Research and studies

Were there warnings that diabetes would become the epidemic of the 21st century? In the early 1970s, Peter Bennett and co-workers reported on the extraordinarily high prevalence of Type 2 diabetes in Pima Native Americans. In 1975, we reported the high rates of diabetes in the Micronesian Nauruans in the Pacific. Similar findings followed in other Pacific and Asian island populations. They all indicated the potential for a future global epidemic.

We usually assume that the ups and downs of blood glucose are solely responsible for changes in the release of insulin into the circulation, such as in response to a meal. However, the release of insulin from the pancreas is supported by signals from the alimentary canal (gut). When food is transported from the stomach into the small intestine, from which glucose, fat and proteins are absorbed into the blood, gut hormones are released into the circulation. Around 50%

Diabetic kidney disease (nephropathy) is a major cause of death in people with diabetes. It affects about one-third of people with the condition. Recent studies have demonstrated that the onset and course of diabetic nephropathy can be improved very significantly by several kinds of intervention. However, these interventions have their greatest impact if made before or very early in the course of the development

People with diabetes are prone to cardiovascular disease (CVD). In people with Type 2 diabetes, the rate of heart-related death is two to four times that in people without diabetes. Traditional risk factors for the build-up of cholesterol-rich plaques in the arteries (atherosclerosis), such as high blood pressure, obesity, smoking, and high blood fat levels (dyslipidaemia), are known to increase the cardiovascular risk in people with diabetes. However, other factors may be operative as well.

Diabetes and the disorders associated with diabetes currently affect one billion people world wide. Surprisingly, specialists care for less than 2% of people with diabetes and its related disorders. General practitioners constitute the principal care providers for almost all of these people. The majority of these health professionals serve in an environment with very limited resources. Nevertheless, within such health-care systems, these resources can be optimized, and evidence-based medicine can be practised. Roger S Mazze reports on the potential improvements to

In the last 10 years, genomic and proteomic technologies have been applied to identify and develop a new generation of diabetes treatments. While these technologies have become increasingly automated, producing a deluge of potential therapeutic targets and biological insights, projections estimate that individual drug development time and cost will continue to rise and soon exceed 1 billion USD. A significant contributor to this rising cost is the large

Despite major fluctuations in supply and demand, sophisticated mechanisms in the body maintain levels of blood sugar (glucose) within narrow limits. Although under normal conditions, insulin is the major regulator of blood glucose levels, growth hormone (GH) and insulin-like growth factor-1 (IGF-1) play an important contributory role. Both of these hormones have potent effects on glucose metabolism which may be utilized in diabetes management. Richard Holt explains the growing interest in exploiting the effects of GH and IGF-1 for people with diabetes.

Diabetes has many complications which can take decades to develop. Scores of therapies are now available for the prevention of Type 2 diabetes, and the complications of diabete. People with diabetes vary widely in their risks and histories of diabetes-related complications. How, then, can we choose from the many treatment options which are currently on offer to people with the condition?

The relative roles of pancreas transplantation and islet transplantation in the management of diabetes are perhaps best examined in the context of the American Diabetes Association (ADA) position statement - revised in 2003. Given the growing success of islet transplantation, it seems worthwhile to examine whether the ADA recommendations should be reconsidered.

Research advances in diabetes have led to increased therapeutic options for people with the condition. This has led to increasing levels of satisfaction among the consumers of these treatment options – people with diabetes. One aspect of satisfaction deals specifically with the person's evaluation of medical treatments. Treatment satisfaction