Considering Type 2 Diabetes Treatment, Experts Say 1
Size Does Not Fit All
International group recommends individualized
therapies; Almost one of every four senior citizens has diabetes
April 5, 2010 (Chevy Chase, MD) - Patients with
type 2 diabetes, a leading chronic disease among senior citizens, are
generally treated similarly despite the fact that they may have
underlying differences that could affect their therapeutic response.
Seeking to address this critical health issue, an international
multidisciplinary group of experts just issued recommendations for
individualized treatment.
This consensus statement is published in the
April 2010 issue of the Endocrine Society's Journal of Clinical
Endocrinology & Metabolism (JCEM).
The group consisted of experts in diabetes
epidemiology, physiology, genetics, clinical trials and clinical care.
Study of seniors finds physical activity, good
dietary habits, not smoking and light alcohol use lowers diabetes risk
by 82%; four in five new cases attributable to not having these low-risk
factors.
Diabetes affects nearly 24 million people in the
United States and slightly over half of these are age 60 or older. Close
to 250 million people worldwide have the disease.
Treatment for diabetes is aimed at lowering
glycemic levels to as close to the non-diabetic range as safely
possible.
However, only slightly more than half of patients
diagnosed and treated for diabetes reach their glycemic targets, leaving
a substantial population exposed to prolonged periods of damaging
hyperglycemia.
Experts believe further insight into the
differences between diabetes patients, both physiologic and genetic ,
should not only help elucidate the pathogenesis of type 2 diabetes, but
lead to individualized treatments for patients that will improve
glycemic control, maximize individual benefit, minimize risk, reduce
diabetes complications, and ultimately provide reductions in global
health cost.
"Recent advances in genetics such as the
identification of the responsible genes for several forms of Maturity
Onset Diabetes of the Young (MODY), now referred to as monogenic
diabetes, have established precedents linking specific drug therapies to
defined subtypes of diabetes patients," said Robert Smith, MD, of Brown
University in Providence, R.I. and co-author of the statement.
"As more genetic factors related to type 2 diabetes
are identified and as our understanding of the progression of the
disease evolves, we can expect to gain precision in identifying the best
drug choices for individual patients and to more effectively halt the
progression of diabetes."
"The progress already seen has stemmed from
combining discoveries of specific genetic susceptibilities with clinical
observations. As we move forward, we should continue to incorporate
these and additional clinical observations with new data on the
physiology and genetics of diabetes to assess which patients will
benefit most from specific treatments," said Robert A. Vigersky, MD,
president of The Endocrine Society.
"The recommendations in this consensus statement
highlight the need for the research community and industry to each play
their part in improving our ability to individualize therapy so that
patients can get the most accurate and appropriate treatment."
The consensus statement includes a series of
recommendations for increasing understanding of the heterogeneity of
diabetes and achieving the goal of individualizing therapy and improving
treatment response. Statement recommendations include:
● Extend analysis of existing data and data
sources There are already a plethora of data and data sources that
could be potentially valuable in individualizing therapy; however, to
date, these have been largely underutilized. Pooled analyses or
meta-analyses of such data may provide important insights into the
relative effectiveness of specific interventions in subgroups of
patients with type 2 diabetes and advance our understanding of
individualized therapy.
● Expand existing or develop new data
registries All new and existing diabetes registries should
systematically collect data to address phenotypic and genetic
heterogeneity measures. Not only should these registries collect
material for future biomarker and genetic analysis, but registries
should be designed to specifically address the heterogeneity of diabetes
with hypotheses generated by examining existing data.
● Develop new clinical trials Future
randomized studies of diabetes therapies should, by design, collect
phenotypic information relevant to response to therapy.
● Develop new technologies Targeting
therapy toward more appropriate subgroups of patients will require
increasingly accurate and efficient methods to measure markers for
diabetes heterogeneity and heterogeneous response to treatment.
● Expand basic research Basic research
is needed to explore numerous fundamental issues that underlie the
heterogeneous response to diabetes therapies.
Other researchers working on the consensus
statement include David Nathan of Harvard Medical School in Boston,
Mass.; Silva Arslanian of the University of Pittsburgh School of
Medicine in Penn.; Leif Groop of Lund University in Malmo, Sweden;
Robert Rizza of the Mayo Clinic in Rochester, Minn.; and Jerome Rotter
of Cedars-Sinai Medical Center in Los Angeles, Calif.
The statement, "Individualizing Therapies in Type 2
Diabetes Mellitus Based on Patient Characteristics: What We Know and
What We Need to Know," will appear in the April 2010 issue of JCEM.
Founded in 1916, The Endocrine Society is the
world's oldest, largest and most active organization devoted to research
on hormones and the clinical practice of endocrinology. Today, The
Endocrine Society's membership consists of over 14,000 scientists,
physicians, educators, nurses and students in more than 100 countries.
Society members represent all basic, applied, and clinical interests in
endocrinology. The Endocrine Society is based in Chevy Chase, Maryland.
To learn more about the Society and the field of endocrinology, visit
The Endocrine
Society
Diabetes is a disease in which your blood glucose,
or sugar, levels are too high. Glucose comes from the foods you eat.
Insulin is a hormone that helps the glucose get into your cells to give
them energy. With
Type 1 diabetes, your body does not make insulin. With Type 2
diabetes, the more common type, your body does not make or use insulin
well. Without enough insulin, the glucose stays in your blood.
Over time, having too much glucose in your blood
can cause
serious problems. It can damage your
eyes,
kidneys, and
nerves. Diabetes can also cause heart disease, stroke and even the
need to remove a limb. Pregnant women can also get diabetes, called
gestational diabetes.
Symptoms of Type 2 diabetes may include fatigue,
thirst, weight loss, blurred vision and frequent urination. Some people
have no symptoms. A blood test can show if you have diabetes. Exercise,
weight control and sticking to your meal plan can help control your
diabetes. You should also monitor your glucose level and take
medicine if prescribed.
Who gets diabetes?
Diabetes is not contagious. People cannot catch
it from each other. However, certain factors can increase the risk of
developing diabetes.
Type 1 diabetes occurs equally among males and
females but is more common in whites than in nonwhites. Data from the
World Health Organizations Multinational Project for Childhood Diabetes
indicate that type 1 diabetes is rare in most African, American Indian,
and Asian populations. However, some northern European countries,
including Finland and Sweden, have high rates of type 1 diabetes. The
reasons for these differences are unknown. Type 1 diabetes develops most
often in children but can occur at any age.
Type 2 diabetes is more common in older people,
especially in people who are overweight, and occurs more often in
African Americans, American Indians, some Asian Americans, Native
Hawaiians and other Pacific Islander Americans, and Hispanics/Latinos.
National survey data in 2007 indicate a range in the prevalence of
diagnosed and undiagnosed diabetes in various populations ages 20 years
or older:
● Age 60 years or older: 12.2 million, or 23.1
percent, of all people in this age group have diabetes.
● Age 20 years or older: 23.5 million, or 10.7
percent, of all people in this age group have diabetes.
● Men: 12.0 million, or 11.2 percent, of all
men ages 20 years or older have diabetes.
● Women: 11.5 million, or 10.2 percent, of all
women ages 20 years or older have diabetes.
● Non-Hispanic whites: 14.9 million, or 9.8
percent, of all non-Hispanic whites ages 20 years or older have
diabetes.
● Non-Hispanic blacks: 3.7 million, or 14.7
percent, of all non-Hispanic blacks ages 20 years or older have
diabetes.
Diabetes prevalence in the United States is likely
to increase for several reasons. First, a large segment of the
population is aging. Also, Hispanics/Latinos and other minority groups
at increased risk make up the fastest-growing segment of the U.S.
population. Finally, Americans are increasingly overweight and
sedentary. According to recent estimates from the CDC, diabetes will
affect one in three people born in 2000 in the United States. The CDC
also projects that the prevalence of diagnosed diabetes in the United
States will increase 165 percent by 2050.
Diabetes is a disease in which your blood glucose,
or sugar, levels are too high. Glucose comes from the foods you eat.
Insulin is a hormone that helps the glucose get into your cells to give
them energy. With
Links for Seniors
(National
Institute on Aging) - Also available in