Charted new course
Dr. Allan Drash stands in front of a stained glass window in his apartment building that says "nature fits all her children with something to do," a quote he likes and finds fitting after spending 40 years at Children's Hospital as a world-renowned pioneer in diabetes care and research.
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Decades ago, doctors treating children with type 1 diabetes would set an insulin dose then order the child to follow it to a T.
But a world-renowned Pittsburgh pioneer in diabetes research and treatment began discounting that practice in the 1960s by redefining type 1 and advocating self-management through a team approach.
It was a radical idea at the time.
Dr. Allan L. Drash helped frame the diabetes debate with landmark research proving his approach, then traveled the globe to convince doubtful physicians he was correct.
Despite criticism, he drew converts.
Dr. Drash, a retired University of Pittsburgh professor of pediatrics and epidemiology and director of research in Children's Hospital's Division of Pediatric Endocrinology, Metabolism and Diabetes Mellitus, helped convince the world that diabetes education and self-management were crucial to good control.
His approach stems from more than 300 medical-scientific publications he wrote or co-wrote, mostly involving type 1 diabetes. As his 64-page curriculum vitae reveals, his studies also defined type 1 and detailed its prevalence worldwide.
Along the way, he advocated improvements in strategies to reduce medical and behavioral complications.
And in time, he convinced doctors that more aggressive insulin regimen, exercise, diet and testing blood sugar were necessary in maintaining normal or near-normal blood sugar levels.
Today, Dr. Drash's ideas are mainstays of treatment for type 1 and type 2 diabetes: "We changed the face of pediatric diabetes over a 10-year period."
Type 1 occurs when an autoimmune disorder destroys the pancreas' ability to produce insulin -- the hormone that allows blood glucose to enter cells and be used as energy. Type 2 usually occurs in adults whose bodies become insensitive to their own insulin.
In both types, blood sugar can rise to dangerous levels, requiring insulin or oral medications among other measures to return it close to normal levels.
Graduating from the University of Virginia School of Medicine in 1957, Dr. Drash soon realized that even the nation's best hospitals lacked programs for diabetes care, mainly due to a lack of research. Those that did focused on adults with type 2.
"There was no training in diabetes," he said. "I was very aware that medical diabetes management was a jumble."
In 1966, Dr. Drash accepted a position at Children's Hospital in Pittsburgh, where he established a diabetes care program that included education and a team approach involving the patient, family, physicians, dietitians and educators.
Research back then showed that adults with diabetes produced excess insulin, which their bodies did not properly use. It was assumed the same occurred in children.
But in his landmark 1967 study, Dr. Drash showed that most children with diabetes were insulin deficient -- a condition eventually identified as type 1. His study proved there were two types of diabetes.
Hooking up with Pitt's Graduate School of Public Health, he helped launch studies of diabetes worldwide to gauge genetic and cultural components of the disease. Those studies showed that poorer nations had few cases of type 2, which was common and now epidemic in nations with opulent food supplies.
Those studies also revealed a higher incident of type 1 in Scandinavia and further revealed genetic, cultural and lifestyle components of the disease.
Dr. Drash also helped convince the National Institutes of Health to fund the landmark Diabetes Control and Complications Trial to determine whether tight blood-sugar control prevented complications. Completed in 1992, the DCCT proved that aggressive treatment did reduce heart and kidney disease, blindness and circulation disorders leading to amputations.
Soon Pittsburgh became a mecca for physicians worldwide interested in studying diabetes.
In the 1980s, Dr. Drash became president of the American Diabetes Association, which in 1988 named him Outstanding Clinician in the Field of Diabetes.
Today he's recognized as a pioneer in the treatment philosophy routinely used today.
Linda Siminerio, director of the University of Pittsburgh Diabetes Institute, describes Dr. Drash, now 76, as "a great visionary" whose research in type 1 has been applied to type 2. He also created a type 1 patient registry in Allegheny County -- a practice adopted worldwide to help understand and control the disease.
"He was one of the earliest endocrinologists to recognize the importance of a team approach and understand the psycho-social aspects of diabetes," Dr. Siminerio said.
But his story comes full circle. The noted doctor who spent his career treating children with type 1 diabetes was diagnosed at age 50 with that very disease.
Then surgery for an unrelated neurological disorder forced his retirement in 2002. Since his retirement, he and his wife, Diane, have split their time between Pittsburgh and Morehead City, N.C. But he plans to continue writing about diabetes.
"I certainly think that the applications of the therapeutic observations we made improved the life and longevity of patients," he said. "But I still don't feel we're where we should be with people still losing vision and suffering kidney disease."
First Published October 17, 2007 12:00 am