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America Losing the Fight With Type 2 Diabetes
Date:12/30/2008

Yet simple lifestyle changes can make all the difference

TUESDAY, Dec. 30 (HealthDay News) -- The type 2 diabetes epidemic that continues to sweep across the United States has left an estimated 24 million Americans struggling with the disease, up more than 3 million people since 2005.

And, of course, with the epidemic comes the wave of illnesses and disabilities brought on by diabetes -- heart disease and stroke, blindness, amputations, kidney disease and nervous system damage.

Doctors are trying to reverse the tide in two ways.

First, they're continuing to press the public to adopt healthy lifestyle changes that can head off type 2 diabetes, or, at the very least, help control it if it's already present. And researchers are pushing to develop new drugs to help people manage their diabetes more effectively.

"You have to look at the management of diabetes as a package, really," said Ann Albright, director of the U.S. Centers for Disease Control and Prevention's Division of Diabetes Translation. "You really need to be taking advantage of all the tools in the toolbox."

Unfortunately, much of America continues to be slow in picking up those tools, particularly needed lifestyle changes, despite mounting evidence that they're very effective.

In type 2 diabetes, either the body doesn't produce enough of the hormone insulin or the cells "ignore" the insulin, which is needed for the body to use blood sugar, or glucose, for energy. Lack of exercise and being overweight are key contributors to type 2 diabetes.

Some type 2 diabetes medications have come under scrutiny recently after research found that a leading drug, Avandia, seemed to increase the risk of heart attack.

"That created a fair amount of uproar about drug safety in diabetes," said Dr. John Buse, director of the Diabetes Care Center at the University of North Carolina School of Medicine, and president of medicine and science for the American Diabetes Association.

Advisors to the U.S. Food and Drug Administration have recommended that drugs designed to control type 2 diabetes be subjected to more thorough safety reviews. The FDA has left Avandia on the market, however, concluding that the risk of heart attack isn't higher than that associated with similar drugs.

The concern now is that worries over heart attack have led many people to leave their diabetes untreated, abandoning their medication without picking up other drugs or other means of controlling the disease, Buse said.

"A lot of people stopped their diabetes drugs and didn't start others," he said. "There's a lot of concern that those people have lost control of their diabetes."

Some excitement has been generated by another drug for type 2 diabetes named Byetta, Buse said. The injectable medication not only controls blood sugar, but has been shown to help diabetics lose weight, he said.

That's important, because studies have shown that if a person loses even a small amount of weight, they can decrease their diabetes risk, Albright said. Dropping just 5 percent to 7 percent of body weight can help.

"It's not huge amounts of body weight that people need to lose," she said. "Weight loss is the best way to head off type 2 diabetes."

But Byetta comes with its own concerns. The FDA plans to strengthen its warnings placed on the drug after two users died and four others were hospitalized, all for pancreatitis.

Buse said it's too soon to tell whether the drug's problems outweigh its benefits.

"Most of the excitement revolves around the weight loss on top of blood glucose control," he said. "We don't know whether this disease association with Byetta is really happening, because people with diabetes get more pancreatitis."

The concerns over type 2 diabetes medications make the need to prevent people from getting the disease even more apparent. And the best way to head off diabetes is to treat yourself right, Albright said.

"The best data we have is that lifestyle interventions are most effective in preventing diabetes," she said.

A half hour of physical activity most days of the week, adding up to 150 total minutes per week, combined with a low-calorie healthy diet, have been shown to help stave off the onset of diabetes, she said.

Once a person has diabetes, the fight shifts to managing the disease and preventing complications.

"We have a lot of problems that are connected with diabetes," Albright said. "Controlling your blood sugar, blood pressure and cholesterol is essential to prevent those complications."

One new tool that could help people control their blood sugar are glucose sensors now being developed that are placed under the skin, Buse said. The sensors monitor blood sugar levels and transmit the information to a sensor.

"You really have to adjust insulin levels based on physical activity and diet, and it can be very tricky," he said. "This gives patients a more continuous way of monitoring their blood sugar."

Added Albright: "It's critical we work on good management of the disease and preventing new cases. It's a two-sided coin we're working with here."

More information

To learn more, visit the American Diabetes Association.



SOURCES: Ann Albright, Ph.D., R.D., director of the Division of Diabetes Translation, U.S. Centers for Disease Control and Prevention, Atlanta; John Buse, M.D., Ph.D., professor of medicine, and director, Diabetes Care Center, University of North Carolina School of Medicine at Chapel Hill, and president of medicine and science, American Diabetes Association


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