WHAT’S HOT IN DIABETES: HISTORICAL PERSPECTIVE

Sunday, February 27, 2011 10:27
Posted in category Diabetes

For many years, physicians who dealt with diabetic patients were often passive in their treatment strategies. There were reasons for this. Many type 1 diabetics were very difficult to manage, alternating between hyper- and hypoglycemia, and progressing with complications of visual impairment, renal insufficiency, and neurologic disabilities. Assessment of results was crude, and action steps were based upon urine glucose levels or on occasional blood glucose determinations done during infrequent office visits. Inaction often was the result.
Concomitantly, the much larger population with type 2 diabetes did not do well. There were limited choices for drug therapy—older insulin preparations which were antigenic and poorly timed for the demands of the disease, and an oral agent formulary which was limited to the sulfonylurea drug class. Huge doses of insulin were needed for glycemic control and some questions had been raised about cardiotoxicity of sulfonylurea drugs. There was little recognition of the input of dyslipidemia, hypertension, or a prothrombotic state to the cardiovascular complications of type 2 diabetes. Further, there was a paucity of effective drugs to address these critical cardiovascular risk factors.
The picture was clouded by a tendency for apathy on the part of the patients. Physicians spoke of “noncompliance,” while patients were not certain what to comply with or how to do it effectively. To many physicians and patients, management of diabetes was a nightmare. Fatalism prevailed.
All of this changed dramatically in the last decade. A proactive climate now prevails. Evidence-based guidelines have emerged, and the tools for effectively dealing with type 1 and type 2 diabetes and preventing progression of complications are now generally available. The key issue now is translation of the findings of this revolution in diabetic care to positive action by physicians and patients.
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