Research into diabetes mellitus and the clinical practice of diabetology are a fascinating illustration how the accumulation of knowledge leads to changing scientific theories and paradigms. The pivotal point in the history of diabetes, the discovery of insulin and its introduction to treatment, was one of the most spectacular events in medicine. Later, diabetes care provided, among other developments, models for multidisciplinary approach to treatment and the blueprint for community-based epidemiological studies. The history of diabetology also illustrates the role of chemistry, and later laboratory medicine, in the management of disease. This article is an introduction to the special issue of Clinical Chemistry and Laboratory Medicine, focused on diabetes mellitus and its complications.

Diabetes Mellitus↗

PubMed2003

Obesity, glucose intolerance and diabetes and their links to cardiovascular disease. Implications for laboratory medicine.

This article provides an overview of the role of metabolite toxicity, low-grade inflammation and disturbed cellular signaling in obesity, glucose intolerance and diabetes. It also highlights links between this continuum of deteriorating glucose tolerance and atherosclerosis. Obesity, diabetes mellitus, and cardiovascular disease are all related to diet and to the level of physical activity. They have reached epidemic proportions worldwide. Glucose intolerance and diabetes increase the risk of atherosclerotic events. Moreover, obesity, and glucose intolerance or diabetes, are components of the metabolic syndrome, which also imparts an increased cardiovascular risk. There is increasing recognition that common mechanisms contribute to diabetes and cardiovascular disease. Following increased calorie intake and/or decreased physical activity, fuel metabolism generates excess of 'toxic' metabolites, particularly glucose and fatty acids. Homeostasis is affected by the endocrine output from the adipose tissue. Reactive oxygen species are generated, creating oxidative stress, which exerts major effects on signaling pathways, further affecting cellular metabolism and triggering low-grade inflammatory reaction. This perspective on the diabetic syndrome has been reflected in the approach to its treatment, which integrates maintenance of glycemic control with primary and secondary cardiovascular prevention. Laboratory medicine should support diabetes care with an integrated package of tests which, in addition to glycemic control, enable assessment and monitoring of the risk of microvascular complications as well as cardiovascular disease.

Cardiovascular Diseases↗

PubMed2002

Hyperlipidaemia and cardiovascular disease.

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Apolipoproteins E↗

PubMed2002

Science, alchemy and light: paintings by Joseph Wright of Derby.

This article considers two paintings by the English painter, Joseph Wright of Derby (1734-97), 'An Experiment on a Bird in the Air Pump' and 'The Alchemist in Search of the Philosopher's Stone' as painterly reflections on the early industrial culture. Particularly interesting in the "Experiment on a Bird" is the broad spectrum of spectator's reactions to the experiment; this can be related to the contemporary debate on the contextualization of science.

Alchemy↗

PubMed2002

Painting, poetry and optics: Johannes Vermeer.

The painter Johannes Vermeer (1632-75) worked in the town of Delft in the Dutch Republic. This article focuses on associations between his painting method and the expertise in optics available in Delft at the time. His art represents an extraordinary combination of technical prowess and poetic expression.

Art↗

PubMed2002

Poetry, images and visions: William Blake.

This article focuses on the work of William Blake (1757-1827), British artist, poet and engraver. Blake is discussed as a thinker opposed to the 'tyranny of reason' interpreted as rational philosophies promoted with a religious zeal. The visionary, mystical character of some of Blake's works is contrasted with his eclectic reading and sharp social criticism. Blake's work is related to the early discourse on science. The article is supported by the images of his two works, the 'Ancient of Days' and the 'Newton'.

Books, Illustrated↗