Elliott P. Joslin
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Elliott Proctor Joslin, M.D. (6 June 1869 - 28 January 1962) was the first doctor in the United States to specialize in diabetes and was the founder of today’s Joslin Diabetes Center. He was the first to advocate for teaching patients to care for their own diabetes, an approach now commonly referred to as “DSME” or Diabetes Self-Management Education. He is also a recognized pioneer in glucose management, identifying that tight glucose control leads to fewer and less extreme complications.
Early life and activities
Joslin first became interested in diabetes while attending Yale, when his aunt was diagnosed with the disease. At the time, diabetes was considered an obscure disease, with no cure and little hope. He made diabetes his focus while attending Harvard Medical School, winning the Boylston Society prize for work later published as the book The Pathology of Diabetes Mellitus.
His postgraduate training was at Massachusetts General Hospital, and he also studied with leading researchers in metabolism from Germany and Austria before starting a private medical practice in Boston’s Back Bay in 1898.
In 1908, in conjunction with physiologist Francis G. Benedict, Joslin carried out extensive metabolic balance studies examining fasting and feeding in patients with varying severities of diabetes. His findings would help to validate the observations of Frederick Madison Allen regarding the benefit of carbohydrate- and calorie-restricted diets. The patients were admitted to units at New England Deaconess Hospital, helping to initiate a program to help train nurses to supervise the rigorous diet program.
Joslin included the findings from 1,000 of his own cases in his 1916 monograph The Treatment of Diabetes Mellitus. Here he noted a 20 percent decrease in the mortality of patients after instituting a program of diet and exercise. This physician’s handbook had 10 more editions in his lifetime and established Joslin as a world leader in diabetes.
Two years later, Joslin wrote Diabetic Manual — for the Doctor and Patient detailing what patients could do to take control of their disease. This was the first diabetes patient handbook and became a best seller. There have been 14 editions of this pioneering handbook, and a version is still published today by the Joslin Diabetes Center under the title The Joslin Guide to Diabetes.
When insulin became available as therapy in 1922, Joslin’s corps of nurses became the forerunners of certified diabetes educators, providing instruction in diet, exercise, foot care and insulin dosing, and established camps for children with diabetes throughout New England.
Joslin always adopted a multi-disciplinary approach, working with nurses in education, surgeons and podiatrists for limb salvage and foot care, pathologists for descriptions of complications and obstetricians for assessment of fetal risk in diabetic pregnancy. The first hospital blood glucose monitoring system for pre-meal testing was developed under his direction in 1940 and was the forerunner of modern glucometers.
Joslin was also the first to name diabetes a serious public health issue. Just after WWII, he expressed concern to the Surgeon General of the U.S. Public Health Service that diabetes was an epidemic and challenged the government to do a study in his hometown, Oxford, Massachusetts. The study was started in 1946 and carried out over the next 20 years. The results would later confirm Joslin’s fear that the incidence of diabetes in the United States was approaching epidemic proportions. He has been named as being, with Frederick Madison Allen, one of the two leading diabetologists from the period between 1910 and 1920.
In 1952, Joslin’s group practice became officially known as the Joslin Clinic. In 1956, the office was moved to its current location at One Joslin Place in Boston. The Joslin Clinic was the world’s first diabetes care facility and today maintains its place as the largest diabetes clinic in the world.
Joslin was adamant in his position that good glucose control, achieved through a restricted carbohydrate diet, exercise, and frequent testing and insulin adjustment, would prevent complications. This was debated for decades by other endocrinologists and scientists, and the American Diabetes Association was divided on this subject from its inception. Joslin’s approach wasn’t validated until 30 years after his death, when in 1993, a 10-year study, the Diabetes Control and Complications Trial Report was published in the New England Journal of Medicine. This study demonstrated that the onset of diabetes complications was delayed by tight glucose control, something Joslin had argued decades prior.
Dr. Joslin died in his sleep on 29 January 1962 in Brookline, Massachusetts.
- The Diabetes Control and Complications Trial Research Group, "The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications in Insulin-Dependent Diabetes Mellitus," N Engl J Med 1993; 329:977-986 September 30, 1993