Foreword Diabetes Mellitus
Anat Ben-Shlomo, MD Maria Fleseriu, MD, FACE Consulting Editors
Diabetes mellitus (DM) has become a global and costly health problem. In 2015, an estimated 5.5% of the world population had type 2 DM, and the prevalence of type 1 DM in children was reported to increase. Yet, hundreds of billions of dollars have been invested in DM research over the years; the American Diabetes Association alone has invested a staggering sum of $735 million in more than 4500 diabetes research projects since it launched its research programs 64 years ago. This discrepancy between investment and results should make us consider what we have learned about the disease and what changes we need to make in our approach to reverse the upward trend in disease prevalence. In this issue on Diabetes Mellitus in Endocrinology and Metabolism Clinics of North America, our guest editor, Dr Sethu K. Reddy, an internationally recognized authority on DM, has gathered an outstanding group of expert researchers and clinicians to summarize key topics in the field, review current knowledge, and discuss future challenges and new developments, with an aim toward improving prevention, detection, and management of DM. This issue is suitable for all medical professionals involved in the DM field and who interact with diabetic patients. The issue sheds light on important comorbidities associated with DM, including nonalcoholic fatty liver disease, which is increasingly common in patients with type 2 DM, and lipodystrophies that cause insulin resistance and DM. Treatment modalities emphasized in this issue include medical nutrition therapy to reduce weight and improve glycemic control, and pharmaceutical compounds such as metformin and insulin in the outpatient and inpatient settings. Surgical interventions are also discussed. Bariatric surgery has been shown to lead to significant improvement in glycemic control and metabolic syndrome components through weight loss. Pancreas and islet cell transplantation can be considered for patients whose type 1 DM cannot be controlled by other modalities; in the near future, human progenitor stem cells may be used to prevent the need for immunosuppressive drugs in these patients.
Endocrinol Metab Clin N Am - (2016) -–http://dx.doi.org/10.1016/j.ecl.2016.09.002 0889-8529/16/ª 2016 Published by Elsevier Inc.
This issue also provides a more general overview of DM, considering new epidemiological, technological, and individualized approaches to control DM and prediabetes. It is clear today that, beyond the known risk factors associated with some ethnicities and genetic profiles, the dominant drivers of the observed increased prevalence are excess body fat and lifestyle. A globalized approach with transcultural protocols are required to adequately address this issue, and the discussions in this issue focus on the significant changes in disease prevalence between countries and across cultures. Such discussions are critical, as determining goals for population health management in DM will lead to reduced cost and improved quality of care. Technological developments fast-forward us into the realm of precision medicine in DM. The many mobile medical applications (“apps”) available allow the diabetic patient to share glucose pattern analysis with health care providers and to guide more individualized treatment. New devices are also poised to improve DM control: The closed-loop “artificial pancreas” system combining automated continuous glucose monitoring and insulin delivery with minimal patient intervention is under intense study. Yet, new technologies create new challenges along with opportunities. Evidencebased guidance for selecting the most appropriate app and health care system infrastructure to handle big data generated by these modalities is sorely needed and is discussed. The issue concludes with this emphasis on the future, as we move toward a personalized approach for individual patients with DM. Integrating our current knowledge of the disease, therapeutic approaches, and technologies may provide better results in disease treatment and prevention. We hope that you, our readers, will find the Diabetes Mellitus issue in Endocrinology and Metabolism Clinics of North America helpful in the management of your diabetic patients and prepare you for the upcoming changes that will lead us toward DM personalized medicine. We thank Dr Sethu K. Reddy for guest-editing this stimulating and timely issue, the authors for their work on these topics, and the Elsevier editorial staff for their assistance. Anat Ben-Shlomo, MD Pituitary Center Division of Endocrinology, Diabetes, & Metabolism Cedars Sinai Medical Center 8700 Beverly Boulevard Los Angeles, CA 90048, USA Maria Fleseriu, MD, FACE Northwest Pituitary Center Division of Endocrinology, Diabetes & Clinical Nutrition Departments of Medicine and Neurological Surgery Oregon Health & Science University 3138 SW Sam Jackson Park Road Portland, OR 97239, USA E-mail addresses: [email protected]
(A. Ben-Shlomo) [email protected]