Management of Diabetes: An Overiew
As stated previously, the management of diabetes has evolved over the years. Since the earliest recorded statements about the disorder in 1552 BCE by Hesy-Ra, an Egyptian physician who wrote, in the Ebers Papyrus, a disorder associated with “frequent urination”, and in the first century A.D., the Greek physician Aretaeus used the following terms to graphically describe the nature of this life-ending disorder which he named “diabetes”. The word comes from the Greek word for "siphon" and reflects what is now known as the earliest description of diabetic patients’ classic, extreme thirst and "melting down of flesh and limbs into urine." "Diabetes indeed appears to have been a death sentence in the ancient era: Aretaeus did attempt to treat it, but could not provide a good prognosis. He commented that ‘life (with diabetes) is short, disgusting and painful.’ With the discovery of insulin in 1921, lives were saved. Eli Lilly and Company responded to the loud clamoring for insulin with the mass production of it in 1922" (Green, n.d.).
For many years, insulin was the only drug used to treat diabetes. Soon, however, an awareness that two types of diabetes afflicted people – the original type in which individuals produced no insulin – victims were typically children – and another type in which individuals seemed to be resistant to insulin – victims were typically adults. These were later labeled Juvenile-Onset Diabetes* and Adult-Onset Diabetes** respectively. Whereas insulin worked for both types of diabetes, the amounts required to control the blood glucose in the latter group were significantly greater than the amounts required to control the blood glucose of those with DMT1.
The discovery of sulfonylureas – the first oral agents used to treat DMT2 – was serendipitous to the use of sulfonamide antibiotics in the treatment of typhoid fever in 1942. Some patients taking these drugs were found to experience severe hypoglycemia. After considerable research, stimulation of insulin secretion by these drugs was confirmed, and the first sulfonylureas were used to treat DMT2 in 1955 (Henquin, 2004). While insulin remains the primary treatment for DMT1, from 1955 until present time many other medications have been developed – both oral and injectable – to treat DMT2.
Management of diabetes has a primary goal – to achieve an A1c value of < 7% without severe hypoglycemic episodes. Along w/ this goal is the goal that individuals with diabetes will experience the highest quality of life possible. This includes the avoidance of the complications associated with diabetes, particularly with poorly controlled diabetes. The incorporation of lifestyle management with foci on nutrition and exercise as well as self-monitoring of blood glucose and regular medical checkups is particularly important in achieving the goals associated with living with diabetes.
The four cornerstones of diabetes management are nutritional therapy, exercise, medication, and self-monitoring of blood glucose (SMBG). Each of these plays a critical role in the achievement of blood glucose control, avoidance or delay of complications, and improving the quality of one's life. Balancing all four is critical to success.
*Now called "diabetes mellitus type 1" (DMT1)
**Now called "diabetes mellitus type 2" (DMT2)
Telemedicine and Diabetes Care
In 2018, the American Diabetes Association (ADA) addressed the need of rural populations and those who experienced limited access to medical care by endorsing the use of telemedicine in such cases (American Diabetes Association, 2018, p. S8). Included in the endorsement were references to "a growing body of evidence for its effectiveness, particularly with regards to glycemic control as measured by A1c" (pg. S8). "Telemedicine is defined as the use of telecommunications to facilitate remote delivery of health-related services and clinical information (American Telemedicine Association, 2018). Interactive strategies that facilitate communication between providers and patients, including the use of web-based portal or text messaging and those that incorporate medication adjustment appear more effective. There is limited data available on the cost-effectiveness of these strategies" (American Diabetes Association, 2018, p. S8).