Professor Don Chisholm AO has been a leader in diabetes research, care and education. He was head of the Diabetes Research Program at the Garvan Institute of Medical Research in Sydney from 1978 to 2003. He was foundation director of the Diabetes Centre at St Vincent’s Hospital in Sydney from 1980 to 1991. He has retired from clinical practice apart from a monthly diabetes clinic at an Aboriginal medical service in western NSW, and continues to work in diabetes research at the Garvan.
My career has centred around St Vincent’s Hospital and the Garvan Institute in Sydney. After resident and registrar training at St Vincent’s, I did about a year and a half of research at the Garvan in its early days and then spent almost two years at McGill University in Montreal in Canada, before returning to Australia to work at St Vincent’s in Melbourne. I returned to St Vincent’s in Sydney in 1978 to a position as staff endocrinologist with the recognition that I would spend a substantial portion of time in research at the Garvan.
I did my registrar training in the mid ’60s when radioimmunoassays for hormones had just been invented. Endocrinology suddenly became an exciting specialty because for the first time you could measure circulating levels of hormones.
One of the most rewarding aspects of diabetes care is working in a team. The best diabetes care is patient-centred, with doctors working closely with nurse educators, dietitians and podiatrists. While teamwork has always been important, the resources and the structure to make it happen weren’t there a few decades ago. It’s much better now — the emergence of diabetes centres and the establishment of the role of diabetes educators in both hospitals and community centres have been enormously important.
The advances in diabetes care during my career have been incredible. When I first started in diabetes in the late 1960s, no one dreamed patients would be able to measure their own blood sugar, and people would go blind from diabetic retinopathy as there was no effective treatment. Nowadays, as long as diabetic retinopathy is recognised at an early stage, laser treatment is a highly effective. On the downside, while the advances in diabetes have been terrific, type 1 and type 2 diabetes have been increasing substantially, so unfortunately it is a growth industry.
I’ve always been very happy working in diabetes. Over the past couple of decades my research focus has shifted from insulin delivery and blood sugar control to insulin resistance and the pathogenesis of type 2 diabetes. Currently, I work with a team at the Garvan and particularly Dr Jerry Greenfield, the head of the department of endocrinology at St Vincent’s in Sydney, to try to understand the molecular mechanisms of insulin resistance and the development of type 2 diabetes.
There are a number of issues transforming diabetes, none of which will bear fruit straight away. One of these is the worldwide push for lifestyle change to prevent type 2 diabetes, including state and federal activity in Australia, which is a step forward but it isn’t enough. In terms of type 1 diabetes, it will become a preventable disease if we can find ways to stop the immune system attacking insulin-producing cells without hitting the immune system with a sledge hammer. One of my roles is to chair the board of the Diabetes Vaccine Development Centre, which is based at the Garvan and supported by the National Health and Medical Research Council and the Juvenile Diabetes Research Foundation International. Through the work of this centre and other research, progress will be made towards the immune prevention of diabetes in the next decade, but the full-scale prevention of type 1 diabetes will likely take another 20–30 years.
One of my most satisfying career achievements was my involvement with others in establishing the Diabetes Centre at St Vincent’s in Sydney in 1980. It was not the first diabetes centre in Australia, but I believe it was the first to undertake diabetes care entirely on an ambulatory basis. Up until then, people who had newly developed type 1 diabetes or had severe complications were regularly hospitalised. The Centre’s contribution to diabetes care has been further enhanced under the direction of Professor Lesley Campbell, who took over from me in 1991. On the research side, I am most proud of my involvement in the growth and development of the Diabetes Research Program at the Garvan.
When a young doctor asks me about career choices, I always urge them not to make up their mind too early. The later they decide, the better they’ll know. I also urge them to find a clinical mentor who’s not only a good clinician but also has good organisational and administrative skills. I had several excellent mentors, including Les Lazarus at the Garvan, and David Pennington who recruited me to St Vincent’s in Melbourne in 1971.
One of my regrets is that I didn’t get a PhD. In the end it didn’t hold me back in my research career, but it’s different these days and I recommend that young doctors interested in an academic career should get a PhD. They should also look for a research mentor who has a good track record of publications.
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