Technology is increasingly proving beneficial in helping patients with diabetes achieve better glycemic control with less hypoglycemia. However, there are little data during pregnancy. Old randomized trials using insulin pump during pregnancy have not shown improvements in glycemic control, while more recent cohort studies obtained variable results with either similar or worse glycemic control and neonatal outcomes. Considering these still unsatisfactory results, many expectations have been raised by the introduction of continuous glucose monitoring (CGM). "Professional" CGM has proved valuable as an investigational tool, giving deeper insight into glucose pathophysiology and effects of diabetes in perinatal outcomes, but its routine clinical application was predominantly disappointing on pregnancy outcome. More recently, real-time CGM (RTCGM) seems to offer the most interesting prospects. While an earlier trial using intermittent RTCGM was not very encouraging, the CONCEPTT study, a multicenter, randomized trial of continuous use of CGM showed improved glycemic control and neonatal outcomes. Preliminary data from closed-loop studies in pregnancy show improved nocturnal time in target and less hypoglycemia. Daytime time in target with postprandial highs remain a challenge. Further large randomized trials in pregnancy with hybrid closed-loop systems are needed to show safety and efficacy in the broader pregnant population. (c) 2020 S. Karger AG, Basel
The relationships between psyche and glycemic disorders can be divided into three historical periods: the first one before Thomas Willis's discovery of "sweet urine" in 1670, the second between this event and the discovery of insulin, and the third one following the introduction of insulin into clinical practice. These relationships can be categorized as: (1) influence of psycho-emotional factors at the onset of diabetes, (2) influence of psycho-emotional factors on the course of diabetes, and (3) influence of diabetes on psychological conditions. Since it was first thought of, the fundamental importance of continual psychological support in achieving complete control of diabetes has been obvious, and progress made thanks to the willpower of diabetologists. This was achieved by such varied means as: summer camps, teaching programs, patient education, development of standards for employment and insurance, proposing diabetic celebrities as models, the organization of public open days, and dedicated newsletters and magazines. Finally came the opening of diabetes centers and setup of patient associations at national and, subsequently, international level, culminating in the first International Congress of Diabetic Associations in 1949 and of the International Diabetes Federation in 1952. All these instruments helped to strengthen and guide patients away from passivity and resignation and towards a philosophy of hope and proactive self-management. (c) 2020 S. Karger AG, Basel
Insulin was discovered in 1921, and was first used to treat diabetes in humans in January 1922 in Toronto, Canada. However, there was little regulation at that time concerning how to share the knowledge of new medications and how to legally produce them in foreign countries. In Europe insulin was first used in August 1922, and its commercial production started in 1923. There was, however, no single strategy to implement insulin manufacturing across recently war-torn Europe, and each country had to find its own way to make insulin available for its people. Three European countries were among the first to produce their own insulin: Great Britain, Denmark, and newly independent Poland. The reason for the variety of pathways to insulin production may be the fact that there was a personal story behind the arrival of insulin to each of these countries. Moreover, people who played the main roles in these processes had shown little interest in diabetes before - just like Banting. Here we present the tormented history of the early days of insulin production and use in those three countries, with focus on how individual initiatives eventually made insulin available across Europe by 1924. (c) 2020 S. Karger AG, Basel
The development of antidiabetic agents prior to 2000 was largely the result of fortuitous discovery coupled with insightful clinical acumen. Many years intervened between the chance discovery and the development of marketable clinically important products. The first hint that biguanides might be useful in managing diabetes was noted in the early 1900s; however, metformin did not achieve worldwide use and recognition as the first-line treatment for type 2 diabetes until the late 1990s. The hypoglycemic potency of sulfa drugs was first noted in 1942, but the introduction of sulfonylurea drugs to treat patients with type 2 diabetes occurred in 1956. Defining their mechanisms of action did not occur until the 1990s. The elucidation of the profound effects of thiazolidinediones through their activation of the transcription factor PPAR. (peroxisome proliferator-activated receptor gamma) came many years after the discovery of ciglitazone. It is of note that in the development of each of these classes of antidiabetic drugs, regulatory agencies struggled with controversial data and made decisions which had profound effects on their clinical use. (c) 2020 S. Karger AG, Basel
The discovery of insulin in Toronto in 1921/1922 was rapidly recognized by a Nobel Prize shared by Dr. Frederick Banting and Prof. John Macleod. However, in the popular imagination it is attributed to "Banting and Best." Here we review the important individual and collective contributions of the four main players in Toronto at that time: Banting, Macleod, Best, and Collip. Drawing on the work of the late Canadian historian Michael Bliss, we reflect on some of the enduring myths that surround the tale. We question the romantic notion that Banting's inspirational "idea" led directly to the discovery, and argue that it can instead be attributed to a fortunate collision of opportunity, ability, experience, and drive. We go on to recount the clashes of personality that detracted from the celebration that should have marked the delivery of insulin to the world. Finally, we set out evidence that Banting consistently overestimated his own contribution, conducting a successful and enduring campaign to downplay the roles of his colleagues. In the hope of redressing the historical balance, we focus on the neglected role of John Macleod, an established international expert on carbohydrate metabolism at the time of the discovery, who directly supervised the work. (c) 2020 S. Karger AG, Basel
