Dr. MengHee Tan has one central message for people living with diabetes mellitus: The future for people living with diabetes is brighter.

“So many advances in diabetes care have been made, especially during the past 50 years,” he says. “To name two such innovations, we can now delay the onset and slow the progression of the chronic eye, kidney, and nerve complications in diabetes. We can also reduce the risk for heart attacks, strokes, and peripheral vascular disease (leading to leg amputations) in people with diabetes.”

Dr. Tan (MD’69) is a retired physician-scientist and professor emeritus of internal medicine at the University of Michigan in Ann Arbor.

He has written a new book entitled Innovations in Diabetes. The book chronicles the new knowledge researchers have uncovered and clinicians have translated to better diabetes care over the last 50 years, as well the history of diabetes’ three-millennia journey.

The book explains the history of diabetes—once known as “the too-sweet malady”—in a readable, question-and-answer style, with patients questioning a diabetes specialist and other diabetes care team members about this serious and costly health problem.

“I hope it will enable people interested in diabetes become more knowledgeable about it,” Dr. Tan says.

Diabetes care is a team effort, he points out. Physicians, diabetes self-management education and support specialists (previously called diabetes educators), and people with diabetes work as a team towards a common goal.

Diabetes care includes making lifestyle changes like exercise and nutrition, taking appropriate glucose-lowering medications and medications that lower glucose or target hypertension and lipid disorders, and monitoring glucose control to learn to live well with diabetes, Dr. Tan writes.

The book covers many advances in these fronts.

“Learning to manage their diabetes themselves is critical for patients as they make daily decisions about their care without healthcare providers,” Dr. Tan says.

Patients make care decisions with their healthcare providers only about one per cent of their waking hours. This implies they are on their own when making care decisions at other times. People with diabetes therefore need to acquire the knowledge, skills, and confidence on how to make those decisions, Dr. Tan writes. They should learn how to live with their diabetes from their healthcare team, especially the education and support specialists, he says.

Most patients need glucose-lowering medications in addition to lifestyle therapy to control their diabetes. In 1921-1922, insulin became the first class of glucose-lowering medication. Fifty years later, in the early 1970s, there were only three classes.

Currently, there are 13 different classes of glucose-lowering medications that target the different defects, uncovered by research, in diabetes. Two new glucose-lowering medication classes that launched in the 21^st Century (2005 and 2013) can not only control glucose but also reduce cardiovascular risks and improve kidney function in patients with diabetes.

Until the 21^st Century, significant weight loss for obese patients with diabetes was a challenge. Two new classes of glucose-lowering medications, recently approved, can result in 15-27 per cent loss of initial body weight. However, they are expensive, as Dr. Tan points out.

Technology plays a leading role in monitoring glucose control and in delivering insulin to patients. “It’s amazing how advanced the technology is in monitoring glucose control in patients,” Dr. Tan says.

Instead of requiring people to prick their fingertips to measure their glucose level using a meter, continuous glucose monitoring systems can now measure the glucose level between cells every five minutes, and use their smart phones to read blood glucose values.

Insulin pumps that can deliver insulin continuously under the skin were introduced in the late 1970s. Now, people can couple insulin pumps with a continuous glucose monitoring system as well as computer algorithms (specific for the patient) to effectively function like an artificial pancreas.

“This is just one example of progress in treating diabetes for people who need insulin to manage the disease,” Dr. Tan says.

For those who cannot afford pump therapy, there are insulin pens with smart pen caps which display the last dose administered. They can also communicate with a continuous glucose monitoring system to calculate the recommended on-demand dose to administer.

“Nowadays, once you are diagnosed with diabetes, treatment is available to control it, unlike in the past,” Dr. Tan emphasizes. “There are so many things we can do today that could not be done 50 years ago when I first became interested in diabetes.”

In the book, Dr. Tan also covers the identification of people at higher risk for developing Type 1 as well as Type 2 diabetes. People can now delay or prevent the progression of pre-diabetes to Type 2 diabetes using intensive lifestyle interventions (diet and exercise) as well as the glucose-lowering medication Metformin.

Certain patients with Type 2 diabetes may be able to reverse their disease with significant weight loss after treatment with very low-calorie diet or weight loss (bariatric/metabolic) surgery. With significant weight loss, people can correct certain metabolic defects in Type 2 diabetes. Their diabetes goes into remission, he says.

“Today’s diabetes care should be evidence-based medicine, not authority-based,” he says. “It should also be patient-centered care. It is important for patients with diabetes to develop a shared-care plan with their healthcare providers,” he writes.

The newer glucose-lowering medications, insulin pump therapy, and continuous glucose monitoring systems are expensive. Increasingly, patients cannot afford them unless their health insurance covers them, he stresses.

Dr. Tan, long an advocate for patients and a past-president of the Canadian Diabetes Association (now Diabetes Canada), hopes patients and policymakers will continue to find ways to make high-quality diabetes care accessible and affordable. He praises Canada for having the Patented Medicine Prices Review Board for “regulating” patented drug prices to make them more affordable.

To learn more about Innovations in Diabetes, go to mengheetanMD.com.