Food As Medicine: Diet, Diabetes Management, and the Patient in Twentieth Century Britain.

In classic accounts of the development of modern medicine in Europe and North America, the sick person is often portrayed as having a history of disappearance with the rise of the objectified body of the modern patient. To this account, sociologists and historians of medicine have added another for the period after 1950, in which the patient as subjective person "reappears" in medical discourse. However, despite histories of practice and identity revising narratives of disappearance, the patient's reappearance has largely escaped further assessment. Using an analysis of dietary management in twentieth-century British diabetes care, this article challenges accounts of this reappearance in three ways. Firstly, it argues that discursive interest in the social and psychological aspects of care emerged earlier than suggested. Secondly, it grounds such interest in reconfigured institutional arrangements that were initially designed to rationalize care and improve efficiency. Finally, it argues that patients regularly exceeded the efforts of even an expanded management regime to normalize and regulate life. Food planning, preparation, and consumption continued to sit at the nexus of competing demands that mediated medical efforts to cultivate governable selves and bodies.

History, Prevalence and Assessment of Limited Joint Mobility, from Stiff Hand Syndrome to Diabetic Foot Ulcer Prevention: A Narrative Review of the Literature.

BACKGROUND: Limited Joint Mobility (LJM) is a dreaded complication of Diabetes Mellitus (DM). During the last half century, LJM has been studied in patients of different age because it has been considered useful for the monitoring of a patient's condition and for the prevention of vascular disease and diabetic foot. OBJECTIVES: The main aims of this review are to describe the relationship between DM and joint mobility as well as its prevalence and assessment. We have also investigated the role of LJM in the development of diabetic foot ulcers. METHODOLOGY: An in-depth literature search was conducted to identify studies that examined the prevalence and characteristics of LJM in patients with DM of different types, age, durations and chronic complications. RESULTS: Many factors (therapy improvements, population characteristics and different evaluation methods) concur to hinder an exact assessment of the prevalence of LJM. However, it has been confirmed that LJM is widespread among patients with DM and may affect more than two-thirds of them in addition to being a major risk factor for foot ulcer. Its role in the monitoring of a patient's condition is also important for the definition of risk thresholds such as in patients with diabetic foot. The efficacy of exercise therapy for the treatment of LJM, also in patients at risk of foot ulcer, has not been discussed. CONCLUSION: Difficulties encountered in the definition of the prevalence of LJM may hinder its study and the establishment of preventive interventions. However, LJM plays a key role in the monitoring of patients, especially those at risk for ulcer.

C-Peptide replacement therapy in type 1 diabetes: are we in the trough of disillusionment?

Type 1 diabetes is associated with such complications as blindness, kidney failure, and nerve damage. Replacing C-peptide, a hormone normally co-secreted with insulin, has been shown to reduce diabetes-related complications. Interestingly, after nearly 30 years of positive research results, C-peptide is still not being co-administered with insulin to diabetic patients. The following review discusses the potential of C-peptide as an auxilliary replacement therapy and why it's not currently being used as a therapeutic.

Pathophysiology of type 1 and type 2 diabetes mellitus: a 90-year perspective.

Diabetes mellitus is a complex metabolic disorder associated with an increased risk of microvascular and macrovascular disease; its main clinical characteristic is hyperglycaemia. The last century has been characterised by remarkable advances in our understanding of the mechanisms leading to hyperglycaemia. The central role of insulin in glucose metabolism regulation was clearly demonstrated during the early 1920s, when Banting, Best, Collip and Macleod successfully reduced blood glucose levels and glycosuria in a patient treated with a substance purified from bovine pancreata. Later, during the mid-1930s, clinical observations suggested a possible distinction between 'insulin-sensitive' and 'insulin-insensitive' diabetes. Only during the 1950s, when a reliable measure of circulating insulin was available, was it possible to translate these clinical observations into pathophysiological and biochemical differences, and the terms 'insulin-dependent' (indicating undetectable insulin levels) and 'non-insulin-dependent' (normal or high insulin levels) started to emerge. The next 30 years were characterised by pivotal progress in the field of immunology that were instrumental in demonstrating an immune-mediated loss of insulin-secreting ß-cells in subjects with 'insulin-dependent' diabetes. At the same time, new experimental techniques allowing measurement of insulin 'impedance' showed a reduced peripheral effect of insulin in subjects with 'non-insulin-dependent' diabetes (insulin resistance). The difference between the two types of diabetes emerging from decades of observations and experiments was further formally recognised in 1979, when the definitions 'type I' and 'type II' diabetes were introduced to replace the former 'insulin-dependent' and 'non-insulin-dependent' terms. In the following years, many studies elucidated the natural history and temporal contribution of insulin resistance and ß-cell insulin secretion in 'type II' diabetes. Furthermore, a central role for insulin resistance in the development of a cluster of cardiometabolic alterations (dyslipidaemia, inflammation, high blood pressure) was suggested. Possibly as a consequence of the secular changes in diabetes risk factors, in the last 10 years the limitation of a simple distinction between 'type I' and 'type II' diabetes has been increasingly recognised, with subjects showing the coexistence of insulin resistance and immune activation against ß-cells. With the advancement of our cellular and molecular understanding of diabetes, a more pathophysiological classification that overcomes the historical and simple 'glucocentric' view could result in a better patient phenotyping and therapeutic approach.

Philip E. Cryer, MD: Seminal Contributions to the Understanding of Hypoglycemia and Glucose Counterregulation and the Discovery of HAAF (Cryer Syndrome).

Optimized glycemic control prevents and slows the progression of long-term complications in patients with type 1 and type 2 diabetes. In healthy individuals, a decrease in plasma glucose below the physiological range triggers defensive counterregulatory responses that restore euglycemia. Many individuals with diabetes harbor defects in their defenses against hypoglycemia, making iatrogenic hypoglycemia the Achilles heel of glycemic control. This Profile in Progress focuses on the seminal contributions of Philip E. Cryer, MD, to our understanding of hypoglycemia and glucose counterregulation, particularly his discovery of the syndrome of hypoglycemia-associated autonomic failure (HAAF).

Autorrelato de diabetes e atividade física no Brasil / Self-reported of diabetes and physical activity in Brazil

Embora exista um consenso de que a prática de atividade física (AF) ajuda a prevenir o Diabetes Mellitus (DM) e melhorar a qualidade de vida destes indivíduos, ainda é alta a prevalência de inatividade física entre os diferentes grupos etários de pessoas. O presente artigo descreve a prevalência de autorrelato de DM, o nível de AF desta população e variáveis associadas a este desfecho em adultos e idosos brasileiros. Foi realizado um estudo transversal de base populacional com amostra de 12.402 adultos e 6.624 idosos de 23 estados brasileiros. A prevalência de autorrelato de DM na população de adultos foi de 3,5% (IC95% 3,2-3,9), enquanto nos idosos foi de 16,9% (IC95% 15,9-17,8). Em relação à prática de AF observou-se que entre os indivíduos que relataram ter DM, 82,6% (IC95% 79,0-86,1) dos adultos e 88,2% (IC95% 86,3-90,1) dos idosos foram considerados insuficientemente ativos. Por outro lado, entre os indivíduos que não relataram DM a prevalência de indivíduos insuficientemente ativos entre os adultos e idosos foi de 82,5% (IC95% 81,9-83,2) e 86,3% (IC95% 85,4-87,2) respectivamente. É a alta prevalência de inatividade física entre os indivíduos que relatam ou não o DM.

Although there is a consensus that the practice of physical activity (PA) helps prevent Diabetes Mellitus (DM) and improve the quality of life of individuals, it is still a high prevalence of physical inactivity among different age groups of people. This article describes the prevalence of self-report of DM, the level of PA of this population and variables associated with this outcome in Brazilian adults and elderly individuals. A cross-sectional population-based was conducted with a sample of 12,402 adults and 6,624 elderly individuals from 23 Brazilian states. The prevalence of self-reported DM in the adult population was 3.5% (IC95% 3,2-3,9), while in the elderly one was 16.9% (IC95% 15,9-17,8). Regarding the PA practice, it was observed that among individuals reporting diabetes, 82.6% (95% CI 79.0-86.1) of adults and 88.2% (95% CI 86.3-90.1) of the elderly were considered insufficiently active. Moreover, among individuals that did not reported DM, the prevalence of PA insufficient was 82.5% (95% CI 81.9-83.2) and 86.3% (95% CI 85.4-87.2) respectively. It is high the prevalence of physical inactivity among individuals who report or not the DM.

Diabetic gastroparesis-backwards and forwards.

Diabetic gastroparesis was once thought to be rare, associated with a poor prognosis, and to affect only patients with type 1 diabetes and irreversible autonomic neuropathy. A landmark study conducted by Horowitz et al. and published in JGH in 1986 paved the way for further studies to examine the pathophysiology, natural history and prognosis of diabetic gastroparesis, as well as its optimal management. This review summarizes the developments in knowledge gained over the last ∼25 years that have led to understanding about normal and disordered gastric emptying in diabetes, with a particular emphasis on the inter-relationship between the rate of gastric emptying and the regulation of blood glucose.

[History of diabetology in Lower Silesia]. / Rys historyczny diabetologii na Dolnym Slasku.

The authors presented the history of diabetology in the time before and after the 2nd world war, the outstanding diabetological scientists f.e. professor Minkowski, Stolte, Lublin. Further presented was the actual situation and development of the diabetology in Lower Silesia.

Disparities in neighborhood food environments: implications of measurement strategies.

Public health researchers have begun to map the neighborhood "food environment" and examine its association with the risk of overweight and obesity. Some argue that "food deserts"­areas with little or no provision of fresh produce and other healthy food­may contribute to disparities in obesity, diabetes, and related health problems. While research on neighborhood food environments has taken advantage of more technically sophisticated ways to assess distance and density, in general, it has not considered how individual or neighborhood conditions might modify physical distance and thereby affect patterns of spatial accessibility. This study carried out a series of sensitivity analyses to illustrate the effects on the measurement of disparities in food environments of adjusting for cross-neighborhood variation in vehicle ownership rates, public transit access, and impediments to pedestrian travel, such as crime and poor traffic safety. The analysis used geographic information systems data for New York City supermarkets, fruit and vegetable markets, and farmers' markets and employed both kernel density and distance measures. We found that adjusting for vehicle ownership and crime tended to increase measured disparities in access to supermarkets by neighborhood race/ethnicity and income, while adjusting for public transit and traffic safety tended to narrow these disparities. Further, considering fruit and vegetable markets and farmers' markets, as well as supermarkets, increased the density of healthy food outlets, especially in neighborhoods with high concentrations of Hispanics, Asians, and foreign-born residents and in high-poverty neighborhoods.

The Framingham Study, diabetes mellitus and cardiovascular disease: turning back the clock.

The global population of individuals with diabetes is important and rapidly growing. Because of the link between diabetes and cardiovascular disease (CVD), it is expected that diabetes will be an important driver of the future burden of CVD around the world. A connection between diabetes and CVD was suspected as earlier as in the mid 19th century. However, CVD in diabetes received less attention until the advent in the 20th century of treatments that allowed people with diabetes to live long enough to experience CVD. Since then the relationship between diabetes and CVD has been extensively investigated and characterised. The present article outlines the important contribution the Framingham Heart Study has made to the recognition of diabetes as a cardiovascular risk factor and the way in which the study has informed the association between other risk factors and CVD in the presence of diabetes, the changing pattern of the risk with time, and the quantification of CVD risk in the presence of diabetes. Through this contribution, Framingham has largely influenced our understanding of CVD in people with diabetes. Lines of investigation regarding cardiovascular health in this population are still wide open, and the Framingham Study continues to be part of this journey.

Was Maria de' Medici a diabetic patient?

Queen Maria de' Medici (1573-1642) died in a miserable, marasmic state. Infections, gangrene, weight loss, fatigue and respiratory problems suggest a progressive decompensation of a previously existing Type 2 diabetes. The lack of biochemical data, however, permits only circumstantial evidence of this hypothesis. The author proposes that the queen developed subclinical diabetes after the age of 45, when she became obese due to excessive eating and lack of exercise. With a clear familial predisposition, she could have become insulin resistant and chronically hyperglycaemic. The presence of an internal deviation of the left eye, visible on several late portraits, suggests a mononeuropathy of cranial nerve VI. Repeated skin infections and gangrene of the lower limbs during the last month of her life complete the clinical diagnosis. Hyperglycaemic ketosis with Kussmaul respiration without adequate treatment may have caused her death.