Diabetes: Historical and Molecular Mysteries

Since 1900, diabetes mellitus has risen from being rarely seen to afflicting 38.5 million Americans in 2024, and the number shows no sign of slowing. It first appeared on the U.S. Census’ top 10 list of fatal diseases in 1932 (then at number 10). Now it ranks sixth, not including deaths due to Alzheimer’s and cystic fibrosis, which also involve poor glycemic control. Projections are for its victims to number 43 million by the middle of this century. Heart disease, stroke, and cancer have higher mortality rates, but cardiovascular disease and malignancy deaths peaked in the previous century. If “cure” means eliminating diabetes altogether, it probably will remain incurable, even if treatable in dramatic new ways. One indicator of its destiny is how its definition has changed. In the early 20th century, diabetes was seen as an aberration of glucose metabolism. Today, its pathology extends to pancreatic beta cell dysfunction, mitochondrial dysfunction, amyloid deposits, “obesogens” (from high-fructose corn syrup to a catalog of organic toxins), gut hormone disorders, gene mutations, insulin resistance, and whatever else molecular biology labs have discovered in the past 24 hours. However, in another sense, the rise of diabetes comes from historical factors such as racism, social policies such as alcohol prohibition that turned people to habitual “sweets,” and sedentary lifestyles. In 2023, the distinguished British medical journal, The Lancet, offered an editorial with these closing remarks: “Diabetes will be a defining disease of this century. How the health community deals with diabetes in the next two decades will shape population health and life expectancy for the next 80 years. The world has failed to understand the social nature of diabetes and underestimated the true scale and threat the disease poses.” ¹

¹ Diabetes: A Defining Disease of the 21st Century, The Lancet, https://www.thelancet.com/action/showPdf?pii=S0140-6736%2823%2901296-5 (June 24, 2023).