Cybermed Update August 2001

Diabetes Mellitus

"The world will witness human calamity of unthinkable proportions destined to strain social and economic resources"
Prof.Dato Dr Anuar Zaini Md Zain

This recent statement by Professor Dato Dr Anuar Zaini, one of Asia's foremost diabetologists, encapsulates well the threat we face from the spectacular rise in the global prevalence of diabetes mellitus. The number of cases has reached epidemic proportions, and continues to increase sharply. The World Health Organization (WHO) predicts that the number of people with diabetes will double within just one generation, from the current 150 million to an estimated 300 million in 2025.
The incidence of diabetes mellitus is rapidly rising all over the world as a result of better affluence and life style changes. There has been some recent articles on diabetes from life style modification to new standards in diagnosis of disease. I do not plan to write a thesis on this subject but will point you to some recent links on the subject as well as links for further information.

The findings came from the Diabetes Prevention Program (DPP), a major clinical trial comparing diet and exercise to treatment with metformin in 3,234 people with impaired glucose tolerance, a condition that often precedes diabetes. On the advice of the DPP's external datamonitoring board, the trial ended a year early because the data had clearly answered the main research questions. Smaller studies in China and Finland have shown that diet and exercise can delay type 2 diabetes in at-risk people, but the DPP, conducted at 27 centers nationwide, is the first major trial to show that diet and exercise can effectively delay diabetes in a diverse American population of overweight people with impaired glucose tolerance (IGT). IGT is a condition in which blood glucose levels are higher than normal but not yet diabetic. (See also Diabetes Prevention Program: Questions & Answers.) "Lifestyle intervention worked as well in men and women and in all the ethnic groups. It also worked well in people age 60 and older, who have a nearly 20 percent prevalence of diabetes, reducing the development of diabetes by 71 percent." said DPP study chair Dr. David Nathan of Massachusetts General Hospital, Boston.

WASHINGTON, DC-Aug. 21, 2001-The American College of Endocrinology (ACE) and the American Association of Clinical Endocrinologists (AACE) today announced their recommendations for new diabetes screening and management guidelines. The group, comprised of world diabetes experts, urged more stringent treatment standards and a lower screening age for people at high-risk for this disease, particularly among ethnic populations. In response to recent diabetes findings, the ACE Diabetes Mellitus Consensus Conference has made the following recommendations:

Age Of Diabetes Screening Lowered To Age 30
A1C Blood Sugar Test Lowered To 6.5%
Post-Prandial Blood Sugar Levels Lowered
The risk of diabetes comes from tissues that are exposed to abnormally high blood sugar levels both before and after meals. Therefore, the panel recommends lowering target levels of blood sugar to 110 before eating (pre-prandial) and to 140 after eating (two hour post-prandial).

A more detailed explanation of these and other conference findings are available in a White Paper issued from the conference.

The Association held a two-day Consensus Development Conference on Postprandial Blood Glucose in January to examine the evidence concerning postprandial glucose concentrations and diabetes outcomes. After hearing selected abstracts and presentations, an expert panel concluded that gestational diabetes is the only clinical setting where evidence has shown that PPG monitoring improves outcomes.

Despite logic that links PPG excursions to hyperglycemia and therefore to HbA1c and the development of diabetes complications, evidence from well-designed, randomized, controlled clinical trials is missing. The panel called for such clinical trials and cited the many options that now exist in the form of insulin analogs and oral agents that target PPG for use in these studies.

The panel arrived at single definition of PPG: plasma glucose concentrations measured, optimally, 2 hours after the start of a meal. Clinicians were advised to monitor PPG:

In addition, testing 1 hour postprandially appears to offer benefits in gestational diabetes.

The consensus statement appears in the April issue of Diabetes Care and can be read on line at http://care.diabetesjournals.org/ .

Below are some links on information on diabetes mellitus.

The links to URL mentioned above are valid at the time of writing (5 September 2001).

Updated 15 January 2006.

This page can be accessed at http://www.vadscorner.com/internet54.html or at http://www.vadscorner.com/mma_internet.html.

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