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Time for diabetes action is now
By Steven E. Kahn, M.D.
Diabetes and obesity are two epidemics that our country faces today. The Centers for Disease Control and Prevention (CDC) estimates that in the United States there are currently 26 million individuals (over 8 percent of the population) over 20 years of age who have diabetes. Further, another 79 million have prediabetes, a high-risk condition for the subsequent development of diabetes.
Prediabetes is characterized by glucose levels that are above normal, but have not yet reached the threshold for the diagnosis of diabetes.
Given that diabetes is a leading cause of kidney failure, blindness and decreased life expectancy, the National Institutes of Health (NIH) has been at the forefront in supporting studies that will inform us on how to prevent and treat type 2 diabetes, the form of diabetes that is typically associated with being overweight and obesity.
One of these studies, the Diabetes Prevention Program, demonstrated that it is possible to slow the progression from prediabetes to type 2 diabetes using a lifestyle intervention or metformin, a medication that is frequently used to treat individuals with type 2 diabetes. Unfortunately, what the prevention program also showed is that it not possible to prevent the development of diabetes in most individuals over time. Thus, more effective approaches are desperately needed.
When treating patients with type 2 diabetes, a number of different medications are available. While they all are effective in lowering glucose, their relative advantages and disadvantages have not been fully compared. Such knowledge is key to guiding health care providers in choosing what glucose-lowering medication is optimal for their patients.
To further advance our knowledge on how best to treat and prevent type 2 diabetes, the NIH has again committed sizable resources to support clinical trials to combat this disease. Given the highly successful and informative partnership of the University of Washington and Seattle VA in diabetes research, residents of the Puget Sound region now have the opportunity to participate in two important studies that could go a long way to improving the health of our nation.
The Glycemia Reduction Approaches in Diabetes (GRADE) Study will examine which is the best medication to add to lower glucose in patients who are taking metformin (www.gradestudy.org), while the Restoring Insulin Secretion (RISE) Study will seek new and better ways to prevent the development of diabetes in those who are at increased risk by virtue of being overweight or obese (www.risestudy.org).
Everyone in our community has a friend or relative who has been impacted by diabetes. In many instances, it may be us who have the disease or are at high risk. We now have the opportunity to help learn more about how to prevent and treat type 2 diabetes. The time for action is now.
Steven E. Kahn, M.D. is a professor of medicine sand director, Diabetes Research Center at the University of Washington, VA Puget Sound Health Care System