Diabetes is a chronic condition characterized by the body’s inability to properly process blood glucose due to inadequate insulin production or because the body becomes resistant to insulin.
This metabolic disorder is primarily categorized into two types: Type 1 diabetes, where the immune system attacks insulin-producing cells in the pancreas, and Type 2 diabetes, which is more prevalent and often associated with lifestyle factors. The history of diabetes dates back to ancient times, with references found in Egyptian and Indian texts. However, it wasn’t until the early 20th century that significant advancements were made in understanding and managing the disease. The landmark discovery of insulin by Frederick Banting and Charles Best in 1921 revolutionized treatment, transforming diabetes from a fatal diagnosis to a manageable condition.
According to the World Health Organization (WHO), diabetes has become a major global health concern, affecting over 422 million people worldwide. The prevalence of diabetes has been rising more rapidly in middle- and low-income countries, contributing critically to mortality rates and the burden of healthcare systems. WHO states that in 2019, diabetes was the ninth leading cause of death, with an estimated 1.5 million deaths directly attributed to the condition.
Fortunately, there have been incredible advancements in diabetes prevention and care over the years. “Diabetes was largely glucose-centric in terms of its management. For folks that have volatile glucose, particularly in Type 1 diabetes, making as smooth an experience as possible so day-to-day living is optimized has been the focus of therapies,” says Dr. John Parker, an endocrinologist at Wilmington Health.
“Now that we have more robust science concerning cardiovascular and kidney disease outcomes with different treatment modalities, that has had a major impact on how we approach diabetes. We still have our eyes on glucose control, but we’re concerned about ensuring we get excellent care regarding the medications to improve all outcomes.”
Even with these advances, there is always more to discover and learn. “We know a lot about treating diabetes, but also we don’t. We have much to learn about the relationship between the brain and diabetes. Not too long ago, we knew nothing about the connections of the incretins (gut hormones), the brain, and the pancreas,” says Dr. Parker. “I think the connection between adrenal dysfunction and type two diabetes is going to create some momentum and push research forward.”
“Diabetes has come a whole long way, and we have a brighter future ahead of us in diabetes management, but we have to master the fundamentals. We still have to make sure that we’re doing as well as we can with diet, physical activity, sleep, stress, and medication adherence,” encourages Dr. Parker. “Many folks live meaningful, productive, and enriching lives with this disease.”
Keep reading to learn about the advances in diabetes prevention and care from Dr. Parker’s perspective.
Meet the Expert: John Parker, MD, FACE, ECNU
Dr. John Parker graduated medical school from the University of North Carolina in Chapel Hill. He completed his internal medicine internship and residency at the University of Kentucky in Lexington. His endocrinology, metabolism, and nutrition fellowship was performed at Duke University in Durham. Currently, he cares for patients and participates in research at Wilmington Health in North Carolina.
Dr. Parker is certified in internal medicine, endocrinology, and diabetes and metabolism. He also received his endocrine certification in neck ultrasound (ENCU) from the American College of Endocrinology. His clinical interests include thyroid diseases, including hypothyroidism, nodular goiter, thyroid carcinoma, bone and calcium disorders, adrenal and pituitary diseases, male hypogonadism, diabetes mellitus, and obesity.
Advances in Equipment
Advancements in physical equipment have significantly transformed diabetes care, offering new ways to monitor and manage the condition with greater precision and ease. From the early days of cumbersome glucose meters to today’s sleek, continuous glucose monitoring (CGM) systems, technology has enabled patients to maintain better control over their blood sugar levels with minimal disruption to their daily lives.
The importance of these advances cannot be understated. “The continuous glucose sensors were a major revolution in our management of patients,” says Dr. Parker. “And now we can get better, easier-to-use versions accepted by patients and insurance companies. It’s make things a lot better.”
But we can do more than monitor blood sugar, too. “We have insulin pumps integrated into the glucose sensors so that insulin delivery is automated. This has been a tremendous benefit in reducing hypoglycemia risk as well as improving a patient’s life so they can have the smoothest experience possible, particularly in Type 1 diabetes.”
Another advancement has been in the delivery of insulin to those who don’t use pumps. Historically, using needles has been a cumbersome and painful process. “The needles are so small now,” says Dr. Parker. “The insulin pen delivery devices with the tiny needles have revolutionized how we treat diabetes.” This has significantly improved the adherence to insulin injections for those with diabetes, making it easier and more comfortable to manage their condition.
Insulin Improvements
Since the discovery of insulin in 1921, there have been monumental advancements in its formulation and administration, enhancing the quality of life for those with diabetes. Initially, insulin derived from animal sources required frequent daily injections due to its rapid action and short-lived effect.
Over the decades, synthetic human insulin was developed, significantly improving compatibility and effectiveness. Today, the advent of long-acting insulins, which provide a more stable and prolonged release of insulin, has revolutionized diabetes management.
These long-acting insulins help patients maintain a consistent baseline insulin level, minimizing the risk of blood sugar spikes or dips. “I think the most significant advancement in diabetes care has been insulin. When Glargine insulin came out in 2001, it was major because of the stability of long-lasting insulin,” says Dr. Parker.
Incretin Treatment
Beyond insulin, there have been significant advancements in oral medications and injectable therapies for diabetes management. The development of incretin-based therapies has provided an alternative to traditional insulin therapy by regulating glucose levels through the gut hormones GLP-1 and GIP. “Incretin therapy has many benefits, and when it came out in 2005, it ushered in the idea that you could have an injectable that was not insulin,” says Dr. Parker. These medications have shown promising results in reducing weight, improving glycemic control, and minimizing side effects such as hypoglycemia.
As GLP-1 medications have become more prevalent, there have been other positive effects:
“Compounds like Victoza, Ozempic, and Mounjaro have been found to have not only glycemic benefits but also weight loss and cardiovascular disease risk benefits,” notes Dr. Parker. “As the medicines were studied more, we have found that they have heart failure benefits as well as mortality due to kidney disease effect. These medications have offered so much more to help our patients.”
Ongoing research in incretin treatment is a promising frontier in diabetes management, focusing on enhancing the efficacy and understanding the broader implications of GLP-1 and GIP-based therapies. “The incretin system relates to the communication between the intestinal hormones and either the pancreas or the hypothalamus regarding metabolism,” explains Dr. Parker. “The research here is very exciting because having a wide variety of the different incretin treatments available will improve patient access tremendously because the cost of these will go down.”
Currently, incretin treatments are very expensive. “I think in some years time, we’re going to get annoying letters from the insurance company asking, ‘Why is your patient not receiving an incretin-based treatment?’ because of the effectiveness of these treatments. These areas are exciting as we increase our understanding of hypercortisolism and its effect on diabetes. Specifically, we are trying to understand more about adrenal hormone excess in the Type 2 diabetes population that contributes to poor glycemic control and complications.”
Dr. Parker continues, “We are also excited about the applications of incretin treatments on obesity. Frequently, obesity and diabetes are intimately connected, and understanding the connection between our counter-regulatory hormones and obesity and weight management will be a huge asset. I also think that we will gain more understanding of liver disease that can come along with type two diabetes and obesity. There are ample areas of therapeutic inquiry”.
Prevention at the Forefront
Prevention is a critical component of diabetes care. While we have many ways to help prevent Type 2 diabetes, that has not been the case for Type 1 diabetes until now.
Introducing medications like Tzield marks a significant milestone in preventing Type 1 diabetes. Tzield, an immunotherapy drug, works by targeting and modifying the immune system’s response, which attacks insulin-producing cells in the pancreas. This proactive approach aims to delay the onset of Type 1 diabetes in individuals at high risk. Studies have shown that using Tzield can slow down the progression of this autoimmune disease, providing extra years of insulin independence and preserving beta-cell function.
“We can detect if someone has pre-Type one diabetes antibodies. We look for the antibodies associated with pancreatic autoimmunity, yet they have normal glucose tolerance. With Tzield, we can hold off Type 1 diabetes in people where it is very likely to progress. The key to this medication and its usage is to be aware of the condition and ensure that people are being screened and tested,” explains Dr. Parker.
Preventing Type 2 diabetes involves a multifaceted approach centered on lifestyle modifications, education, and early intervention strategies. Maintaining a healthy weight through balanced nutrition and regular physical activity is at the core of prevention. Incorporating whole grains, fruits, vegetables, lean proteins, and healthy fats into one’s diet can help manage weight and regulate blood sugar levels.
Additionally, research shows that at least 150 minutes of moderate-intensity weekly exercise has proven effective in reducing the risk of Type 2 diabetes. Beyond lifestyle changes, routine screening for those at high risk, such as individuals with a family history of diabetes or those experiencing prediabetes, is crucial. Early detection through regular monitoring allows for timely interventions to reverse or stall the progression of prediabetes to full-blown diabetes.
Over the years, physicians have become more proactive about helping prevent this disease. “We must be aware as doctors. We’ve got to bring this up with our patients. We’ve got to test. We need to empower our patients and educate them on how not to get Type 2 diabetes,” says Dr. Parker.
Kimmy Gustafson
WriterAt HealthcareDegree.com, Kimmy Gustafson has delivered in-depth and insightful articles since 2019, aiding prospective students to navigate the complexities of choosing the right healthcare degree. Her recent work includes topics such as the ethics of gene editing and physician assistant’s fight for autonomy.
Kimmy has been a freelance writer for more than a decade, writing hundreds of articles on a wide variety of topics such as startups, nonprofits, healthcare, kiteboarding, the outdoors, and higher education. She is passionate about seeing the world and has traveled to over 27 countries. She holds a bachelor’s degree in journalism from the University of Oregon. When not working, she can be found outdoors, parenting, kiteboarding, or cooking.