As incidence of diabetes rises, a major effort is launched to head off costly and debilitating illness
Chances are, you think of diabetes as a problem of sheer bad luck — either you get it or you don’t.
But preliminary studies have suggested that, far from being inevitable, diabetes may actually be preventable, even if you’re among the 21 million Americans at higher-than-normal risk.
Now, a major study under way at two hospitals in Boston and 23 others across the country is trying to determine whether an aggressive program of diet and exercise or drug therapy can prevent or at least delay diabetes in people most at risk.
And that’s not only a hypothesis. It’s also the fervent hope of people like Maureen Oliver, 32, of Norwood, who works at the Center for Blood Research in Boston and who became worried about her own health when her sister, 33, was diagnosed with Type II diabetes last year.
Oliver is among 4,000 people nationwide expected to participate in the five-year study, and so far, she says, the perks of being a human guinea pig are worth all the prodding and poking.
“They are watching your health so much more closely” than normal doctors do, Oliver says of researchers at the Joslin Diabetes Center. “My sister probably had this for a year without knowing it. . . I’d rather know right away” if diabetes develops.
Diabetes, which comes in two types, is one of the most debilitating of all medical problems.
Type I is an autoimmune disease that must be treated by daily injections of insulin and often strikes children and young adults; Type II, which constitutes 95 percent of all cases and can be treated with insulin, other drugs or diet and exercise, may have several causes and often begins later in life.
If diabetes really can be prevented much of the time, the payoff would be enormous, for individuals and the world.
In this country alone, diabetes is an epidemic affecting one of 10 adults, says Dr. David M. Nathan, director of the diabetes center at Massachusetts General Hospital and the leader of the national prevention study.
“Once it develops, it is difficult to treat, and it is the major cause of blindness, kidney failure and limb amputations. It also raises the risk of heart disease, stroke and peripheral blood vessel disease two- to seven-fold,” he says.
Worldwide, diabetes rates are also soaring, and the main reason is that people aren’t eating right or exercising enough, says Dr. Richard C. Eastman, who runs the diabetes program at the National Institute of Diabetes and Digestive and Kidney Diseases, sponsor of the study.
And the costs, both human and economic, are staggering.
Diabetes is now “the most expensive disease in the country,” says Dr. Gerald Bernstein, a New York City diabetes specialist and president-elect of the American Diabetes Association. With all its complications, it costs the nation $138 billion a year, 15 percent of the health care bill.
Yet while the government spends $5-$10 on research for every $100 spent on patient care for other major diseases, it invests only about 25 cents for every $100 spent on diabetes care, says Bernstein.
That low priority is hard to fathom, say diabetes specialists, given that there are an estimated 8 million diagnosed diabetics in America and another 8 million who are unaware they have the disease.
Those numbers are expected to rise as Americans continue packing on pounds — obesity is a risk factor — and as Baby Boomers age.
If you are genetically predisposed, “it may take only 10 to 15 pounds of weight gain” to become diabetic, says Dr. Om Ganda, a senior physician at the Joslin who is working on the prevention study with Dr. Edward S. Horton, the study’s lead researcher at the Joslin.
And the number of diabetics may also rise because diabetes specialists recently lowered the threshold score on the fasting blood sugar tests that are used to detect diabetes, from 140 milligrams per deciliter of blood to 126 mg. People with normal blood sugar usually score less than 110 if they have not eaten for eight hours.
The reason doctors are so concerned about diabetes is that it interferes at such a basic level with metabolism. In a healthy person, blood sugar is maintained at a relatively constant level because the body secretes insulin from the pancreas in the right amounts to make sure that sugar gets into muscle and other cells that need it for fuel.
But in Type I, which can be inherited and is caused by a misguided attack by the body’s own antibodies against the insulin-producing cells in the pancreas, a person winds up making little or no insulin.
In Type II diabetes, the pancreas still makes insulin, but over time, the body becomes “resistant” to its effects. Some people become resistant through genetic predisposition but others acquire the resistance as a result of being overweight. As resistance develops, the pancreas tries harder and harder to make enough insulin, but eventually it can’t keep up with the demand, and blood sugar rises to dangerous levels.
Diabetes can be “so big, so bad and so ugly” that if it is not detected early, says Nathan, damage to the eyes, kidneys and other organs can happen before treatment begins.
That is the logic behind the new study, “the first of its kind ever done at this magnitude,” says Ganda.
People who want to join the study are first screened for blood sugar levels. In the screening test, if your blood sugar is between 80 to 140, you are then given a “glucose tolerance” test — a sugary drink that, within two hours, may raise your blood sugar dramatically.
If your blood sugar soars to between 140 and 199, you have “impaired glucose tolerance,” which means that you, like 21 million other Americans, have roughly a 50 percent chance of developing diabetes over time.
Other risk factors include being overweight, being over 40, having a family history of diabetes, belonging to an ethnic group that is at higher risk (including African-Americans, Hispanic-Americans, Asian-Americans, Pacific Islanders and Native Americans) and having a history of diabetes during pregnancy.
Clinical symptoms such as feeling tired or sick, unusual thirst, weight loss, blurred vision, frequent infections or slow healing of sores may also be warning signs.
If you are accepted into the study, you are then randomly assigned to one of four groups. The first group gets an intensive diet and exercise program, with the goal of losing at least 7 percent of body weight by eating fewer calories than usual and burning up 700 calories a week more through exercise.
The other three groups all get one of three daily medication regimens, though neither participants nor doctors know who is getting placebo (a dummy drug), metformin (Glucophage, a drug that lowers blood sugar by decreasing the amount of sugar made in the liver), or troglitazone (Rezulin, a newer drug that improves the body’s sensitivity to insulin in people with Type II diabetes.
Those who participate in the study, of course, are most likely to reap the direct benefits of diabetes prevention.
But the very existence of the study, researchers hope, will also remind people who don’t participate that there may be a lot they can do to prevent diabetes, such as eating a good diet and exercising regularly.
This summer, the American Diabetes Association also recommended that everyone 45 and older get a baseline diabetes screening, with follow up tests every three years for people at normal risk, and every year for those at higher risk.
And for those, like Oliver, who do volunteer? The benefits of “really good health care” — free — as a participant in the study far outweigh the downside. “I’d recommend joining,” she says, if you are at all worried about getting diabetes.
SIDEBAR 1.
DIABETES IN AMERICA
PLEASE SEE MICROFILM FOR CHART DATA
GLOBE STAFF CHART
SIDEBAR 2.
To learn more
If you are interested in joining the diabetes prevention study, call:
– 1-800-339-6482, to join at either the Joslin Diabetes Center or Massachusetts General Hospital.
– 1-888-DPP-JOIN (1-888-377-5646), outside New England.
To read more about diabetes, try:
– “Diabetes — The Most Comprehensive, Up to Date Information Available to Help You,” by Dr. David M. Nathan with John F. Lauerman.
– “The Joslin Guide to Diabetes,” by Dr. Richard S. Beaser, with Joan V.C. Hill.