Editor’s Note: This column was written in 2003, when Dr. Gabbe was dean of the Vanderbilt University School of Medicine. In 2008, he was appointed senior vice president for Health Sciences and chief executive officer of the Medical Center at Ohio State University.
One of the pivotal events of the 20th Century was the discovery of insulin in 1921 by researchers at the University of Toronto. Within a year, diabetes had been transformed from a hopeless, wasting disease into one that could be controlled through the injections of a miraculous pancreatic extract.
Daily injections of the hormone saved hundreds of thousands of lives, but it was not the cure for diabetes that many people had hoped it would be. Because glucose control was fairly crude, many patients developed long-term complications of chronic hyperglycemia — blindness, kidney failure, heart disease, neuropathy, and poor circulation requiring amputation of the lower extremities.
When I diagnosed myself to have type 1 diabetes as a medical student in 1968, there were two schools of thought. One of my professors discouraged tight glucose control because of the risk of hypoglycemia, too little glucose in the blood that could lead to coma and death. Others, including my personal physician, urged me to try to keep my glucose level as close to normal as possible.
I chose the latter course because I didn’t want to find out at some future time that I had missed an opportunity to prevent the complications of the disease. This was before the Diabetes Control and Complications Trial confirmed the value of tight glucose control. And it was before glucose meters, so I had to guess what my glucose level was by testing my urine.
Thanks to the technological and pharmacological innovations of the past 15 years, I now use an insulin pump that injects a rapid-acting form of the hormone below the skin, and a glucose meter that gives me a reading of my blood glucose level in five seconds.
But we still don’t understand why and how diabetes and its complications develop as clearly as we’d like. Obesity and type 2 diabetes have reached epidemic proportions throughout the world, and the incidence of type 1 diabetes also is increasing.
This is where medical research plays a critical role. Following in the footsteps of Dr. Frederick Banting, Charles Best and their colleagues at Toronto, scientists around the world are pursuing avenues of inquiry that are improving understanding of this complex disease and which may lead to better methods of treating, preventing and – perhaps one day – curing it.
Vanderbilt University Medical Center has an especially rich heritage in diabetes-related research. Charles “Rollo” Park, John Exton, Earl Sutherland, Joel Hardman, Oscar Crofford, Daryl Granner and Alan Cherrington, to name only a few, helped pioneer current understanding of how glucose and lipid metabolism is regulated. That tradition and that dedication to deciphering the riddle of diabetes continue today. I consider it to be a privilege to be here, both as a patient and as a faculty member.
This issue of Lens provides a glimpse of exciting advances in understanding diabetes: new ways of visualizing the pancreas; decoding the complex interplay of tissues and chemical signals that regulate glucose and body weight; and the prospects for “cell-based therapy” – transplants of insulin-secreting cells that have been created in the laboratory.
I hope our readers will come away with an appreciation for how discoveries in what appear to be unrelated research fields provide important clues to improving diabetes treatment. Interpreting and integrating diverse sources of information is crucial for understanding. That’s the scientist’s job. That’s the nature of science.