Paul Zimmet: A Voice for Diabetes

Paul Zimmet has been one of the leading figures, globally, in transforming the understanding and threat of diabetes from a Cinderella disease to a major plank of most governments’ health policies. His science, particularly a series of epidemiological studies, has been at the forefront of the campaign, but it is fueled by his genuine passion to improve the life of people with diabetes. After more than 50 years of working in the diabetes field, he continues to actively push the boundaries of our understanding of the condition. The Zimmet family has medicine running through its veins, but it was not always the somewhat privileged life of the professional classes. Paul Zimmet’s father, Jacob, was born in Tarnopol, Poland, and graduated in medicine from the University of Vienna in 1935. However, with rising anti-Semitism, the only position available to him was an unpaid one at the Tarnopol Hospital. Jacob realized there was no future in Poland, and in 1938, he, along with his wife and first child, Rena, fled Poland and fortunately was able to obtain passage to Australia. Of all the family that remained behind, only one survived the Nazi concentration camps. Australia was far from the horrors of the Holocaust, but life was still not easy, as Jacob had to requalify in medicine, which he achieved at the University of Adelaide in 1942. Paul was born in 1941 and grew up in his father’s country medical practice in Whyalla, a small town nearly 400 km from the city of Adelaide. From such small beginnings, a dynasty of medicine began, as Paul, two of his siblings Rena and Leon, Paul’s two sons Hendrik and Marcel, and Paul’s nephew Adam entered the profession, and between them have specialized in diabetes, cardiology, pediatrics, and cardiac surgery. Paul graduated from the University of Adelaide in 1965 but moved to Melbourne to start his clinical work at the Alfred Hospital. It was in Melbourne that he met his wife, Vivien. Vivien has accompanied Paul and participated in field trips and on conference travel and, indeed, has been a wonderful partner and inspiration during his career, enabling him to translate his vision and research into action. In 1967, Paul was offered the position of Diabetes Registrar in the Alfred Hospital’s Diabetes and Metabolic Unit and also had his first of more than 1,000 publications. As with many great scientists, a casual observation, which most people would ignore, led to an important insight. An inpatient with hypocalcemia and tetany was unresponsive to calcium replacement. While half listening to the “Farmers’ Hour” on the radio, Paul’s ears pricked up when the discussion turned to magnesium as a treatment for grass tetany in cows. After then checking the patient’s serum magnesium, and finding it to be very low, magnesium replacement cured the hypocalcemia and the tetany, and the British Medical Journal published the report (1). The journey of curiosity, investigation, and dissemination had begun. Paul’s academic career began in earnest in 1970, when he commenced a PhD at Melbourne’s Monash University with Professor Joe Bornstein. Joe had previously developed one of the first insulin bioassays, which he used, along with R. D. Lawrence, to demonstrate that there were two types of diabetes, differentiated by the absence or presence of circulating insulin. Paul’s PhD focused on two growth hormone fragments as potential contributors to glucose regulation in type 2 diabetes, one of which entered clinical trials as a potential drug for diabetes 35 years later. However, Paul believed he needed to take his work beyond the bench and into the field of epidemiology to understand its significance and so took up a postdoctoral position in London’s Guy’s Hospital with Harry Keen and John Jarrett, two of the great pioneers of diabetes epidemiology. While he was in London, Paul came across the work of the leading New Zealand epidemiologist, Ian Prior, who, in a 1966 paper on gout, also reported an elevated prevalence of diabetes in New Zealand Maori and in Paul Zimmet