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JAMA Revisited |

The Changing Theories of Diabetes

JAMA. 2014;311(22):2339. doi:10.1001/jama.2013.279551.
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The treatment of diabetes in recent years has been kept in close harmony with the prevailing theory of the immediate cause of its symptoms. It is agreed among all who have first-hand knowledge of the disease that the glycosuria is due to an overloading of the blood with sugar. As we have previously pointed out,1 the hyperglycemia is the uppermost fact which establishes the abnormal metabolism of diabetes. How the overloading of the organism with sugar comes about is, of course, a fundamental question. The practice in the direction of restricting the intake of carbohydrate has been based on the belief in the inability of the diabetic organism to use sugar in the normal manner; and there is no dearth of evidence to support the current assumption. Of late, however, another theory has begun to be spread about in this country; and since it bears the advocacy of one of the best-known investigators and writers on the subject, von Noorden of Vienna, it is certain to find a favorably disposed audience. The view is now promulgated that the hyperglycemia of diabetes does not arise from a disturbance in the power of the organism to destroy sugar, but rather to the overproduction of sugar. We are told that there exists an abnormally increased “mobilization” of sugar, whether from glycogen or from some other substance, together with an increased production of sugar from other sources—proteins and perhaps fat.

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