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Diabetes and the human condition

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Adapting to a global dilemma

The treatment of diabetes before insulin therapy tested the skills of the clinician and the commitment of the patient. But by the 1920s, insulin became widely available for the diabetic community in North America.1

If diabetes was once considered a simple problem of insulin deficiency it is not seen that way now. Instead it is a window on complex metabolic distortions, signals, substrates and reactions.

A second form of diabetes

An extraordinary twist in the diabetes story has been the epidemic of type 2 diabetes. Rapid changes in the human environment — massive migrations from rural to urban environments with upheavals in diet away from traditional foods — have accompanied soaring prevalence rates in developed and developing economies alike.

Why cannot humans adapt to our new environments? Maybe we can — but it will take ages. Plutella xylostella caterpillars adapt to an obesogenic environment, but in eight generations.2 So we must turn instead to the environmental factors that promote diabetes and hinder its treatment.

What we eat is inextricably linked to the food that is available, affordable and acceptable. In order to make lasting and sustainable changes to the food environment, the food system from paddock to plate must change.…