THE THREE FIRST’S in
DIABETES CARE,
21
YEARS BEFORE DCCT
“First to advocate and perform blood
glucose self monitoring”
“First to use a blood glucose self
monitoring and bolus/basal insulin dosing to achieve tight control”
“First to
publish a paper on reversing complications by tight control”
Being the first for
anything in the medical field is not the easiest.
As you will see, it took a great commitment and a desire to
help others to achieve what Dr. Bernstein achieved.
We are proud to be
friends with Dick would like to thank him for providing us with the
materials to write this feature.
We know you will find it interesting and informative.
We have made it a
3-week series, discussing the 3 first’s.
Included is the actual article on how tight control can prevent
complications, that was finally accepted by Diabetes Care and also the
rejection letters from NEJM, ADA, AMA and Lancet which stated that:
“No physician or
patient would ever be interested in such a time consuming program of
using a device to check blood glucose multiple times a day and
adjusting insulin doses”
Part
1 will be, “First to
advocate and perform blood glucose self monitoring”
Part
2 will be, “First to
use a blood glucose self monitoring and bolus/basal insulin dosing to
achieve tight control”
Part
3 will be, “First to
publish a paper on reversing complications by tight control”
If you have any
comments, please email us at publisher@diabetesincontrol.com
PART
3
“First
to publish a paper on reversing complications by tight control”
 I
submitted the article and its revisions to many medical journals over
a period of years — a period during which I was continually
improving in health, and continually proving to myself and my family,
if to no one else, that my methods were correct. The rejection letters
I received are testimony that people tend to ignore the obvious if it
conflicts with the orthodoxy of their early training. Typical
rejection letters read in part:
“Studies
are not unanimous in demonstrating a need for ‘fine control” (the New
England Journal of Medicine), or “How many patients would use
the electric device for measurement of glucose, insulin, urine,
etc.?” (Journal of the American Medical Association). As a
matter of fact, since 1980, when these “electric devices” finally
were made available to patients, the worldwide market for blood
glucose self-monitoring supplies has come to exceed $3 billion
annually. Look at the array of blood glucose meters in any pharmacy,
and you can get an idea of just how many patients use, and will use,
the “electric device:’
Trying
to cover several routes simultaneously, I joined a few lay diabetes
organizations, in the hope of moving up through the ranks, where I
could meet physicians and researchers specializing in the disease.
This met with mediocre success. I attended conventions, worked on
committees, and met many diabetologists. In this country, I met only
three physicians who were willing to offer their patients the
opportunity to put these new methods to the test.
Meanwhile,
Charlie Suther was traveling around the country to university
research centers with copies of my unpublished article, which by now
had been typeset and privately printed at my expense. The rejection
by doctors of the concept of blood sugar self-monitoring, even though
essential to blood sugar control, was so intense, however, that the
management of his company had to turn down the idea of making meters
available to patients until many years later. His company and others
could clearly have profited from the sale of blood glucose meters and
test strips. However, the backlash from the medical establishment
prevented it on a number of counts. It was unthinkable that patients
be allowed to “doctor” themselves. They knew nothing of medicine
— and if they could, how would doctors earn a living? In those days,
patients visited their doctors once a month to “get a blood
sugar:’ If they could do it at home for 25 cents (in those days),
why pay a physician? But almost no one believed there was any value
to normal blood sugars anyway. In some respects, blood glucose
self-monitoring remains a serious threat to the incomes of many
physicians who specialize in the treatment of the symptoms of
diabetes and not the disease. Drop into your neighborhood
ophthalmologist’s office and you will find the waiting room
three-quarters filled with diabetics, many of whom are waiting for
expensive fluorescein angiography or laser treatment.
With
Suther’s backing in the form of free supplies, by 1977 I was able to
get the first of two university-sponsored studies started in the New
York City area. These both succeeded in reversing early complications
in diabetic patients. As a result of our successes, the two
universities separately sponsored the world’s first two symposia
on blood glucose self-monitoring. By this time I was being invited to
speak at international diabetes conferences, but rarely at meetings in
the United States. Curiously, more physicians outside the
United States seemed interested in controlling blood sugar than did
their American colleagues. Some of the earliest converts to blood
glucose self-monitoring were from Israel and England.
By
1978, perhaps as a result of Charlie Suther’s efforts, a few additional
American investigators were trying our regimen or variations of it.
Finally, in 1980, manufacturers began to release blood glucose meters
for use by patients.
This
“progress” was entirely too slow for my liking. I knew that while
the medical establishment was dallying there were diabetics dying
whose lives could have been saved. I knew also that there were
millions of diabetics whose quality of life could be vastly improved,
so in 1977, I decided to give up my job and become a physician — I
couldn’t beat ‘em, so I had to join ‘em. This way, with an M.D.
after my name, my writings might be published, and I could pass on
what I had learned about controlling blood sugar.
After
a year of premed courses and another year of waiting, I entered the
Albert Einstein College of Medicine in 1979. I was forty-five years
old. During my first year of medical school I wrote my first
book, Diabetes: The Glucograf Method for Normalizing Blood
Sugar, enumerating the full details of my treatment for Type I, or
insulin-dependent, diabetes.
In
1983 I finally opened my own medical practice. By that time, I had
well outlived the life expectancy of an “ordinary” Type I
diabetic. Now, by sharing my simple observations, I was convinced I
was in a position to help both Type I and Type II diabetics who still
had the best years of their lives ahead of them. I could help others
take control of their diabetes as I had mine, and live long,
healthy, fruitful lives.
Recently
for this anniversary issue, I asked Dr. Bernstein for his recollection
regarding the acceptance of his article “Virtually Continuous
Euglycemia……
|
May
8, 2002
Dear
Steve
One
of these letters is from DIABETES HEALTH CARE, which was the working
title for DIABETES CARE prior to initial publication, the ultimate
publication of “Virtually Continuous Eug1ycemia.” …..in the
journal DIABETES CARE, occurred in 1980 via a flukey set of
circumstances. In 1978,
Sheldon Bleicher M.D. and I began a research project using his
Patients and my blood sugar control methods in an attempt to reverse
early retinal leakage in diabetics by normalizing blood sugars. We
were indeed able to demonstrate the successful accomplishment of our
goal.
The
Ames Division of Miles Laboratories had provided us with the 3’ lb.
blood sugar meters that I describe in my book and blood sugar test
strips, all gratis. Because of the favorable, outcome of the study, Ames
sponsored a symposium on blood sugar self monitoring under the
auspices of Dr. Bleicher and the New York Downstate University. A
select group of diabetologists from around the country was invited to
attend. Since my agreement with Dr Bleicher was that my name would be
cited in any publications and I would be allowed to present the
methodology to any symposia, I was allowed to present this paper at
the meeting. The firm that was responsible for Ames publicity
negotiated an arrangement with Jay Skyler, editor of DIABETES CARES to
publish all of the papers presented at the symposium. Since I had read
this paper at the symposium, it was automatically published even
though it had been rejected in 1971.
It
is worth noting that the ADA continued to reject blood sugar
self-monitoring as a viable methodology until a joint meeting with the
American Association of Diabetes Educators in 1986. At that time,
self-monitoring was approved, only for insulin users, thereby keeping
out 90% of diagnosed diabetics.
Richard
K. Bernstein, M.D., F.A.C.N., F.A.C.E
View the Actual
Rejection Letters.
View
the rejection letters for publication from AMA, ADA, NEJM
Actual Paper Submitted.
Virtually Continuous Euglycemia
for 5 Yr in a Labile
Juvenile-onset Diabetic Patient Under Noninvasive Closed-Loop Control
Part
1: First
to advocate and perform blood glucose self monitoring
Part
2: “First
to use a blood glucose self monitoring and bolus/basal insulin dosing
to achieve tight control”
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