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Contents
Introduction
Diabetes has been known for well over 3,500 years. About
2,000 years ago, Arataeus of Cappadocia described this condition
as ‘...a melting down of the flesh and limbs into urine...’,
reflecting the weight loss and excess urine produced in acute
diabetes. Just over 200 years ago, the excess sugar in the
urine of people with diabetes was recognised – an observation
that led to the addition of the word mellitus (from the Latin
word for sweet) to the word diabetes. Just over 100 years
ago, it was demonstrated that the pancreas was involved, when
experimental removal of this organ from animals was shown
to cause diabetes. About this time, Langerhans had discovered
the clusters of cells (islets) in the pancreas that now bear
his name. In 1893, these various observations were brought
together when Láguesse suggested that the Islets of Langerhans
made a substance that prevented excess blood glucose.
Despite several attempts, it was a further 28 years before
two Canadian scientists isolated insulin, the substance
formed in the pancreas that is fundamental to diabetes. This
discovery has been described as one of the first spectacular
triumphs of science and the greatest since the introduction
of antiseptics 50 years earlier. Insulin became available
in 1922 and has continued to be a life-saving medicine ever
since.
Its availability also led to the division of diabetes into
two forms: type 1, an autoimmune disease in which most of
the beta cells have been destroyed and the individual is insulin-dependent
from the start, and type 2, where the body is producing inadequate
amounts of insulin, or the insulin that the body produces
does not work properly. This type can often be controlled
by diet and tablets. In the past 50 years, several other forms
of medication for type 2 have become available and with a
combination of diet, life-style changes and medicines, many
people with diabetes can now enjoy a much improved quality
of life and a near normal life span. However, it is important
to recognise that diabetes can cause great inconvenience and
considerable suffering and can greatly limit an individual’s
activity. As diabetes progresses, many people are increasingly
prone to complications and a significant number develop damage
to their eyes, kidneys, blood vessels, heart and nerves. Major
efforts to develop medicines for these problems are being
made.
Economically, diabetes is a considerable burden on society
and the NHS. About 1.4 million people over the age of 16 have
the condition in the UK and a sharp increase is projected
by the year 2010, due to the ageing population and the effects
of obesity. It has been suggested that as many as half the
people with type 2 diabetes are undiagnosed. If treatment
of the basic condition plus all the possible complications
are considered, diabetes has been estimated to consume from
5.5 to 9.4 per cent of NHS resources. In financial terms,
this means an excess cost of £2.1 to £2.4 billion – excess
cost is the cost of treating diabetes over and above the cost
of treating other diseases. NHS prescriptions for people with
diabetes cost some £123.7 million in 1996 – only a small proportion
of the total cost of diabetes care.
Diabetes can be tackled in several ways: by the development
of improved medicines, by taking steps to improve diet, taking
more exercise and avoiding obesity, and by improving the control
of high blood pressure. Many current approaches to new medicines
development are described in this booklet, and the importance
of diet and exercise, which can help prevent type 2 diabetes
in many people, is also highlighted. In the longer term, pancreas
transplantation and gene therapy may bring about a cure, but
such techniques are unlikely ever to be widely available.
Hopefully, this booklet may encourage some to adopt an altered
lifestyle and thus greatly reduce their risk of developing
diabetes.
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