diabetes mellitus (T2DM) can develop in genetically susceptible individuals in parallel with weight (that is, fat) gain. Accordingly, studies show that weight loss can produce remission of T2DM in a dose-dependent manner. A weight loss of ~15 kg, achieved by calorie restriction as part of an intensive management programme, can lead to remission of T2DM in ~80% of patients with obesity and T2DM. However, long-term weight loss maintenance is challenging. Obesity and T2DM are associated with diminished glucose uptake in the brain that impairs the satiating effect of dietary carbohydrate; therefore, carbohydrate restriction might help maintain weight loss and maximize metabolic benefits. Likewise, increases in physical activity and fitness are an important contributor to T2DM remission when combined with calorie restriction and weight loss."

"Type 2 diabetes accounts for almost 90% of all cases of diabetes in adults worldwide. In general, as countries become richer, people eat a more sugar- and fat-rich diet and are less physical active — and the incidence of diabetes rises. On average, nearly 8% of adults living in high-income countries (see map for country classification) have diabetes. It is, however, upper-middle and middle-income countries that have the highest prevalence of diabetes; over 10% of adults in these countries have the condition."