Type 2 Diabetes

By Sally Squires
Washington Post Staff Writer
Tuesday, January 1, 2002

U.S. cases: 15 million

Deaths: 450,000 a year

A major study confirmed in August that diet and exercise can prevent type 2 diabetes, a chronic disease that elevates blood sugar levels and heightens risk of heart disease, kidney failure, vision loss and limb amputation. Untreated, it often leads to death.

The number of cases has jumped in recent years, fueled by the increase in overweight and obesity. Yet the study found that losing 15 pounds (via 30 minutes a day of exercise five times a week and a low-fat, low-cholesterol diet rich in fruit, vegetables and fiber) slashed diabetes risk by 58 percent in those poised to develop it. Adults 60 and older benefited even more – improving their odds by 71 percent.

Once diagnosed, diabetes can't be cured but can be controlled through diet, exercise and medication. This year the American College of Endocrinology called for screening to begin at age 30 for people in high-risk groups.

Daily home blood sugar testing helps determine the "dose" of diet and exercise needed to lower blood sugar and allows many of the 2.5 million people with type 2 who need insulin injections to figure the amount they need. Treatment also includes drugs that stimulate the pancreas to make more insulin, slow absorption of starches in the gut and make the body more sensitive to insulin. One of the most highly promoted and most widely used drugs – Glucophage (metformin) – lowers blood sugar by decreasing the amount of glucose made by the liver. A new generic form may reduce costs for users in 2002. In May, the Food and Drug Administration also cleared Lantus, a long-acting insulin requiring only one injection daily.

A recent public health effort urges those with diabetes to have their doctor check blood levels of A1c, the best long-term indicator of blood sugar control. Tests should be done twice a year. Optimal levels are 7 or below. Other program goals: blood pressure below 130/80; and low-density cholesterol less than 100.

New forms of insulin now in clinical trials include Exubera, an inhaled version, as well as a pill and spray.