The Diabetes Prevention Program
The diabetes prevention program (DPP) is a long term study that was designed to find out whether diabetes could be prevented or delayed in people who had a risk for developing type 2 diabetes. The participants of this study had blood sugar levels that were above the normal range but not quite yet in the diabetic range (in medical terms it is called impaired glucose tolerance or IGT). The participants were put into one of four treatment groups. The first group was the intensive lifestyle group, which exercised at least 120 minutes a week and lost 10-15 pounds over the three year duration of the study. The other three groups were put on either metformin (Glucophage, troglitazone, Rezulin) or a fake pill (placebo) with only minimal lifestyle changes.
The DPP was ended one year early because of the remarkable results gathered from 25 research institutions around the United States including more than 4,000 people. Compared to the group that received a fake pill (placebo) the group that was randomized to the intensive lifestyle group reduced their chances of developing type 2 diabetes by 58%! The individuals who were given metformin with minimal lifestyle changes showed a reduction in the development of diabetes by 31% over the three years study, compared to the placebo group. There was also a significant reduction in the conversion to type 2 diabetes in the troglitizone or Rezulin treated group, although this group was only on medication for 10 months of the three year duration of the study because it was pulled from the U.S. market because of liver toxicity.
The DPP is only one of several prevention trials recently completed demonstrating beyond any shadow of a doubt that intensive lifestyle can reduce the incidence of type 2 diabetes in individuals who are at risk. The risk factors for type 2 diabetes include having a family of history of type 2 diabetes, being overweight, having high blood pressure or abnormal cholesterol levels, having gestational diabetes, or having a baby over 9 lbs, and being a member of an ethnic group that has a very high incidence of diabetes (Native American Indians, Latinos, Pacific Islanders, Asian Indians and African Americans). The bottom line is that you should know your risk factors for type 2 diabetes and if you already have diabetes let your relatives know that they should be tested and that intensive lifestyle is the most powerful tool to prevent type 2 diabetes. In the second to last chapter in the Taking Control of Your Diabetes book there is a very nice discussion on the Prevention of Diabetes.
How often should you be seen?
If you are currently on insulin, you should be seen approximately every 3 to 4 months. If you are not on insulin, you should be seen approximately every 3 to 6 months. The frequency of visits obviously depends on how well or poorly you are doing, and if you have taken control of your diabetes. For example, if your home glucose monitoring values are consistently good, and your diabetes regimen is stable, then you do not need to see your care giver as often as someone who never tests their own blood sugar levels at home and has no clue how they are doing.
When you visit your physician you should be prepared to discuss any issues that you have questions about. Table 2 lists some of the areas that you may want to discuss with your care giver. There is obviously not enough time at any one visit to discuss all of these issues, however you should decide which one(s) is the most important to you at the time of your visit.
Table 2: What Should You Discuss With Your Care Giver?
- Home glucose monitoring results
- Problems with hypoglycemia
- Medication questions
- Test or exam results and options for therapy, if appropriate
- Pregnancy issues
- Exercise routine
- Meal Planning
- Immunization requirements (i.e., yearly flu shot)
- Any tests or exams not completed that are recommended by your Diabetes Warranty Program
It is also helpful to have a basic information sheet about your medical history (table 3). Much of your medical history does not change and is easy to update periodically. You can then bring a copy of your medical history, along with your Diabetes Warranty Program sheet, to any of your health care providers, such as your dentist, physician, nurse or pharmacist. It makes life a lot easier for them, and will allow more time for other important things during your appointment. As an example, I have listed my medical information in table 3.
Table 3: Diabetes Medical History
Name: Steven V. Edelman
Date of Birth: Sept. 6, 1955
Date of Diabetes Diagnosis: 1971
Type of Diabetes Therapy:
1971-1976: One injection per day (NPH/Reg.)
1976-1982: Two or three injections per day
1982 to present: Insulin Pump (Basal rate 0.7 units per hour and 5 to 10 units of Reg. pre-meals.
Incidence of hypoglycemia: once or twice a week, not at any consistent time, with symptoms of light headedness and dizziness. I no longer get palpitations and sweaty.
Other Medical Problems
- Retinopathy diagnosed in 1979 (received laser treatment to both eyes) Dr. Paul Tornambe is my Ophthalmologist (619) 558-9666
- Kidney disease diagnosed ~ 1985 (see Diabetes Warranty sheet for most recent Kidney tests) Dr. David Ward is my kidney doctor (619) 543-6737
- High blood pressure diagnosed ~ 1985 on 3 different medications (see list below)
- High cholesterol levels diagnosed ~ 1989 on medication
Recent Hospitalizations
None
Surgery or Operations
- Right middle trigger finger repair 1997
Medications
- Lispro (Humalog) Insulin in my pump (~45 units/day)
- Indapamide (Lozol) 2.5 mg one each morning
- Fosinopril (Monopril) 20 mg twice a day
- Diltiazem HCI (Cardizem CD) 180 mg twice a day
- Atorvastatin (Lipitor) 20 mg once a day at bedtime
- Aspirin 81 mg once a day
- Vitamin E 400 IU two capsules twice a day (4 total)
- Vitamin C 1000 mg twice a day (2 total)
Allergies
None
Important Family History (Heart disease, Cancer, Diabetes)
- Great Uncle (mothers side) and Grandmother (fathers side) with diabetes
- Grandfather (mothers side) died of a heart attack at the age of 65
- Several relatives on my father's side of the family died of stomach cancer.
If you discover that a test or exam has not been done, and is needed to comply with your Diabetes Warranty Program, you should discuss this with your care giver and request the test or exam. Phrase your comments and questions constructively and not too aggressive (i.e. Is it possible to please check my cholesterol levels next visit? My last values were done over a year ago and I am concerned about them.) Remember some physicians aren't accustomed to getting suggestions from their patients. You must work with your care giver in order to maintain your health and quality of life. Staying healthy is much easier when preventative measures are taken early. If your doctor has a hissy fit that you are taking responsibility for your health, then get a new doctor! It is that plain and simple.
In addition to following the Diabetes Warranty Program, you must be knowledgeable about the tests and be aware of what kinds of therapies are available for any abnormality or problem. Remember, it is not enough to just know your results. You must also understand them, and thus be able to seek out the best therapy available, if necessary. This is what Taking Control of Your Diabetes is all about.
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