Welcome to Dr Edelman's Corner, the ultimate personal resource for people living with diabetes.
Type 2 Diabetes Can Be Prevented
What are we waiting for?!
Two well documented studies dramatically prove that we can prevent type 2
diabetes. Unfortunately, little is being done about it.
Back in 2002, the results of the long term, government funded Diabetes
Prevention Program (DPP) were announced at major conferences and in medical
literature (New Engl J Med 2002;346:393-403). The DPP focused on individuals
who have pre-diabetes (see Know Your Numbers, page 6). The DPP demonstrated
very clearly that lifestyle modification (exercising 30 minutes, 5 days a week and
losing a few pounds) significantly reduces the chance of developing type 2 diabetes in
people who are at risk and classified as pre-diabetic. The study also showed that
the medication, metformin (Glucophage), is effective in a certain subset
of people.
As you know, a family history of type 2, obesity, high cholesterol,
high blood pressure gestational diabetes and being a member of an ethnic
group hit hard by diabetes--African American, Native American, Latino
and Pacific Islander--are risk factors that increase the likelihood of
developing type 2 diabetes. When fasting and post-meal blood sugars
reach a certain range, we call that "pre-diabetes."
Why aren't health insurers promoting and financially supporting lifestyle
modification programs around the country to stop the diabetes epidemic?
Why is it that the only way a person can get professional medical help is
to have a heart attack and then be eligible for a "Cardiac Rehab" program,
which includes an exercise specialist and dietitian?
The results of this study now seem
to have been forgotten and are rarely
talked about. Shocking to me is the continued
medical apathy despite recent
announcement of the powerful
DREAM trial results (Lancet 2006;
368:1096-1105). The DREAM trial
recruited 5,269 people with prediabetes
and they were randomized
into one of two groups. One half of
these at risk people received the oral
medication, rosiglitazone (Avandia),
a drug that reduces insulin resistance
and is commonly prescribed for
people who already have type 2
diabetes. The other half received a
placebo. Well, in less than five years
the study was halted early because
of the markedly positive results. Of
the people who took placebo, 658
developed type 2 diabetes whereas
only 280 people who took Avandia
developed type 2 diabetes. This represents
a 60% reduction in developing
type 2 diabetes. It is important to
note that in the DREAM trial, there
were no lifestyle modifications made
by the patients. If people with prediabetes
took Avandia or Glucophage
and increased their exercise routine
and lost a few pounds as they did
in the DPP, just think what the reduction in diabetes diagnoses would
have been. Both the DPP and the
DREAM studies proved beyond any
shadow of doubt that type 2 diabetes
can be prevented, however little is
being done to put into action what
we learned from these very
large and costly studies.
Here is what we're up
against. Skeptical doctors
are searching for flaws in the
study design and the results.
Insurance companies are
worried that implementation
of these solid results will hurt their
bottom line. Most general physicians
are too busy in their practices to learn
about these landmark studies. Also,
people living with type 2 diabetes
don't know about the results and are
not spreading the word to their first
and second-degree relatives.
Type 2 diabetes can, unfortunately,
be a devastating disease leading to
heart disease, blindness, amputation,
kidney failure, erectile dysfunction,
depression and loss of productivity.
Prevention will improve the lives of
millions of individuals who are at risk
for type 2 diabetes, and it will reduce
the amount of health care dollars
spent on treatment of end stage
complications of diabetes. No one wants to spend resources on prevention
because prevention has not
traditionally perceived to help
the bottom line in the health care
industry. There is a lack of education
and motivation on the part of
the caregivers and people at risk
for this increasingly common public
heath problem. Despite ample data,
even the FDA has not made any
formal recommendation regarding
proven medications for the prevention
of type 2 diabetes.
People at risk must be identified
and then motivated to start a lifestyle
modification program slowly
and safely. In addition, at risk individuals
should consider adding a
medication to prevent type 2
diabetes. The concept is simple
but the implementation is difficult.
Taking Control of Your Diabetes
is not standing idle. We are discussing
the results of these studies
at each of our patient and physician
conferences around the country as
well as on our website, newsletter,
TCOYD TV show and in the 3rd
edition of the TCOYD book. We
will try to lead by example and your
job is to help spread the word to
your family and friends at risk for
type 2 diabetes.
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