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Advances made in ongoing struggle with diabetes

Category: Diabetes

The revelation that U.S. Supreme Court nominee Judge Sonia Sotomayor has type 1 diabetes provoked much reaction, with some wondering whether or not the disease should disqualify her.

In fact, these days diabetes can be quite well controlled. Advancements in care and monitoring have made it far easier to live with the disease.
A new class of drugs to treat type 2 diabetes, called GLP-1s, made a splash at the 69th Annual Scientific Sessions of the American Diabetes Association (ADA). Unlike drugs currently on the market, they only need to be taken once a day or even once a week, making them far easier for patients to deal with.

Only one, Byetta, has been approved by the FDA so far but others are coming and some have shown evidence they control blood sugar more effectively than Byetta. Another approach is being taken by Roche, who is taking a drug type called PPAR agonists and repurposing it into a diabetes drug.

Diabetes is a chronic disease and the damage to organs and increased risk of heart attack and stroke is a gradual process. Controlling diabetes is important to minimize these risks, but of the 23.6 million people in the U.S. with diabetes, the ADA estimates that one-quarter are not aware they have the disease.

A study presented at the ADA conference this weekend showed that evidence of insulin resistance and changes in blood sugar that indicate the likely onset of type 2 diabetes can be detected as far as 10 years in advance of diagnosis.

Vice president of clinical affairs for the ADA, Dr Sue Kirkman, told WebMD that the potential for even earlier detection will help control the disease.

"The earlier we can identify people at risk and intervene, the better off they are likely to be," she said.

The study, which appears in The Lancet, followed more than 6,500 British civil servants without diabetes for an average follow-up of 10 years. They found what appeared to be three phases in the progression of diabetes.

The first phase occurs six or more years before diagnosis and has relatively stable glucose levels, but blood tests show increased insulin resistance and insulin secretion.

"This is the time when relatively straightforward lifestyle changes, like increasing physical activity, changing diet, and reducing obesity, could have the biggest impact," said study co-author Dr Daniel R. Witte of the University College London.

Phase two shows increased beta-cell activity as the pancreas starts producing more and more insulin to try and overcome insulin resistance in the body. Prevention and control here would probably require more aggressive therapy, Witte said.

The third phase sees insulin production drop and blood glucose rises dramatically. This is the phase many people currently refer to as pre-diabetes.

At the same conference, researchers presented papers showing evidence of risk factors for type 2 diabetes appearing in children as young as 7 years old.

That potential diabetes has identifiable characteristics so many years out may open the door for people getting diabetes tests even if they have no signs of the disease yet, so that they can take active preventative measures well before diabetes has a chance to set in.

Some, such as Dr Lawrence S. Phillips of Emory University School of Medicine, call for universal screening of adults.

"The economic costs of diabetes threaten the financial integrity of our healthcare systems," said Phillips in a statement accompanying his research paper in which he screened over 1,250 adults for diabetes and found that 24 percent of them had undiagnosed diabetes or pre-diabetes. The cost of screening and preventative treatment would be less than the costs of not screening and having to treat them later, concluded the paper.