20 years of diabetes breakthroughs

Since Practical Diabetes International was first published in 1984, the world of diabetes research has progressed enormously and we at JDRF believe that we are now closer to a cure for type 1 diabetes than ever before. As the largest voluntary funder of diabetes research in the world, JDRF has funded, at least in part, every major breakthrough in these past 20 years and the decade before, including a recent study to identify genetic variation in ‘molecular brake’ for the immune system that increases the risk of type 1 diabetes as well as autoimmune hypothyroidism and Grave's disease. To wish Practical Diabetes International happy birthday and continued success as the foremost monthly information source for diabetes practitioners, we celebrate by giving an overview of the amazing breakthroughs and research discoveries since the journal was first published.

20 years ago: Researchers believed that type 1 diabetes developed suddenly, without warning.

Now: It has been discovered that onset of type 1 diabetes is very gradual, often beginning shortly after birth.

20 years ago: Scientists thought that a single specific environmental factor triggered the onset of diabetes and people were made susceptible to the disease by certain particular genes.

Now: Not only are there a number of genes that increase susceptibility, but also some that protect against developing diabetes. In addition, there are a number of environmental factors that can play a role in developing type 1 diabetes.

20 years ago: Researchers were looking for the single best marker or auto-antibody to predict whether a person will get type 1 diabetes.

Now: Accurate tests for identifying individuals at risk of type 1 diabetes have been developed by focusing on combinations of auto-antibodies.

20 years ago: Researchers started to learn about certain biochemical mechanisms that may play a role in complications and began testing drugs that address them.

Now: Scientists have discovered that the overproduction of superoxide, which happens when the presence of excess blood glucose causes a destructive sequence of events causing damage to otherwise healthy cells and bringing about the occurrence of diabetes based complications. They are now developing a drug to rid the body of superoxide, a treatment that could become integral in the prevention and treatment of complications in the next 10 years.

20 years ago: It was speculated that blood glucose affected the onset of diabetes complications; however, there was no way to test it.

Now: The link between blood glucose control and complications has been proved once and for all by the DCCT: tight glucose control limits the risk of complications.

20 years ago: Home glucose monitoring was new and in the early stages of development and many people were still using urine tests to monitor their glucose levels.

Now: Reliable, fast and small home blood glucose monitoring devices have been developed.

20 years ago: Animal insulins contained up to 20 000ppm of impurities.

Now: Animal insulins contain fewer than 100ppm of impurities.

20 years ago: Traditional human insulins worked well when injected directly into the bloodstream via the pancreas, but were absorbed slowly and unpredictably when injected into human tissue.

Now: Insulin analogs which more closely mimic normal insulin secretion have been developed.

20 years ago: Development had begun into strategies for preventing diabetes in animals.

Now: Clinical trials are underway to test intervention strategies in people at high risk of developing diabetes in order to prevent manifestation of the disease.

20 years ago: Researchers reversed diabetes in laboratory animals using islet transplantation. Pancreas and islet transplantation in humans had a very poor success rate.

Now: Islet transplantations have been shown to work in clinical human trials, although they must still contend with a shortage of islets and the need for immunosuppressive therapies.