Trends in diabetes self-management education: where are we coming from and where are we going? A narrative review.

AIMS: To summarize the history, development and efficacy of diabetes self-management education on glycaemic control and mental health in adults and children or adolescents with type 1 diabetes and people with type 2 diabetes. A further aim was to review the status of implementation of diabetes self-management education into routine care and outline current gaps in implementation and research. METHODS: We searched PubMed and Google scholar for German- and English-language articles regarding diabetes self-management education, glycaemic control and mental health, and restricted this search to meta-analyses. RESULTS: Diabetes education has evolved from a compliance- and knowledge-oriented approach to an empowerment- and self-management-oriented approach. Diabetes self-management education seems to have a greater impact on glycaemic outcomes than on mental health outcomes, but the latter are rarely assessed. Technological development and digitalization can provide chances and challenges for diabetes self-management education. Digital solutions show promising results and great potential for improving the efficacy of diabetes self-management education further and providing ongoing support. The implementation of diabetes self-management education into routine clinical care frequently remains a challenge. CONCLUSION: Diabetes self-management education has been acknowledged as an essential part of diabetes therapy; however, current gaps regarding the efficacy of diabetes self-management education on mental health, and the need for education on the use of diabetes technology, are future avenues for research.

Diabetes Technology in the Inpatient Setting for Management of Hyperglycemia.

In past decades, a rapid evolution of diabetes technology led to increased popularity and use of continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) in the ambulatory setting for diabetes management, and recently, the artificial pancreas became available. Efforts to translate this technology to the hospital setting have shown accuracy and reliability of CGM, safety of CSII in appropriate populations, improvement of inpatient glycemic control with computerized glycemic management systems, and feasibility of inpatient CGM-CSII closed-loop systems. Several ongoing studies are focusing on continued translation of this technology to improve glycemic control and outcomes in hospitalized patients.

Insulin: Almost a Century of Lifesaving.

The identification and purification of insulin in 1922 changed life for individuals with type 1 diabetes mellitus (T1DM). Its discovery was, to a certain extent, serendipitous. Although medical researchers suspected that some type of hormone was responsible for carbohydrate metabolism, by the end of the 19th century they had made little progress. When World War I broke out, efforts stalled. A somewhat cantankerous group of Canadian researchers led by Frederick Grant Banting, a surgeon, are credited with insulin's discovery. Their initial research was discredited and criticized for poor technique. Regardless, they persevered, and in January 1922 they successfully treated their first patient. A mere nine months later, collaboration between the University of Toronto and Eli Lilly Company made insulin available in North America. Derived from beef and pork pancreases, the 40 unit/mL product little resembled today's more refined human insulin. While insulin is indispensable to individuals with T1DM, it is also used or being studied for several different conditions. Some researchers have dubbed Alzheimer's disease "type 3 diabetes" because of similar aberrations in the blood-brain barrier and protein deposits.

Diabetes and "defective" genes in the twentieth-century United States.

In the decades following the discovery of insulin, eugenicists grew concerned that more diabetics would survive into their reproductive years and contribute "defective" genes to the gene pool. Insulin thus came to be seen as both a blessing for the individual and a problem for the future of humankind. Nevertheless, diabetics in the United States were neither prevented nor discouraged from reproducing. I argue that this stemmed from the widespread belief that diabetes was a disease primarily of middle-class whites, who possessed positive traits that outweighed their particular genetic defect. Historians of eugenics have demonstrated convincingly that race and class stereotypes made some populations more vulnerable to coercive eugenic practices. The case of diabetes demonstrates that race and class stereotypes could also confer protection. In the end, possession of a defective gene mattered less than the perception of one's contribution to society.

Non-exercise physical activity in agricultural and urban people.

With evidence that urbanisation is associated with obesity, diabetes, hypertension and cardiovascular disease, this article compares daily physical activity between rural and urban dwellers. Specifically, it examines habitual daily activity levels, non-exercise activity thermogenesis (NEAT) and energy expenditure in agricultural and urban Jamaicans and urban North Americans. Ambulation was 60 per cent greater in rural Jamaicans than in the urban dwellers (4675 ± 2261 versus 2940 ± 1120 ambulation-attributed arbitrary units (AU)/day; P = 0.001). Levels of ambulation in lean urban Jamaicans were similar to those in lean urban North Americans, whereas obese urban dwellers walked less than their lean urban counterparts (2198 ± 516 versus 2793 ± 774 AU/day; P = 0.01). The data with respect to daily sitting mirrored the walking data; obese Americans sat for almost four hours more each day than rural Jamaicans (562 ± 78 versus 336 ± 68 minutes/day; P < 0.001). Urbanisation is associated with low levels of daily activity and NEAT.

A socio-biological explanation for social disparities in non-communicable chronic diseases: the product of history?

This study places social disparities in the major non-communicable chronic diseases within their global economic and historical contexts. Rapid economic transition outside the developed world provides a unique opportunity to re-examine the origins of, and biological mechanisms driving, social disparities. Gaps in prevailing theories focusing on material resources, civic infrastructure and social structure are identified. Using longstanding experimental evidence and epigenetic theories, it is suggested that exposure to economic development over generations (ie, improved living conditions over historical time) could by acting on different biological axes (somatotrophic and gonadotrophic) generate specific patterns of social disparities. Moreover, these same processes could initially generate a transient epidemic of diabetes as well as a permanent increase in male risk of premature ischaemic heart disease. As such, this study demonstrates the importance of context, and implies that current evidence from the developed world may be largely uninformative for preventing or mitigating social disparities in non-communicable chronic diseases elsewhere, suggesting research efforts should be focused on developing countries.

"Couldn't live without it": diabetes, the costs of innovation and the price of insulin in Canada, 1922-1984.

This article traces insulin prices in Canada from 1922, just after its discovery at the University of Toronto, to 1984 when production fell out of Canadian control. Connaught Laboratories (part of the University of Toronto from 1914 to 1972) was the first to manufacture insulin and remained the sole Canadian producer. As a public trust, Connaught remained committed to providing insulin at the lowest possible price despite increasing economic pressures. This article analyzes the context surrounding the price of insulin preparations and how they fell from 1922 to 1942, remained unchanged until 1967, and rose during the 1970s.

Antidiabetic drugs used in Europe prior to the discovery of insulin.

Many therapeutic agents had been used for the treatment of diabetes mellitus before insulin was discovered and several hundred plants have shown some extent of antidiabetic activity. This study tries to explore which agents were most widely used in Europe in the pre-insulin era. According to the scientific literature and the proprietary drug industry around 1900, more than 100 agents were considered to have hypoglycemic activity. Most of them seem to have been used only occasionally while some others were recommended and marketed to a large extent. Among the medicinal plants, Syzygium cumini (syn. S. jambolanum, Eugenia jambolana), Vaccinum myrtillus and Phaseolus sp. were most common, and other frequently used agents were opium, opium alkaloids, other alkaloids like quinine or Belladonna alkaloids, salicylates, alkaline substances like sodium (bi)carbonate and even strong poisons like arsenic or uranium salts. Syzygium jambolanum seed powder seems to be one of the most intensively studied antidiabetic agents of plant origin.

Socioeconomic gradients in cardiorespiratory disease and diabetes in the 1960s: baseline findings from the GPO study.

OBJECTIVES: To describe the socioeconomic distribution of risk factors for cardiorespiratory disease and diabetes in employed women and men in the late 1960s. STUDY DESIGN AND METHODS: Cross-sectional data were collected from 3345 General Post Office (GPO) employees in London, via a questionnaire and clinical examination, between October 1966 and April 1967. RESULTS: Our occupational grade classification conformed to expected patterns of greater car ownership and gardening among higher-grade women and men, and greater height in higher-grade men (highest-lowest grade 175.0-170.7 cm, P<0.001). A strong inverse grade gradient in bronchitis (2.1-9.4%, P<0.001) and a strong positive gradient in FEV1 (3.10-2.58l, P<0.001) were observed in men, although smoking was less consistently associated with grade. There was no consistent inverse association between grade and any cardiovascular risk factor in either sex, but strong inverse gradients in prevalence of impaired glucose tolerance (IGT) (5.1-18.2%, P<0.001) and 2-h glucose (4.14-4.25 mmol/l, P<0.001) in non-diabetic men. Using car ownership as an alternative measure of socioeconomic position, findings in men were replicated for respiratory measures, IGT and 2-h glucose prevalence. Inverse gradients were additionally observed for blood pressure, cholesterol and electrocardiogram abnormalities. CONCLUSIONS: The GPO study confirms existing evidence of socioeconomic gradients in respiratory risk factors and provides new evidence of gradients in risk factors for diabetes in men. Although there was no conclusive evidence of an occupational gradient in any cardiovascular risk factor, car ownership was a good indicator of lower risk in men. No socioeconomic gradients in cardiorespiratory or diabetic risk factors were observed in women.