| During the twentieth century, diabetes mellitus emerged from clinical obscurity to become a pressing public health problem. While this transformation reflects demographic changes in nutrition and lifestyle, it is also a product of evolving methods of medical surveillance emphasizing early detection and continuous oversight of disease. These methods are a centerpiece of disease management—a term often used to refer to the integrated system of practices surrounding risk assessment, treatment, and follow-up associated with many chronic diseases. This dissertation explores the evolution of diabetes management in the last century, charting efforts to align clinical, epidemiological, and political approaches to the disease in order to construct a coherent system of care. The persistent failure to achieve this alignment has resulted from the different perceptions of diabetes and its risks held by those interested in its growing place as part of the disease burden—particularly epidemiologists, insurers, researchers, clinicians, and patients. While alignment failures resulted in serious disagreements among experts, they also encouraged the growth of the complex multidisciplinary strategies of disease management that often define modern healthcare. Using a range of historical materials, including clinical archives, patient letters, congressional testimony, and clinical literature, I examine the dynamic relationships between changing medical practices, changing institutions, and the definition of diabetes itself. Such relationships have informed cultural appraisals of diabetes and the particular challenges that it poses for American healthcare. |
