Changing Fashions in Diabetes

Abstract

The increasing tempo of change in outlook and way of life is a characteristic of our modern age, and our changing attitudes in medicine keep pace with the rapid metamorphosis of the intellectual and material world around us. When I was asked to write an article for Res Medica on diabetes I thought, therefore, that it might be amusing and instructive to contrast my attitude to the disorder twenty-five years ago when I was a young physician with what it is now when I am a middle-aged or elderly one, for in almost every respect the change has been revolutionary.

Twenty-five years ago we regarded the pathogenesis of diabetes as being very simple, however complicated it might be to treat. We knew that the pancreatectomised animal or the animal poisoned with alloxan became diabetic and died but that it could be kept alive by the appropriate administration of insulin. Diabetes was therefore regarded as being due to a simple deficiency of the internal secretion of the pancreatic islet tissue just as primary myxoedema was due to a simple failure of the thyroid to secrete the thyroid hormone.