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State of diabetes care 100 years after the first insulin injection

 


Take a walk in the main corridor of Joslin Diabetes Center In Boston, Massachusetts, it’s easy to see why adjectives that are often associated with names are “famous.”

A graphic timeline extends down the hallway, sharing many breakthroughs in diabetes treatment that began there.From the early pioneering efforts of Dr. Elliott Joslyn This legendary study, from the first insulin injections given to human patients (almost exactly 100 years ago), advances in treatment, advances in how and why care is delivered, simply to keep diabetics alive. And the care center has been at the forefront for a long time.

This year CEO Dr. Roberta Herman A new partnership based in Cambridge, Massachusetts, in control Beth Israel Leahy Health (BILH)Joslyn not only respects its history, but also wants to continue to make progress towards better treatment, less stressful access and, of course, final treatment.

Joslin is the world’s largest diabetes research center, diabetes clinic, and diabetes education provider. It employs 600 people and has satellite clinics in Massachusetts, Maryland, Illinois, and New Jersey. BILH has more than 4,800 doctors and 36,000 employees.

“Together, we are the driving force behind metabolic research,” Harman told Diabetes Mine.

Herman, who lost his mother to a chronic illness at an early age, has played a leading role in primary care for many years and later became Chief Operating Officer of Harvard Pilgrim Healthcare, one of the largest insurance companies in the United States. She took over the leadership of the Joslin Diabetes Center in January 2020 in the midst of the COVID-19 pandemic.

Diabetes Mine has recently been with Joslyn’s legendary history 100th anniversary of insulin, And the outlook for the current and future status of diabetes treatment.

Herman reminded us that insulin co-discoverer Dr. Frederick Banting and his team administered insulin. First patient, Canadian teenager Leonard Thompson, 100 years ago, January 11, 1922.

Later, the team knew that they needed to administer insulin into the hands of a doctor who understood diabetes and could speed up the use of insulin quickly.

Elliott Joslyn was a natural choice. Graduates from Yale and Harvard were motivated to study and treat diabetes after their mother and aunt were diagnosed with a fatal condition at the time.

He did not discover insulin, but above all, he created the world’s first diabetes registry and continued to keep the patient alive by treating the patient with a diet before insulin (his aunt was at the time in his plan). Lived an amazing 13 years), promoted more closely Management for better health (not verified to landmarks) Diabetes Management and Complications Tria; (DCCT) (1993, after his death) And, of course, once insulin is created, help incorporate insulin into the daily lives of diabetics.

Joslyn has always sought to find a way to live and live longer with this illness.

He was a master of teaching how to live in that condition and a facilitator of education as an important part of treatment.

Some of his most famous quotes still stand today:

“The most familiar diabetics live the longest.”

“It’s better to discuss the distance you walked than the amount you ate.“”

“A well-trained nurse is more valuable than a patient’s doctor.”

Today, the success of diabetes treatment is believed to require education, healthy living and good team support from nurses and other healthcare providers, as well as doctors.

By the time he died in 1962, Joslyn had supported and empowered the discovery and early use of home glucose meters. Dr. Priscilla White To create a program to help diabetic women give birth and raise their children well, we have laid the foundation for the still most influential program on longevity called type 1 diabetes (T1D). Medalist research, And founded his Joslink Clinic — sitting in the same place as it is today — as a global leader in care and breakthroughs.

Over the years, the Joslyn Center has been responsible for many advances in improving the lives of diabetics.

The Beast Eye Institute, This location within the Joslyn Center is a brilliant example of how quality care (which is accessible) can improve lives, Harman said.

The institute has been treating diabetes and eye diseases for decades and in 1967 offered the first laser surgery to stop blindness. Dr. George King They told the crowd at the JDRF National Conference three years ago that they reduced the incidence of blindness in long-term diabetics from 40 percent to less than 1 percent.

Harman said the evidence was in Beatham’s waiting room.

“Fifty years ago, there were as many guide dogs as patients. [here], “She said,” Currently there are few. ”

Even laser surgery, which was said to be revolutionary these days, is becoming an old school, she said. Today, they can treat and prevent diabetic eye disease, for the most part, with drugs.

“It’s a big clinical outcome,” she said. “But we need to do more.”

Joslyn Pediatric Medical Center It’s relatively new compared to the Joslin program over 100 years ago. Harman said he continues to focus on creating programs that support the entire family.

“It’s a family problem,” she said she had a T1D kid at home. “We are not just treating our children. We are involved with the whole family. This is a 24/7 illness and the family needs full support.”

They also focus on the often overlooked segments of the diabetic population: the transition from teens to adults, and the families that surround them.

“Technology must be a great equalizer,” Harman said of that stage of life. This means that teenagers who become young adults can see the team remotely, and families can support the team from a distance (if needed). Continuous blood glucose monitor With remote option.

And there is a population of type 2 diabetes (T2D). Herman is a group that feels that Joslyn will give better results. The BILH Partnership, which accepts approximately 100,000 diabetics and provides resources to the entire BILH network, should support it.

“That’s the question I asked from the beginning,” she said. “What is the proper role Joslyn plays in Type 2?”

They have already opened Latin and Asian clinics, she said, “but there’s more to do here as well.”

The question she wants to answer is, “How can I successfully transition diabetes treatment to primary care?”

“The BILH health system is a perfect fit for this,” she said. She believes that we can “magnify our influence by a factor of five,” but the steps towards this require meticulous attention to detail.

The primary care team needs help, she said. Because management is now more complex, both with more medications to consider and different lifestyle choices to take.

“Test the boundaries between what you should manage and what you should be referred to in primary care [to a specialized diabetes clinic]”Herman said.

In other words, home care is the goal, but so is the understanding when referrals to another location are needed.

Dr. Roberta Herman

Joslin wants to continue the quest to make diabetes treatment accessible and effective, to drive long-term and new research projects, and to improve the lives of all people with diabetes of all kinds as a whole.

For Herman, leading that push is humble and motivating.

She remembers the first time she set foot in her office and the Joslyn Library. The Joslyn Library stores not only literature, but also Joslyn’s famous relics of the past, such as the table in Elliott Joslin’s dining room. “I felt like a little girl walking to my dad’s office,” she said.

The first step in further improving diabetes treatment is to recognize that this condition has a significant impact on the world, she said.

“Before COVID made” pandemic “a common term, diabetes was a pandemic.And that’s still probably later [this pandemic passes].. “

She hopes that the coming era will make educational programs and team approach guidance for living with diabetes more accessible to all.

The pandemic may have helped it, but Joslyn had done it before, she says. They introduced the concept of remote / online care in 2015.

Prior to the 2020 National Quarantine, less than 5% of patients used telemedicine for appointments. When a pandemic occurred, it jumped to 90 percent. Now Harman said Joslyn will continue to promote accessibility for continuous, and hopefully more frequent and influential care.

Benefits of that bonus: Schedule cancellations have decreased exponentially, Harman said.

On the research side, she said, the medalist program (mostly funded by JDRF) will continue to consider people who have lived with T1D for decades and what they can learn from them.

Already, medalist research has unleashed some important discoveries. Perhaps more than that is the discovery that even people who have had T1D for more than 50 years still produce at least small amounts of insulin.

That discovery leads to another important area of ​​research in which Herman wants to continue to focus on Joslyn. Beta cell regeneration..

“Beta cell research is a prime candidate for treating diabetes,” she said.

Joslyn holds the key to progress in converting adult human stem cells into functioning insulin-secreting beta cells, and hopes that they will eventually be safely transplanted into humans.

They are also working on finding ways to fix beta cell defects and identifying new growth factors that stimulate beta cell regeneration, so the still-functioning cells found in medalist studies can help. .. They are also working on evolving technologies for detection, modulation, and protection of immune responses that cause disease or threaten the potential feasibility of transplantation.

And what of push Make insulin more affordable and accessible To all?

Herman said advocacy and policy activities are not included in Joslyn’s main charter because of their focus on treatment and research, but they are helping as much as possible.

First, if the patient is in trouble, work to connect the patient to the insulin supply, such as by accessing insulin through a drug company’s discount program or other means.

“For our patients, an important way our role is growing is to help them get the most out of their interests,” she said, including discount programs and clinical trials. Guide patients to resources.

They also lend their voice whenever needed. “I have a desire to influence policy,” Harman said, adding that when asked, she was happy to appear and speak out.

She said the Joslyn Center played a voice role in getting the US Centers for Disease Control and Prevention (CDC) to include both T1D and T2D as risk factors for COVID-19.

Harman said technology has been incorporated and woven into diabetes treatment in a variety of ways, and that it will continue. Currently, about 50 percent of patients choose it, she said. They are still working on when and why patients should choose to visit telemedicine and face-to-face care.

In addition to the telemedicine changes that appear to be positive for patients, Joslyn is researching ways to better integrate technology into the lives of people with diabetes and those who help them. This includes the T2D community.

Use technologies such as Continuous blood glucose monitor Early in the diagnosis of type 2 diabetes, she said, she could help people control their condition faster and perhaps keep more people away from insulin.

“Insulin is overused,” she said of the T2D community. “And it takes too long from discovery to” properly managed. ” I want to change that. “

BILH’s partnership will make those things more achievable, she said. The increased “satellite presence” in more locations will help Joslin reach more patients, identify trends, and guide better treatment on a larger scale.

Harman said he was excited to take command at this important time, keeping in mind Joslyn’s famous past.

“We remain true to our founder’s goal of being at the forefront of discovery, education and treatment. I don’t think it’s more complicated than that,” he said.

Sources

1/ https://Google.com/

2/ https://www.healthline.com/diabetesmine/diabetes-care-joslin-100-years-first-human-insulin-shot

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