Breaking Patterns: The Long Road to a Diabetes Solution

In 1872, German Egyptologist Georg Ebers made a surprising discovery related to the ancient practice of medicine. The discovery, found in southern Egypt, was a papyrus believed to contain the first documented reference in history to diabetes. Although Eber’s papyrus was estimated to date back to 1550 B.C., it contained passages referencing older documents—some as old as 3400 B.C. From that period through the 19th century, there were very few milestones in our understanding of the disease or in our ability to manage it. The next 200 years or so would witness a much faster pace of progress but would also show a repeated pattern of enthusiasm, disappointment, and recurring hope.

As I sat—a few hundred kilometers north of where Eber’s papyrus was written—to prepare to write this column, I was reading a recent review paper on the subject. The authors concluded enthusiastically that “we are witnessing a revolution in the area of diabetes management.” My reading was interrupted by a phone call from a friend who wanted to reschedule a preplanned lunch because his uncle, who is diabetic, was admitted to the hospital in preparation for leg amputation surgery. While my friend was wondering what kind of clinical and psychological support his uncle would need after the surgery, my thoughts wandered back to the paper I was reading, and I found myself wondering if my friend’s uncle would agree with its main conclusion. The situation was a manifestation of the fact that, despite all the progress we have made in our fight against diabetes, we cannot claim in any way that we are close to winning. This is the story found within this issue of IEEE Pulse: interviews and articles written by correspondents and diabetes experts from around the world demonstrate much of the science, technology, and social dynamics behind the recurring pattern of enthusiasm, frustration, and hope.

The opening article by science journalist Shannon Fischer is an overview of the fight against diabetes, and David Katz, director of the Prevention Research Center at Yale University School of ­Medicine, provides an objective attempt to capture the nature of this fight and to propose ways to be betterequipped to handle it.

We learn about the situations of two regions especially affected by this epidemic in the articles by Ismail Laher, who takes a closer look at the state of the disease in the Middle East, and Viswanathan Mohan, who explains how communication technologies are being used to screen and manage diabetes in rural India.

While prevention may not require much thinking outside the box, having better technology to manage the disease does. This is clear in the work of Jochen Lang and his research fellows at Bordeaux University, France, who employ real pancreatic beta cells to work as a true biosensor. And finally, correspondent Leslie Mertz reports on advances in the struggle against diabetes complications such as foot ulcers, a major scourge among diabetics.

Despite all of the contributions by researchers around the world, many open questions remain. One such question is: Do we have the right environment to incentivize solutions that can resolve the problem? Health care providers are getting paid for their services regardless of the outcomes, and technology and pharmaceutical vendors are making good margins on their products, again, regardless of the outcomes. However, one must be careful when drawing conclusions suggesting that performance-related compensation schemes could result in better patient outcomes. What makes diabetes different from many other diseases (e.g., cancer) is that, in many cases, patient behavior is the most fundamental component of the performance circuit.

In addition, an important question related to obesity is still without definitive answers: which factor causes the other, obesity or insulin resistance? While the conventional medical belief asserts that obesity is the cause of insulin resistance, it has been suggested that obesity may be a defense mechanism to protect the body from the negative effects of insulin resistance. Can such a theory stand? And what would be the implications? Moreover, obesity is related to two main components: overeating and underexercising, with the latter being a behavioral issue for sure. But what about overeating? Is it purely a behavioral issue for which the patient is to blame? Are we ignoring other important physiological factors? Are we ignoring the negative contributions from other entities, including the diet industry? Do clinicians and dietitians need to revise the current body mass index tables to avoid unnecessarily tight targets that cause more people to fail in their weight-management initiatives? These questions still need resolution if we are to better understand the disease parameters.

I am excited to be the guest editor of this issue and am grateful for the tremendous efforts of the authors and our outstanding editorial team. I hope the varying perspectives presented in this issue of IEEE Pulse and the somewhat stimulating questions that I presented will trigger a discussion on the blog of the Web version of this issue. In our long struggle against diabetes, we need to challenge—together—every bit of the conventional wisdom and join our efforts if we want to break the cyclical pattern of enthusiasm followed by disappointment and focus instead on renewed hope for a successful path to managing this disease.