The diabetic problem of today, TOGETHER WITH Hyperinsulinism and dysinsulinism by Seale Harris, and "Optimal" diets for diabetic patients by Russell M. Wilder de Joslin, Elliott P - 1924: EXTRACTED FROM JAMA, Vol. 83, No. 10, pp 727-737

Chicago: American Medical Association, 1924. First edition.

1924 BRIEF REVIEW OF THE TURNING POINT IN DIABETES MANAGEMENT FOLLOWING DISCOVERY OF INSULIN, BY "THE DEAN OF DIABETES," ELLIOTT JOSLIN.

11 inches tall extract from JAMA including 3 papers on diabetes, unmarked and very good. The first by Joslin, who comments on the increasing life span of diabetics, and the increasing incidence of symptoms at later ages: an early recognition of the rise of type 2 diabetes. He comments on the importance of population studies comparing ethnic groups, and warns against assuming racial predispositions. Responding to the first use of insulin in 1922, he concludes that "insulin is better than any of us thought a year ago." He reports on status of his first 127 patients treated with insulin less than 2 years after its discovery. The patients received insulin an average of 18 months, and all for more than one year. 23 patients died, but "not one of the patients who died succumbed during the first year of the disease. ... Coincident with the increasing use of insulin, the death rate from diabetes has been declining for a year and half. There is no proof as yet that these two phenomena are connected. ... It was also shown by this study that insulin was much more commonly used in hospitalized cases than in the cases treated at home and that it is more extensively used in the larger cities than in rural areas or small towns."

ELLIOTT PROCTER JOSLIN, M.D. (1869 - 1962) was the first doctor in the United States to specialize in diabetes and was the founder of today's Joslin Diabetes Center. Dr. Joslin was involved for seven decades in most every aspect of diabetes investigation and treatment, save for the fact that he did not discover insulin. Following the Toronto group's blockbuster discovery of insulin in 1921, and the group's disbanding several years later, Joslin became effectively the Dean of diabetes mellitus. In the mid 1920s, Joslin, in his mid 50s, took the reins as the world spokesman for the "cause of diabetes." He was the first to advocate for teaching patients to care for their own diabetes, an approach now commonly referred to as "DSME" or Diabetes Self-Management Education. He is also a recognized pioneer in glucose management, identifying that tight glucose control leads to fewer and less extreme complications. From the beginning of his medical practice he kept a diabetes registry, the first of its kind in the world. His carefully assembled data from his medical ledgers eventually allowed him to predict a global diabetes epidemic that is evident today. In 1908, in conjunction with physiologist Francis G. Benedict, Joslin carried out extensive metabolic balance studies examining fasting and feeding in patients with varying severities of diabetes. Joslin included the findings from 1,000 of his own cases in his 1916 monograph The Treatment of Diabetes Mellitus, the first textbook on diabetes in the English language. Here he noted a 20 percent decrease in the mortality of patients after instituting a program of diet and exercise. This physician's handbook had 10 more editions in his lifetime and established Joslin as a world leader in diabetes. When insulin became available as therapy in 1922, Joslin's corps of nurses became the forerunners of certified diabetes educators, providing instruction in diet, exercise, foot care and insulin dosing, and established camps for children with diabetes throughout New England. With insulin available, Joslin enlarged his medical practice into a team that evolved into the Joslin Clinic that was affiliated with the New England Deaconess Hospital and the Harvard Medical School. Joslin was adamant in his position that good glucose control, achieved through a restricted carbohydrate diet, exercise, and frequent testing and insulin adjustment, would prevent complications. This was debated for decades by other endocrinologists and scientists, and the American Diabetes Association was divided on this subject from its inception. Joslin's approach wasn't validated until 30 years after his death, when in 1993, a 10-year study, the Diabetes Control and Complications Trial Report was published in the New England Journal of Medicine.