Developments in Diabetes and Insulin Resistance

Abstract

This is the second in a series of articles on presentations at the American Diabetes Association Annual Meeting, San Diego, California, 10–14 June 2005. Alan Cherrington (Nashville, TN) gave the President’s Address at the American Diabetes Association (ADA) Annual Meeting, reviewing some of the progress, and lack thereof, occurring over the past 2 decades. In 1985, there were 6.4 million adults with diagnosed diabetes. The National Institutes of Health invested <$200 million in diabetes research. Human insulin had just become available, and the only oral agents were the sulfonylureas. Home blood glucose monitoring and insulin pump technology were in their “infancy.” Pancreas transplantation had met with little success, with a 25% surgical mortality. Only 30% of patients were insulin independent for ≥1 year, and islet transplants were unsuccessful. The genetic bases of type 1 and type 2 diabetes were unknown, triggers for disease onset were unknown, mechanisms of insulin action were not understood, diabetes prevention was nonexistent, and the team approach to diabetes treatment had just begun. Now there has been an alarming increase in diabetes across the country, with the U.S. in 2003 having 13.8 million people with diagnosed and 5 million with undiagnosed diabetes, as well as 41 million pre-diabetic individuals. The prevalence of diabetes increased virtually every year since 1990, due to population changes, particularly with an increase in diabetes in minorities, increased awareness and detection of diabetes, a change in diagnostic criteria, a reduction in macro- and microvascular complications with attendant increase in life expectancy of diabetes, further increasing the number of individuals and, most important, a tremendous increase in obesity, causing insulin resistance and hence diabetes. The cost of the disease was $92 billion, and the investment in research was somewhat under $800 million in 2002; Cherrington pointed out that spending ∼1% on research is …