2005 Presidential Address: Diabetes: past, present, and future.

O ne of my favorite authors is the En-glish writer Charles Dickens. His novels captured the human spirit, while detailing life in England in the 1800s. In 1843, he published a book entitled " A Christmas Carol. " In it, Ebenezer Scrooge, a stingy man of business is visited by the ghost of his deceased partner, Jacob Marley. The purpose of the visit is to prepare Scrooge for the subsequent appearance of three spirits: the spirit of Christmas past, the spirit of Christmas present, and the spirit of Christmas yet to come. The first spirit provides Scrooge with a look back at his early days. The second spirit opens his eyes to the reality of the present. Finally, the third, and most ominous spirit, allows him a glimpse into his future. It is my goal today to use this approach to examine the epidemic of diabetes in the U.S. I will first remind you of where we were a generation ago; I will then focus on the situation today, and finally I will attempt to look into the future. The first spirit to visit Scrooge was the ghost of Christmas past, so let us begin there. In 1985, there were 6.4 million adults with diagnosed diabetes in the U.S. The cost of the disease that year (both direct and indirect) was 14 billion dollars. The National Institutes of Health (NIH) investment in diabetes research was only 189 million dollars. The American Diabetes Association (ADA) and the Juvenile Diabetes Research Foundation (JDRF), on the other hand, were collectively investing only 8.2 million dollars. By 1990, there were 6.7 million adults with diagnosed diabetes, but only four states had a prevalence Ͼ6%. Treatment options were limited. Five insulin preparations were available, including the newly approved human insulin. For the treatment of type 2 diabetes, the only drugs available were the sulfonylureas. These drugs were known to stimulate insulin secretion from the pancreas but to fail as the disease progressed. Home glucose monitoring was in its infancy, as was insulin pump technology. While the early devices were novel advances at the time, their value was not appreciated, and their use was limited. The concept of pancreas replacement as a treatment for type 1 diabetes had emerged but met with little success. Only a few pancreas transplants were carried out each year. The surgery was risky, and the number of recipients who were insulin …