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A preventable condition

Keep active: Half an hour of physical activity a day and exercise like regular walking help to reduce your risk of developing diabetes. In contrast, people who spend a lot of time sitting down at work and have a less than ideal diet because they are short of time are at increased risk.

Diabetes: If you know early on that you are in an at-risk group, you have a good chance of avoiding the type 2 form of this condition. A change in lifestyle is important, and a medication developed by Bayer HealthCare can help. It is already being used for prophylaxis in some countries.

It will take you about five minutes to read through to the end of this article. During that time, 60 people all over the world will have been diagnosed with diabetes and 30 will have lost their lives as a result of the consequences of diabetes. Two shocking statistics based on recent calculations by the International Diabetes Federation (IDF). The prevalence of diabetes, which is now estimated to affect 245 million people throughout the world, has prompted the United Nations (UN) to take action. The General Assembly of the United Nations adopted resolution 61/225 on December 20, 2006. This recognized diabetes as a “chronic, debilitating and costly disease, associated with severe complications, which poses severe risks for families, Member States and the entire world.” The resolution designated November 14, which has been observed as World Diabetes Day since 1991, as a United Nations Day.

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People who spend a lot of time sitting down at work and have a less than ideal diet because they are short of time are at increased risk of developing diabetes.

A good 90 percent of people with diabetes have the type 2 form of the condition, in which the body does produce insulin but this no longer works as well as it should. Those affected do not normally realize that anything is wrong when the disease first develops, as it causes no symptoms. But there are recognized risk factors, such as obesity, lack of exercise, and a diet lacking in fruit and vegetables. Anyone to whom these apply should take action early to avoid diabetes. This is what Corinna Hartmann (name changed) did. Although only 23 years old, the trainee tax clerk from Dresden weighed 106 kilograms in May 2007. Even regular visits to the gym didn’t have any effect, so she sought professional help. She found a local nutrition advice center offering classes. For two months she attended sessions led by nutrition assistant Mandy Selzer every week. This gave her an introduction into how the body’s metabolism works, and how certain things affect the glucose balance. “For example, many people don’t know how important it is to drink enough water,” Selzer comments. For other people it was more important to analyze damaging patterns of behavior, such as why they felt the need to munch on chocolate or potato chips in the evening.

With Selzer’s help, Corinna Hartmann devised an alternative eating plan in the summer of 2007. She now drinks a lot more water and eats more fruit and vegetables. She has also gone back to the gym, but now follows a clever combination of muscle and endurance training.

Some of the participants who attend Mandy Selzer’s classes have been referred directly by their doctor because they have been diagnosed with “pre-diabetes.” This is a condition in which the body is no longer able to direct the glucose molecules that are released into the bloodstream after a meal into the cells, leading to a temporary rise in blood glucose levels. Doctors refer to this as impaired glucose tolerance, or IGT. It is regarded as a precursor of diabetes.

The good news is that if it is picked up early, those affected can take action to reduce their risk of going on to develop diabetes. “The best way of curing diabetes is to avoid it in the first place,” says Dr. Peter Schwarz, who runs the “Prevention and Care of Type 2 Diabetes” unit at Dresden University Hospital. He estimates the “preventive effect of lifestyle changes and early drug intervention among at-risk individuals at 25 to 60 percent.” Along with other scientists, Dr. Schwarz published an article in 2007 in the journal of the Saxony Medical Association, in which they stated that the reduction in cardiovascular risk is probably even greater. He estimates that there are around 500,000 people with pre-diabetes in Saxony alone, and that the important thing is to get them involved in prevention programs. Programs like the one Mandy Selzer runs at the nutrition advice center.

Dr. Schwarz’s practical experience has led him to work for the European Union. He is one of two experts engaged in a project called “IMAGE” (see box), a standardized prevention program being developed on behalf of Brussels. Current estimates put the number of people with diabetes in the EU at 53 million. Systematic clinical studies have shown how effective prevention measures can be, as Professor Jean-Louis Chiasson from Montreal University demonstrated in a recent article. “Lifestyle changes should obviously be the first step,” said Dr. Chiasson in his article. These include more exercise, a better diet, and weight-loss programs. But studies have also shown that taking particular drugs can cut the risk of developing diabetes. These could be considered if behavioral changes alone have not achieved the desired results. The Canadian scientist believes that not enough research has been done to investigate how far changes to lifestyle and drug treatment can complement each other.

Having looked at the results of previous studies and the side-effect profile of various drugs, his opinion is that in cases where lifestyle changes have not been effective, “the substance acarbose should be the first-choice option as a supplementary treatment.” Acarbose is the active ingredient in Bayer HealthCare’s antidiabetic drug Glucobay. It has been given marketing authorization for the treatment of prediabetes in 25 countries, including China. The International Diabetes Federation estimates the number of diabetics in this country at almost 40 million. The only country with a higher number is India. Effective prevention is therefore a high priority in this booming economic power. Dr. Thorsten Petruschke, describing a study which he is monitoring on behalf of Bayer HealthCare, said, “We hope that this new study will increase our understanding of how effective acarbose can be in preventing both diabetes and recurrent cardiovascular disease.” Diabetes is often the cause of subsequent heart attack or stroke. This is why experts put the global number of deaths due to diabetes at almost four million. The four-year study, due to end in 2011, involves 7,000 people with pre-diabetes. They are all at least 50 years old and have already had a heart attack.

In the meantime, Corinna Hartmann in Dresden is already appreciating the first fruits of her new diet and exercise regime. She has lost 16 kilos. Not only does she feel much better, but she has also significantly reduced her risk of getting diabetes by losing weight.